The Frequency of AVN Following Reconstructive Hip Surgery in Children With Cerebral Palsy

Hesketh, Kim; Leveille, Lise; Mulpuri, Kishore

doi:10.1097/bpo.0000000000000485

Cited by 24 publications

(21 citation statements)

References 32 publications

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“…While an additional procedure, epipihysiodesis can easily be combined with hardware removal and has minimal postoperative restrictions. Our rate of AVN (14.7%) compares with previously reported rates of 0 to 69% 14,26–28. Phillips et al26 demonstrated that large changes in MP and NSA were predictors of development of AVN.…”

Section: Discussionsupporting

confidence: 75%

Can Over-containment Prevent Recurrence in Children With Cerebral Palsy and Hip Dysplasia Undergoing Hip Reconstruction?

Zakrzewski¹,

Bryant

McCarthy³

2022

Journal of Pediatric Orthopaedics

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Introduction: Hip reconstruction is often necessary in children with cerebral palsy (CP) but is associated with high failure rates. Over-containment deeply seats the hip within the acetabulum at the time surgical reconstruction. The goal of this study is to evaluate the effect of over-containment on radiographic outcomes and failure rates in children with CP undergoing hip reconstruction. Methods: This study is a retrospective chart review of children with CP that underwent hip reconstruction between 2010 and 2019 with at least 2 years of radiographic follow-up. Migration percentage (MP), acetabular index (AI), and neck shaft angle (NSA) were recorded preoperatively, postoperatively and throughout follow-up. Failures were defined as a MP at latest follow-up ≥30% or need for revision hip reconstruction. Hips were divided into groups based on postoperative MP—group 1 (over-containment group) had a MP≤0% and group 2 had an MP>0%. Radiographic parameters and failure rates were compared across Gross Motor Functional Classification Score (GMFCS) level, age at the time of surgery, and degree of preoperative subluxation. Results: A cohort of 108 patients (197 hips) with an average age of 7.3±3.2 years met inclusion criteria with an average follow-up of 49.6 months (range: 24 to 118 mo). There were 147 hips in group 1 and 50 hips in group 2. At latest follow-up, group 1 demonstrated lower MP, AI, and NSA in comparison to group 2. The overall failure rate in our cohort was 8.1% (16 hips). Failure rates trended lowest in hips that were over-contained (6.1% v. 14.0%) although not statistically significant. Over-containment resulted in significantly lower failure rates in GMFCS IV/V hips, children under age 6 at the time of surgery and those with a higher degree of preoperative hip displacement (MP>50%). Conclusions: Over-containment at the time of hip reconstruction can positively affect radiographic outcomes and failure rates in children with CP. Over-containment should be considered in hips at high risk of failure, especially non ambulatory children with significant hip subluxation at an early age. Level of Evidence: Level III—retrospective comparative study.

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Section: Discussionsupporting

confidence: 75%

Can Over-containment Prevent Recurrence in Children With Cerebral Palsy and Hip Dysplasia Undergoing Hip Reconstruction?

Zakrzewski¹,

Bryant

McCarthy³

2022

Journal of Pediatric Orthopaedics

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“…The reported rate of postoperative complications after hip reconstructions varies considerably, from 0% to 81% (Ruzbarsky et al 2013). In a systematic review (Hesketh et al 2016), the AVN rate varied from 0% to 46%. These rates are difficult to compare because different classifications were used and because of mixed populations of patients.…”

Section: Discussionmentioning

confidence: 99%

Femoral and pelvic osteotomies for severe hip displacement in nonambulatory children with cerebral palsy: a prospective population-based study of 31 patients with 7 years’ follow-up

Terjesen

2019

Acta Orthopaedica

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Background and purpose — There is no consensus regarding the optimal treatment of hip displacement in children with cerebral palsy (CP). This prospective study assessed the outcome of femoral and pelvic osteotomies for severe hip displacement in nonambulatory children and analyzed prognostic factors for outcome.Patients and methods — 31 nonambulatory children (20 boys), recruited from a population-based screening program, consecutively underwent unilateral (23) or bilateral (8) osteotomies and bilateral soft-tissue releases at a mean age of 6.1 years (2.2–9.9). The procedures were femoral varus osteotomy alone (20 hips) and combined Dega-type pelvic osteotomy and femoral osteotomy (19 hips). Final outcome was termed good if the patient had not undergone further bony surgery and migration percentage (MP) was < 50%. The mean follow-up time was 7.1 years (3.8–11).Results — The mean preoperative MP was 69% (36–100). The outcome was good in 22 patients (29 hips) and poor in 9 patients (10 hips). Mean time to failure was 3.6 years (1.0–6.0). GMFCS level V and high MP 1-year postoperatively were statistically significant risk factors for poor final outcome. There was a higher rate of good outcome after combined osteotomies compared with isolated femoral osteotomy, but the difference was not statistically significant (p = 0.2).Interpretation — Better primary correction was obtained after combined femoral and pelvic osteotomies than after isolated femoral osteotomy, indicating that combined osteotomies are the preferred method in hips with the most severe degrees of displacement. Prophylactic femoral osteotomy of the contralateral non-subluxated hip is hardly indicated.

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“…The reported incidence of AVN of the femoral head in children with CP after hip reconstruction is in the range of 0% to 69%. 10 , 11 , 13 , 18 , 20 , 28 - 30 A recent systematic review 31 on the subject revealed that most authors simply comment on the presence or absence of AVN in their complications, without further detail. Interestingly, the reported rates in our study as well as three others where AVN was the primary outcome measure are among the highest within the literature at 27% to 69%.…”

Section: Discussionmentioning

confidence: 99%

Avascular necrosis in children with cerebral palsy after reconstructive hip surgery

Phillips

Hesketh

Schaeffer

et al. 2017

Journal of Children's Orthopaedics

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PurposeProgressive hip displacement is one of the most common orthopaedic pathologies in children with cerebral palsy (CP). Reconstructive hip surgery has become the standard treatment of care. Reported avascular necrosis (AVN) rates for hip reconstructive surgery in these patients vary widely in the literature. The purpose of this study is to identify the frequency and associated risk factors of AVN for reconstructive hip procedures.MethodsA retrospective analysis was performed of 70 cases of reconstructive hip surgery in 47 children with CP, between 2009 and 2013. All 70 cases involved varus derotation osteotomy (VDRO), with 60% having combined VDRO and pelvic osteotomies (PO), and 21% requiring open reductions. Mean age at time of surgery was 8.82 years and 90% of patients were Gross Motor Function Classification System (GMFCS) 4 and 5. Radiographic dysplasia parameters were analysed at selected intervals, to a minimum of one year post-operatively. Severity of AVN was classified by Kruczynski's method. Bivar- iate statistical analysis was conducted using Chi-square test and Student's t-test.ResultsThere were 19 (27%) noted cases of AVN, all radio- graphically identifiable within the first post-operative year. The majority of AVN cases (63%) were mild to moderate in severity. Pre-operative migration percentage (MP) (p = 0.0009) and post-operative change in MP (p = 0.002) were the most significant predictors of AVN. Other risk factors were: GMFCS level (p = 0.031), post-operative change in NSA (p = 0.02) and concomitant adductor tenotomy (0.028).ConclusionAVN was observed in 27% of patients. Severity of displacement correlates directly with AVN risk and we suggest that hip reconstruction, specifically VDRO, be performed early in the 'hip at risk' group to avoid this complication.

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The Frequency of AVN Following Reconstructive Hip Surgery in Children With Cerebral Palsy

Cited by 24 publications

References 32 publications

Can Over-containment Prevent Recurrence in Children With Cerebral Palsy and Hip Dysplasia Undergoing Hip Reconstruction?

Can Over-containment Prevent Recurrence in Children With Cerebral Palsy and Hip Dysplasia Undergoing Hip Reconstruction?

Femoral and pelvic osteotomies for severe hip displacement in nonambulatory children with cerebral palsy: a prospective population-based study of 31 patients with 7 years’ follow-up

Avascular necrosis in children with cerebral palsy after reconstructive hip surgery

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