Bony reconstruction of hip in cerebral palsy children Gross Motor Function Classification System levels III to V: a systematic review

Abstract

Hip dislocation is a common source of disability in cerebral palsy children. It has been remedied by various reconstructive procedures. This review aims at providing the best evidence for bony reconstructive procedures in cerebral palsy hip migration. The literature extraction process yielded 36 articles for inclusion in this review. There is fair evidence to indicate that the comparative effectiveness of femoral versus combined pelvifemoral reconstruction favours pelvifemoral reconstruction. All except one were retrospective articles with a significant degree of selection and performance bias and confounding variables that limited the validity and generalizability of the conclusions. The findings of this systematic review provide fair evidence for the use of adequate soft tissue and combined pelvifemoral reconstruction in the management of hip migration in none and minimally ambulatory cerebral palsy children in the short and long term. This has been shown in studies with a summed sizable patient population. There is limited evidence available that would support the use of soft-tissue and isolated femoral reconstruction. In the context of these retrospective and biased studies, it is extremely difficult to identify, with great precision, predictors of surgical success. Future studies should consider prospective designs that allow for bias control, strict patient selection criteria and incorporation of validated quality-of-life scales.

Primary surgery to prevent hip dislocation in children with cerebral palsy in Sweden: a minimum 5-year follow-up by the national surveillance program (CPUP)

“…2015, El-Sobky et al. 2018). However, in studies that included FO and PO only, the failure rates varied widely from 2% (Rutz et al.…”

Supra Condylar Femoral Extension Osteotomy With Patellar Tendon Advancement to Treat Fixed Knee Flexion Deformity in Crouching Ambulatory Adolescents With Cerebral Palsy

“…A considerable majority of studies on major orthopedic interventions in CP children are retrospective. (24)(25) Generally, retrospective studies are known for their defective capability of controlling bias and confounding variables. (24)(25) We believe that the prospective nature of our study adds strength to the results.…”

“…(24)(25) Generally, retrospective studies are known for their defective capability of controlling bias and confounding variables. (24)(25) We believe that the prospective nature of our study adds strength to the results. Outcome measures for single event multilevel surgery in crouching CP children include a wide variety of objective and subjective assessment tools.…”

Physiologic and Pathologic Development of the Infantile and Adolescent Hip Joint: Descriptive and Functional Aspects

“…53 Free walkers of level I or II seldom experience a decentration, but patients of higher levels III to V do so and frequently need surgery. 54 Depending on the view about the importance of the greater trochanter apophysis, the pathogenesis of spastic hip decentration is much debated. 24,25,28,30,31,55,56 Children who suffer exclusively from cerebral palsy and not from a simultaneous congenital dysplasia of the hip typically have normally configured hip joints without any pathologic findings in the first months.…”