Periacetabular osteotomy with or without femoral osteotomy for the treatment of hip subluxation in children and young adults with cerebral palsy

Abstract

Background This study is aimed to investigate retrospectively the radiographic and clinical outcomes in children and young adults with cerebral palsy (CP) undergoing periacetabular osteotomy (PAO) with or without femoral osteotomy (FO) for hip subluxation. Methods A consecutive cohort of twenty-one patients (23 hips) with symptomatic CP hip subluxation were treated with PAO with or without FO and reviewed retrospectively. Two patients (2 hips) were excluded due to insufficient follow-up and lost to follow-up, respectively. The Reimers migration percentage, lateral center-edge angle (LCEA), Sharp angle, neck-shaft angle (NSA), femoral anteversion (FNA), Gross Motor Function Classification System (GMFCS) and hip pain were assessed. Results Twenty-one hips (19 patients) with CP treated with PAO with or without FO were included. Five hips received PAO. Sixteen hips underwent PAO with FO. Mean age at surgery was 19 ± 6 and 15 ± 4 years for PAO and PAO plus FO, respectively. Mean follow-up was 44.0 ± 28.3 months for PAO and 41.5 ± 17.2 months for PAO + FO. All hips were painful before surgery and painless at final visits. The GMFCS improved by one level in 10 of 19 patients. There was significant increase in LCEA (p < 0.001) and decrease in the Reimer’s MP (p < 0.001), NSA (p < 0.001) and Tonnis angle(p < 0.001) postoperatively. Resubluxation occurred in 7 hips (30%) due to insufficient correction and loosening of fixation. Nervus cutaneus femoris lateralis was impaired in 4 patients after surgery. There was no avascular necrosis of the femoral head, resubluxation or infection. Conclusion PAO with or without FO can be effective for children and young adults with concomitant hip subluxation and CP.

Comparison of Two Surgical Approaches for Periacetabular Osteotomy: A Retrospective Study of Patients with Developmental Dysplasia of the Hip

“…However, due to the deep osteotomy site and the wide distribution of blood vessels and nerves around the hip joint, this operation demands a high level of surgical skill from the operator, has a prolonged learning curve, and is susceptible to severe surgical complications. 4,5 To address these challenges, surgeons are continually exploring novel surgical approaches to increase surgical success rates and minimize surgical complications. 6 Bernese PAO, as described by Ganz et al, is frequently utilized as a reorientation osteotomy in adolescents.…”

“…This procedure moves the hip joint's rotation center inwards, enhancing acetabular coverage, increasing the contact area of the weight‐bearing joint surface, and reducing cartilage stress on the acetabulum and the weight‐bearing surface of the femoral head, thereby preventing and delaying the onset of hip arthritis. However, due to the deep osteotomy site and the wide distribution of blood vessels and nerves around the hip joint, this operation demands a high level of surgical skill from the operator, has a prolonged learning curve, and is susceptible to severe surgical complications 4,5 . To address these challenges, surgeons are continually exploring novel surgical approaches to increase surgical success rates and minimize surgical complications 6 …”