Outcome of bilateral hip reconstruction in unilateral hip subluxation in cerebral palsy: Comparison to unilateral hip reconstruction

Kamisan, Norazian; Thamkunanon, Verasak

doi:10.1016/j.jor.2020.06.017

Cited by 3 publications

(9 citation statements)

References 33 publications

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“…Kamisan and Thamkunanon 26 report 33.3% of patients had contralateral hip subluxation in the UHR cohort, compared to 35.1% in our cohort (their threshold for subluxation was slightly higher at 40% MP). Of their unilateral reconstruction group, the contralateral hip subluxed during follow-up in 21.6% of patients, compared with 20.8% in our cohort.…”

Section: Discussioncontrasting

confidence: 58%

“…In the literature, the definition of failure is variable. Reidy et al 37 used an MP of < 30%, Huh et al 16 used an MP of < 33%, Minaie et al 40 used an MP > 50%, Ruzbarsky et al 39 used an MP > 60%, whereas Kamisan and Thamkunanon 26 used an MP > 40%. We have chosen a less conservative MP of > 33% to represent relapse because of the progressive nature of hip deformity in CP.…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20][21][22] Patients with CP often have asymmetrical hip deformities with associated pelvic obliquity beneficial to the patient in the long term. [23][24][25][26] Unilateral surgery in CP has been found to lead to an increased risk of subsequent subluxation and instability in the affected or contralateral hip, even in the absence of preoperative instability, leading some authors to advocate bilateral reconstruction in one sitting if possible. 12,[25][26][27] There are also reports of good outcome without compromise of the "normal" hip in unilateral reconstruction.…”

Section: Introductionmentioning

confidence: 99%

“…[23][24][25][26] Unilateral surgery in CP has been found to lead to an increased risk of subsequent subluxation and instability in the affected or contralateral hip, even in the absence of preoperative instability, leading some authors to advocate bilateral reconstruction in one sitting if possible. 12,[25][26][27] There are also reports of good outcome without compromise of the "normal" hip in unilateral reconstruction. 6,28 Therefore, the question of whether bilateral procedures should be the gold standard of care in a clinical scenario in which there is significant pelvic obliquity, a large MP, or contralateral contracture is still considered to be unanswered.…”

Section: Introductionmentioning

confidence: 99%

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Hip reconstruction in cerebral palsy: Lessons from a single center and 137 hips

Ayub,

Graff,

Horvat

et al. 2023

Journal of Children's Orthopaedics

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Background: This large, retrospective, single-center study aimed to compare the outcomes of unilateral hip reconstruction and bilateral hip reconstruction in children with non-ambulatory cerebral palsy and ascertain risk factors for recurrent instability and reoperation. Method: We performed a retrospective review of 137 hip reconstructions performed for patients with cerebral palsy. Preoperative and postoperative clinical and radiological parameters were documented, including hip migration percentage, acetabular index, the Gross Motor Function Classification System, the Melbourne Cerebral Palsy Hip Classification System, hip abduction, and pelvic obliquity. Results: Overall, 49 patients underwent bilateral hip reconstruction, and 37 patients underwent unilateral hip reconstruction. In the unilateral hip reconstruction group, the reconstructed hip remained stable (with a migration percentage < 33%) in 59% of patients compared to 74.4% of the more affected hips in the bilateral hip reconstruction group (p = 0.02). Of the unreconstructed hip in the unilateral hip reconstruction group, 74.4% remained stable (with a migration percentage < 33%), compared to 78.8% of the less affected hips in the bilateral hip reconstruction group. A level pelvis was maintained at final follow-up in significantly more patients in the bilateral hip reconstruction group than the unilateral hip reconstruction group (p = 0.002). Further surgical intervention was performed in 41% of the unilateral hip reconstruction group, compared with 11.5% in the bilateral hip reconstruction group (p = 0.001). Surgery performed under the age of 8 years and not performing an acetabular osteotomy were found to be risk factors for recurrent instability in all groups. Conclusion: Our series suggests that in terms of recurrent instability after hip reconstruction in cerebral palsy, protective factors against this complication include bilateral hip reconstruction, hip reconstruction after 8 years of age, and the use of an acetabular osteotomy.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hip reconstruction in cerebral palsy: Lessons from a single center and 137 hips

Ayub,

Graff,

Horvat

et al. 2023

Journal of Children's Orthopaedics

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“…Unilateral APR or bony reconstructive surgery are associated with a high rate of displacement in the contralateral hip in long-term follow-up [ 1 , 43 ]. Most surgeons recommend bilateral APR and bilateral reconstructive surgery [ 43 , 48 , 67 , 68 , 69 ]. Bilateral surgery is more durable, maintains symmetry and has only marginal increased risks of morbidity [ 68 , 69 ] ( Figure 7 ).…”

Section: Bilateral Surgery For Unilateral Hip Displacement?mentioning

confidence: 99%

Hip Surveillance and Management of Hip Displacement in Children with Cerebral Palsy: Clinical and Ethical Dilemmas

Howard

Willoughby

Thomason

et al. 2023

JCM

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Hip displacement is the second most common musculoskeletal deformity in children with cerebral palsy. Hip surveillance programs have been implemented in many countries to detect hip displacement early when it is usually asymptomatic. The aim of hip surveillance is to monitor hip development to offer management options to slow or reverse hip displacement, and to provide the best opportunity for good hip health at skeletal maturity. The long-term goal is to avoid the sequelae of late hip dislocation which may include pain, fixed deformity, loss of function and impaired quality of life. The focus of this review is on areas of disagreement, areas where evidence is lacking, ethical dilemmas and areas for future research. There is already broad agreement on how to conduct hip surveillance, using a combination of standardised physical examination measures and radiographic examination of the hips. The frequency is dictated by the risk of hip displacement according to the child’s ambulatory status. Management of both early and late hip displacement is more controversial and the evidence base in key areas is relatively weak. In this review, we summarise the recent literature on hip surveillance and highlight the management dilemmas and controversies. Better understanding of the causes of hip displacement may lead to interventions which target the pathophysiology of hip displacement and the pathological anatomy of the hip in children with cerebral palsy. We have identified the need for more effective and integrated management from early childhood to skeletal maturity. Areas for future research are highlighted and a range of ethical and management dilemmas are discussed.

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Prediction Model for Contralateral Hip Dislocation in Cerebral Palsy Patients with Unilateral Hip Dislocation: A Scoring System to Guide Decision Making

Tangadulrat

Adulkasem

Suganjanasate

et al. 2022

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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BACKGROUND: Cerebral palsy (CP) patients commonly present with unilateral hip dislocation. However, the decision for concurrent prophylaxis surgery on the contralateral hip in this condition is still controversial. AIM: This study aims to explore the prognostic factors for contralateral hip dislocation and develop a scoring system. MATERIALS AND METHODS: Data on CP patients with unilateral hip dislocation between January 2005 to January 2019 were reviewed. We explored the difference of preoperative parameters between the group in which the contralateral hip is eventually dislocated or remains stable. A multivariable logistic regression analysis was performed to develop a model for predicting contralateral hip dislocation. RESULTS: Seven of included 30 patients (23.3%) developed contralateral hip dislocation. Pre-operative contralateral hips Reimers Migration Index (RMI), Acetabular Index (AI), Lateral Center Edge Angle of Wiberg (CEA), and Pelvic obliquity (PO) were significantly different (p = 0.049, 0.019, 0.030 and 0.038 respectively). The multivariable logistic regression analysis reveals that RMI 25% (mOR 36.66, 95% CI 1.131185.50, p = 0.042) and age 9 years old (mOR = 22.55, 95% CI 0.76665.37, p = 0.071) are significant predictors. Both parameters were included in the model, which revealed an AuROC of 0.84 (95% CI 0.690.99). Each factor was assigned a score of 1. There was no contralateral hip displacement in patients with a score of 0. Two out of 15 patients (28.6%) with a score of one developed contralateral hip displacement. Five out of eight (71.4%) patients with a score of 2 developed contralateral hip dislocation. CONCLUSIONS. Significant predictors for contralateral hip dislocation in CP patients are RMI 25% and age 9 years old. The proposed scoring system might help guide the surgeons decision to perform contralateral prophylactic surgery.

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Outcome of bilateral hip reconstruction in unilateral hip subluxation in cerebral palsy: Comparison to unilateral hip reconstruction

Cited by 3 publications

References 33 publications

Hip reconstruction in cerebral palsy: Lessons from a single center and 137 hips

Hip reconstruction in cerebral palsy: Lessons from a single center and 137 hips

Hip Surveillance and Management of Hip Displacement in Children with Cerebral Palsy: Clinical and Ethical Dilemmas

Prediction Model for Contralateral Hip Dislocation in Cerebral Palsy Patients with Unilateral Hip Dislocation: A Scoring System to Guide Decision Making

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