Long-Term Results and Outcome Predictors in One-Stage Hip Reconstruction in Children with Cerebral Palsy

Abstract

Our data on 168 hip reconstructions at a mean follow-up of seven years showed significant and clinically meaningful improvements in pain intensity and frequency as well as in clinical scores and hip coverage. Analysis of potential risk factors showed only the preoperative migration percentage to have a relevant influence on outcomes.

Preoperative botulinum neurotoxin A for children with bilateral cerebral palsy undergoing major hip surgery: a randomized double‐blind placebo‐controlled trial

“…The Gross Motor Function Classification System (GMFCS) describes their level of motor ability and over 25 per cent of children with CP are in the most severely affected groups, classified as GMFCS levels IV and V. These children are not independently ambulant, are more likely to have cognitive and communication difficulties, and are at high risk of developing hip displacement, which causes pain for many children . Those children who present to orthopaedic services with progressive femoral head displacement require bony surgery (osteotomy) as long‐term follow‐up studies have demonstrated that this maintains the position of the femoral head in the acetabulum over time better than muscle surgery alone, and reduces the likelihood of a painful hip due to dislocation …”

Satisfaction and pain levels after proximal femoral valgus osteotomy according to Schanz in patients with cerebral palsy and hip dislocation

“…Only half of the caregivers were satisfied with this salvage procedure: hip reconstruction in these patients gives better results [13,27]. The potential limitations of this study may be confounding variables such as different follow-up times; the effect of the surgery with increasing postoperative time is less likely to be solely contributable to the surgery.…”

“…Most of the nonsurgical interventions, like orthotics, positioning or botulinum-toxin injections, are unsuccessful to relieve pain or they relieve pain only for a short period of time [11,12]. The outcome of surgical interventions such as adductor release, reconstructions of the hip joint [13], proximal femoral head resection, proximal femoral valgus osteotomy (Schanz osteotomy), total hip replacement or hip arthrodesis seem superior in this phase [11,12]. When children with CP experience pain or problems in care because of a dislocated hip and a reconstructive hip procedure is not indicated, a palliative salvage surgery is required [2,11,14,15].…”

Bilateral hip reconstruction improve hip stability, pelvic balance and mobility function in children with cerebral palsy

“…However good lever arm of the hips which surgeon could correct might help better control of lower extremity and trunk motion. Many authors have reported the better of patient care, rang of hip motion and relief of pain in long term outcome after reconstruction but no any detail of mobility improvement [8,14,15]. In this study we try to assess simply a mobility function of patients at pre and post operation.…”

“…Early soft tissues release can prevent progression of hip displacement when there is no bony deformi-ty, but bone reconstructive surgery can effectively correct most of hip displacement, improve hip function and relieve pain in long term outcome [7,8].…”