Postoperative Immobilization After Hip Reconstruction in Cerebral Palsy: No Difference Between Hip Spica and Abduction Pillow

Abstract

PurposeThis study aims to compare radiographic outcomes and complication rates of immobilization with an abduction pillow to spica casting for postoperative care after a hip reconstruction with varus derotational proximal femur osteotomy (VDRO) with or without pelvic osteotomy for children with cerebral palsy (CP).Methods233 children (1–18 years old) diagnosed with CP that underwent VDRO with or without pelvic osteotomy were identified, of which 188 patients were immobilized with a spica cast and 45 were immobilized with an abduction pillow, based on surgeon preference. 123 (65%) in the Spica group and 21 (47%) in the pillow group had pelvic osteotomies. Demographic data and complication rates were collected. Radiographic parameters, including anatomic medial proximal femoral angle (aMPFA), acetabular index (AI) and migration percentage (MP), were measured for each patient at the completion of surgery, six weeks post-operatively, and one year post-operatively.ResultsThere was not a statistically significant difference in BMI (p = 0.285), gender distribution (p = 0.984), or median follow-up time (p = 0.314) between groups. Rates of complications were consistent among groups with no differences in instances of delayed unions (p = 0.10), subluxations (p = 0.55), infection (p = 0.71), or non-unions (p = 0.10). There was no statistically significant difference in number of patients with an ideal aMPFA, AI, or MP (p = 0.44, p = 0.19, p = 1.00) at one year post-operatively.ConclusionsImmobilization with an abduction pillow is a safe and effective alternative to hip spica casting following hip reconstruction.

Bony hip reconstruction for displaced hips in patients with cerebral palsy: Is postoperative immobilization indicated?

“… 20 Ruzbarsky et al 21 also reported decubitus ulcers in 3/61 (4.9%) and Pisecky et al 22 counted superficial skin lesions in 7/83 (8.4%). When compared spica cast and abduction pillow, Vasconcellos et al 23 reported incidence of pressure sore associated with abduction pillow especially over bony prominences and from pillow straps. In our series, we have had 2/148 (1.3%) rate of skin sores that were managed by tissue viability team and did not need any intervention.…”

“…In their case series, Tabaie et al 31 compared the complication rate of three different types of immobilization after hip reconstruction in CP, namely, hip spica, Petrie cast, and abduction pillow. Likewise, Vasconcellos et al 23 compared hip spica and abduction pillow. They both did not find a significant difference in complication rate between groups and recommended use of less restrictive types of immobilization.…”