The Fate of the Nonoperated Hip in Cerebral Palsy

Carr, Charles F.; Gage, James R.

doi:10.1097/01241398-198705000-00004

Cited by 80 publications

(42 citation statements)

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“…Some authors consider that only the displaced hip should be operated on [1][2][3], while others recommend bilateral osteotomy in all cases [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…Carr and Gage [1] analysed 36 unilaterally operated children after an average of 4.8 years (minimum 1 year). Children operated on with unilateral VOPF had a 0.9 % deterioration of MP in the contralateral hip, whereas those operated on with unilateral soft-tissue release had a 12.8 % deterioration of MP in the contralateral hip.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding VOPF, some studies have shown a low risk of contralateral displacement [1][2][3], whereas others have shown a higher risk [4][5][6], and the recommendations concerning bilateral or unilateral VOPF in children with unilateral displacement differ in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Unilateral varus osteotomy of the proximal femur in children with cerebral palsy: A five-year follow-up of the development of both hips

Larsson

Hägglund

Wagner

2012

Journal of Children's Orthopaedics

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Background Varus osteotomy of the proximal femur (VOPF) is one treatment option to prevent hip dislocation in children with cerebral palsy (CP). It is questioned whether the osteotomy should be performed in the displaced hip only, or if it should be performed bilaterally to prevent later displacement of the contralateral hip. CPUP is a register and healthcare programme for children with CP that was initiated in 1994 in southern Sweden. In the programme, range-of-motion and radiographic examination of the hips is performed regularly. These data have been analysed preoperatively and for 5 years postoperatively in children treated with unilateral VOPF. Methods Children with CP living in the counties of Skåne and Blekinge in the south of Sweden, who were treated with unilateral VOPF at least 5 years ago, were included in the study. The degree of hip displacement and the range of hip motion were analysed preoperatively and after 5 years. Repeat hip operations after the index operation were recorded. Results Twenty-four children fulfilled the inclusion criteria. Mean age at index operation was 7.6 (2.8-13.2) years. No child died within 5 years postoperatively, and no child was lost from follow-up. At follow-up after 5 years, 2 of the 24 children had been operated on with VOPF in the contralateral hip. The range of motion in both hips decreased, but the difference between the index hip and the contralateral hip did not change significantly. Conclusion Children with CP and unilateral hip displacement have a low risk of later contralateral displacement after being operated on with unilateral VOPF. This supports healthcare programmes that advocate unilateral VOPF in children with unilateral hip displacement.

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“…Some authors consider that only the displaced hip should be operated on [1][2][3], while others recommend bilateral osteotomy in all cases [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Unilateral varus osteotomy of the proximal femur in children with cerebral palsy: A five-year follow-up of the development of both hips

Larsson

Hägglund

Wagner

2012

Journal of Children's Orthopaedics

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“…Literature review and determination of probable events based on consensus building A literature review was performed with a focus on the following: the natural history of unstable hips in CP, [9][10][11][12] operative complications of FVO 13 and delayed hip reconstruction including pelvic osteotomy, [14][15][16] contralateral hip instability after unilateral FVO in individuals with CP, 1,5,17,18 and pain utility measures in the hips. 19 Each event was reviewed on the basis of probability.…”

Section: Methodsmentioning

confidence: 99%

“…This rate was assumed to be the probability that the contralateral stable hip undergoing a prophylactic FVO would become an unstable hip. It has been reported that 44% of individuals with CP who underwent unilateral hip reconstructive surgery, including FVO, finally needed further hip reconstructive surgery for the contralateral hip before skeletal maturity, 5 which was used for a baseline value of the unstable hip rate of contralateral stable hips in the observation branch, and the range was between 4% and 75% 1,17,18 (Table I). The recurrence rate of hip reconstructive surgery ranges from 0 to 29% according to previous studies, 14,23,[26][27][28][29][30] which was also used for the recurrent unstable hip rate after delayed reconstructive surgery in the observation branch.…”

Section: Probabilitiesmentioning

confidence: 99%

Prophylactic femoral varization osteotomy for contralateral stable hips in non‐ambulant individuals with cerebral palsy undergoing hip surgery: decision analysis

Park

Chung

Kwon

et al. 2012

Develop Med Child Neuro

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FVO Femoral varization osteotomyAIM This study was undertaken to determine the need for concurrent prophylactic femoral varization osteotomy (FVO) of contralateral stable hips at the time of hip reconstructive surgery on unstable hips in non-ambulant individuals with cerebral palsy (Gross Motor Function Classification System levels IV and V).METHOD A decision analysis model was constructed that included (1) the probability of unstable hips during observation of the contralateral stable hips, (2) unstable hip rate (subluxation or dislocation rate) after prophylactic FVO or after delayed reconstructive surgery (including FVO) for unstable hips, and (3) complication rates after concurrent prophylactic FVO or after hip reconstructive surgery. The final outcome score was based on pain utility measures. The probabilities of all cases and the utility score were obtained by literature review. RESULTSThe decision model favoured concurrent prophylactic FVO for the contralateral stable hips over observation (pain utility measure scores 0.814 vs 0.781). In a one-way sensitivity analysis, the decision model favoured concurrent prophylactic FVO when the unstable hip rate of contralateral stable hips during observation was 27% or over. Concurrent prophylactic surgery also demonstrated higher utility scores than observation when the unstable hip rate after FVO was between 0% and 29%.INTERPRETATION The decision analysis model demonstrated that concurrent prophylactic FVO for a contralateral stable hip in individuals with cerebral palsy undergoing hip reconstructive surgery was beneficial from a medical perspective, which was based on current evidence.Studies have reported that a considerable portion of radiographically stable contralateral hips eventually dislocate or subluxate in individuals with cerebral palsy (CP) with a unilateral unstable hip. 1-4 A recent study showed that 44% of severely involved individuals with CP undergoing unilateral femoral varization osteotomy (FVO) required subsequent bony surgical management of the contralateral hip for subluxation or dislocation before reaching skeletal maturity. 5 This high probability of dislocation of the contralateral stable hip during follow-up has generated interest in concurrent prophylactic FVO on the radiographically stable contralateral hip during reconstructive surgery of an unstable hip.Every medical practice must come to terms with the two opposing aspects of risk and benefit represented by optimal treatment and socio-economics. The merits of a procedure include increased life expectancy and improved healthrelated quality of life, and the demerits include complications and costs. Physicians usually weigh up these pros and cons when deciding whether to perform a medical procedure, although such assessments are invariably informal and subjective. These processes necessarily imply that analyses should be performed on the basis of the probabilities of various outcomes.Randomized controlled trials (RCTs) are most commonly used to verify the effectiveness of health-care se...

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Hip

Cerebral Palsy

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The hip joint is the largest joint in the body and is the joint that causes the most problems both from a functional perspective and at the level of walking, sitting, and lying in children with cerebral palsy (CP). Hips in children with CP are normal at birth, and the problems develop slowly as the children grow and deform under the influence of abnormal forces caused by the CP. A second group of children with CP do not actually develop deformity; however, the infantile shape of their proximal femur does not resolve because there is not enough normal force present. In summary, these children develop contractures and increased abnormal forces that lead to dislocation and dysplasia, or alternatively, they fail to resolve the infantile torsional malalignment. After addressing the concerns of equinus contractures in children with CP, hip problems are the next main area of interest to orthopaedists treating these children. The treatment of hip problems has the largest literature base in the area of orthopaedic management of CP. A review of the abstract listings in the National Library of Medicine revealed 496 references published from 1963 to 2000 that address hip problems in children with CP. Although the literature is extensive, much of it does not include any standardized control or standardized radiographic measurements and has a poor description of specific patterns. A substantial body of this literature addresses the natural history of the problem of hip dysplasia, and its etiology has been fairly well understood. The evaluation of treatment outcomes suffers especially from poor categorization, poor standard evaluation procedures, and, most of all, very poor long-term follow-ups. Spastic HipsHip problems in children with CP first need to be divided by children's level of tone into either spastic children or those children who are hypotonic. The spastic (hypertonic) group should also include children with movement disorders such as athetosis and dystonia. The hypertonic hips can be subdivided further by the direction of the dysplasia or the abnormal force into posterosuperior, anterior, inferior and, additionally, by several contracture patterns that may be independent of or concurrent with dysplastic hips. These contracture patterns include windblown hips and hyperabducted hips. The hypotonic hips in children with CP are a little more diffuse and are harder to further categorize.

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The Fate of the Nonoperated Hip in Cerebral Palsy

Cited by 80 publications

References 0 publications

Unilateral varus osteotomy of the proximal femur in children with cerebral palsy: A five-year follow-up of the development of both hips

Unilateral varus osteotomy of the proximal femur in children with cerebral palsy: A five-year follow-up of the development of both hips

Prophylactic femoral varization osteotomy for contralateral stable hips in non‐ambulant individuals with cerebral palsy undergoing hip surgery: decision analysis

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