Orthopedic surgery for cerebral palsy

	Surgery Overview
	What To Expect After Surgery
	Why It Is Done
	How Well It Works
	Risks
	What To Think About
	References
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Orthopedic surgery is used to treat tight muscles and spasticity related to cerebral palsy. An incision is made in the skin over the affected muscle. Parts of the muscle are then cut to release the tightness.

After orthopedic surgery:

• Joints that were previously stiff can move more easily. However, the affected muscle may be weak.
• Some people may need to wear a cast or brace to support an area where movements are not under control. In addition, some people may need to have additional orthopedic surgeries.

The type of orthopedic surgery done to treat problems from cerebral palsy depends on which muscle groups are affected. Some basic goals are to loosen the:

• Muscles that make the hips turn toward the body (partial release of the hip adductor muscles). This surgery increases hip movement, allowing a child to sit and walk more easily.
• Muscles on the back of the thigh (partial hamstring release). These muscles control the tension in the thigh and around the knee, allowing a child to sit and walk with a more normal posture.
• Tendon at the back of the ankle (Achilles tendon lengthening or heel cord lengthening). This surgery helps a child walk with a flatter foot.

Orthopedic surgery usually is considered when a child with CP has:¹

• A bone or joint deformity that causes pain or interferes with function and is getting worse over time.
• A permanent contracture.
• Dislocated or irregularly functioning joints.
• A spinal deformity that is not improving with other treatment.
• A deformity that makes some caregiving functions, such as bathing, extremely difficult or impossible.

Corrections made during orthopedic surgery may be temporary. As a person grows, the same muscles or other muscles may become tight and cause contractures. Additional surgery may be needed.

Surgery of any kind carries the risk of bleeding, infection, or need for repeated surgery. Orthopedic surgery carries the additional risk that it may resolve some problems only to create more as a child grows and develops.

If surgery is postponed until the child is older than age 2, doctors may be able to release many tight muscles during the same surgery, instead of releasing only one muscle at a time. Avoiding repeated surgeries has many advantages, such as decreasing the number of times a child needs to go to the hospital, decreasing overall time spent in physical therapy, and less disruption of the child's school and social life.

Before a child has orthopedic surgery, it is important to determine whether he or she will be able to walk after the procedure. The goals for children who will walk differ from the goals for children who will not walk.

Surgical procedures are individualized according to a child's age, type and severity of CP, and overall health and well-being, and whether other conditions are present.¹

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Citations

1. Koman LA, et al. (2004). Cerebral palsy. Lancet, 363(9421): 1619–1631.