Bilateral hip reconstruction in severe whole-body cerebral palsy: ten-year follow-up results
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Published on: September 7, 2022
M J Barakat1, T While, J Pyman
1Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, UK.
Insights
This study on cerebral palsy hip surgery in children found that combined soft-tissue and bony surgery significantly improved hip function, reduced pain, and enhanced radiological outcomes. These positive results were maintained long-term, indicating the procedure
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Cerebral Palsy Research
Background:
- Cerebral palsy (CP) often leads to hip deformities like windsweep.
- Surgical correction is crucial for improving function and quality of life in affected children.
- Long-term outcomes of combined surgical approaches for CP hip windsweep deformity require further investigation.
Purpose of the Study:
- To evaluate the long-term functional, clinical, and radiological outcomes of bilateral simultaneous combined soft-tissue and bony surgery for windsweep deformity in children with cerebral palsy.
- To assess the maintenance of improvements over time.
Main Methods:
- Retrospective review of 30 children (60 hips) with cerebral palsy undergoing hip surgery.
- Bilateral simultaneous combined soft-tissue and bony surgery performed at a mean age of 7.7 years.
- Functional, clinical, and radiological assessments at a mean follow-up of 10.2 years, including the Gross Motor Functional Classification System (GMFCS).
Main Results:
- Significant improvements in hip range of motion and a reduction in the mean windsweep index (50 to 36).
- Improved radiological containment: mean migration percentage improved from 50% to 20%, and mean center-edge angle from -5° to 29°.
- Functional gains observed: 82% reported improved handling, 7 patients showed GMFCS improvement, and pain reduced significantly (12 pre-op to 1 post-op).
Conclusions:
- Bilateral simultaneous combined soft-tissue and bony surgery is an effective treatment for windsweep deformity in children with cerebral palsy.
- The surgical intervention leads to sustained improvements in hip function, pain reduction, and radiological parameters.
- The procedure is considered worthwhile by patients and caregivers, with long-term benefits maintained up to 10 years post-surgery.
Abstract:
The results of a functional, clinical and radiological study of 30 children (60 hips) with whole-body cerebral palsy were reviewed at a mean follow-up of 10.2 years (9.5 to 11). Correction of windsweep deformity of the hips was performed by bilateral simultaneous combined soft-tissue and bony surgery at a mean age of 7.7 years (3.1 to 12.2). We were able to recall 22 patients; five had died of unrelated causes and three were lost to follow-up. Evaluation involved interviews with patients/carers and clinical and radiological examination. The gross motor functional classification system was used to assess overall motor function and showed improvement in seven patients. Of the 12 patients thought to have pain pre-operatively, only one had pain post-operatively. Improved handling was reported in 18 of 22 patients (82%). Those with handling problems were attributed by the carers to growth of the patients. All patients/carers considered the procedure worthwhile. The range of hip movements improved, and the mean windsweep index improved from 50 pre-operatively to 36 at follow-up. The migration percentage and centre-edge angle were assessed on plain radiographs. Radiological containment improved, the mean migration percentage improved from 50 pre-operatively to 20 at follow-up and the mean centre-edge angle improved from -5 degrees to 29 degrees . No statistical difference was noted between the three-year and ten-year follow-up results, indicating that the improvements in clinical and radiological outcome had been maintained.