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)

Abstract

Background and purpose — Children with cerebral palsy (CP) have an increased risk of hip dislocation. Outcome studies after surgery to prevent hip dislocation in children with CP are usually retrospective series from single tertiary referral centers. According to the national CP surveillance program in Sweden (CPUP), hip surgery should preferably be performed at an early age to prevent hip dislocation. Preventive operations are performed in 12 different Swedish hospitals. We compared the outcomes between soft tissue release and femoral osteotomy in children with CP treated in these hospitals.Patients and methods — 186 children with CP underwent either adductor–iliopsoas tenotomy (APT) or femoral osteotomy (FO) as the primary, preventive surgery because of hip displacement. They were followed for a minimum of 5 years (mean 8 years) regarding revision surgery and hip migration. A good outcome was defined as the absence of revision surgery and a migration percentage (MP) < 50% at the latest follow-up. Logistic and Cox regression analysis were used to investigate the influence of age, sex, preoperative MP, Gross Motor Function Classification System (GMFCS) level, and CP subtype.Results — APT was performed in 129 (69%) children. After 5 years, the reoperation rate was 43%, and 2 children (2%) had an MP > 50%. For the 57 children who underwent FO, the corresponding figures were 39% and 9%. Of the potential risk factors studied, the outcome was statistically significantly associated with preoperative MP only in children who underwent APT, but not in those who underwent FO. None of the other factors were significantly associated with the outcome in the 2 procedure groups.Interpretation — Reoperation rates after preventive surgery are high and indicate the importance of continued postoperative follow-up. Age, sex, GMFCS level, and CP subtype did not influence the outcome significantly.

Hip development after surgery to prevent hip dislocation in cerebral palsy: a longitudinal register study of 252 children

“…In the 79 hips that underwent VDRO without a 2nd operation during the follow-up period the MM that best fit the data was also a linear trend with time before the operation and a 2nd-degree polynomial trend with time after the operation together with a random intercept to describe the individual mean developments. The hips showed an instantaneous reduction of MP postoperatively from 55% (CI 51-60), SD 13 (10)(11)(12)(13)(14)(15)(16) to 11% (CI 6.1-17), SD 15.6, which represents a mean reduction of 44% (CI 37-51), SD 9.9 (CI 6.2-16). This was followed by a recurring displacement at a gradually decreasing velocity from 6.8%/year (CI 5.0-8.7) 1 year postoperatively to 0%/year (CI -1.5-1.4) after 4 years (Figure 3).…”

“…There are different opinions about when and the type of surgery needed, especially in relation to the child's age, degree of displacement, and gross motor function level. Regardless of the surgical procedure, there is a high risk that repeat surgery is needed during the child's remaining growth period (6)(7)(8)(9)(10).…”

Orthopedic treatment of the lower limbs in spastic paralysis

“…Orthopedic surgery can roughly be divided into tendon lengthening, tendon transfer, osteotomy, and arthrodesis. The indications include fixed contracture, joint deformity, joint dislocation, and subluxation that affect function or cause pain [18][19][20][21][22]. Furthermore, the purpose of surgery is to improve motor function, prevent deformity, relieve pain, and modify the appearance of patients [23,24].…”

A community-based exercise program for ambulant adolescents with cerebral palsy, a feasibility study

“…Pediatric care for people with CP is generally quite comprehensive and involves regular multidisciplinary treatment such as orthopedic surgery (Kiapekos, Broström, Hägglund & Åstrand, 2019) and physiotherapy (Lauruschkus et al, 2013;Majnemer et al, 2014). However, once the young person reaches a certain age, generally around 16-21 years, they are discharged from child services (Blackman & Conaway, 2014).…”