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Published on: January 11, 2016
Unilateral hip reconstruction in children with cerebral palsy: predictors for failure
Pinak Y Shukla1, Sarabdeep Mann, Stuart V Braun
1Tufts Medical Center, Department of Orthopaedics, Boston MA, USA.
Insights
Predictors for hip complications after unilateral reconstruction in patients with severe cerebral palsy (CP) were identified. Lack of soft-tissue release and pelvic obliquity angle changes predicted contralateral hip subluxation, while worsening pelvic obliquity predicted ipsilateral hip failure.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Cerebral palsy management
Background:
- Unilateral hip reconstruction in cerebral palsy (CP) patients (GMFCS IV-V) carries risks of contralateral subluxation and ipsilateral failure.
- Identifying predictors is crucial for improving surgical outcomes in this vulnerable population.
Purpose of the Study:
- To identify predictors of ipsilateral hip failure and contralateral hip subluxation after unilateral hip reconstruction in patients with GMFCS IV-V CP.
- To analyze the impact of various factors on hip stability post-surgery.
Main Methods:
- Retrospective study of 35 GMFCS IV-V CP patients with unilateral hip reconstruction and minimum 2-year follow-up.
- Radiographic assessment included acetabular index, femoral migration index (FMI), lateral center edge angle (LCE), and pelvic obliquity.
- Analysis of age, sex, pelvic obliquity, scoliosis surgery, and contralateral hip soft-tissue release as potential predictors.
Main Results:
- 51% of patients experienced ipsilateral hip failure or contralateral hip subluxation.
- Contralateral hip subluxation occurred in 28%, and ipsilateral hip failure in 34%.
- Lack of contralateral soft-tissue release, reversed pelvic obliquity, and high initial contralateral FMI (>25%) predicted contralateral subluxation (P=0.03).
- Persistent or worsening pelvic obliquity predicted ipsilateral failure (P<0.04).
Conclusions:
- Key predictors for contralateral hip subluxation include absence of contralateral soft-tissue release, reversed pelvic obliquity, and elevated initial contralateral FMI.
- Persistence or worsening of preoperative pelvic obliquity is the sole identified predictor for ipsilateral hip failure.
Background:
Unilateral hip reconstruction in patients with cerebral palsy can be complicated by contralateral subluxation and ipsilateral failure. We sought to identify predictors for failure after unilateral reconstruction in patients with GMFCS IV-V CP with unilateral hip involvement.
Methods:
We performed an IRB-approved retrospective study on GMFCS IV-V CP patients with unilateral hip reconstruction at a minimum 2-year follow-up. Radiologic data included acetabular index, femoral migration index (FMI), lateral center edge angle (LCE), and pelvic obliquity. The effects of age, sex, pelvic obliquity, scoliosis surgery, and contralateral hip soft-tissue release at the index surgery were analyzed for ipsilateral hip failure and contralateral hip subluxation. Statistical analysis was performed using the χ and t tests.
Results:
There were 35 patients (M:F, 23:12) with mean age of 110 months (range, 45 to 215 mo) with mean follow-up of 60.5 months (range, 24 to 129 mo). The mean preoperative ipsilateral hip FMI was 60% (range, 40% to 100%) and the mean LCE was -16.7 degrees (range, -85 to 17.2 degrees). Contralateral soft-tissue release was performed in 13/35 patients. Ipsilateral hip failure or contralateral hip subluxation was observed in 51% (18/35) patients. Contralateral hip subluxation developed in 28% (10/35) of patients. Ipsilateral hip failure was observed in 34% (12/35) patients. Four had both ipsilateral failure and contralateral subluxation. Lack of contralateral hip soft-tissue release, reversal of pelvic obliquity angle, and high initial contralateral hip FMI (> 25%) significantly predicted the risk of contralateral hip subluxation (P = 0.03). Similarly, persistence or worsening of preoperative pelvic obliquity significantly predicted ipsilateral hip failure (P < 0.04). There was a strong trend toward contralateral hip subluxation in patients below 8 years of age (P = 0.1) and ipsilateral hip failure in those who had spinal fusion surgery for scoliosis (P = 0.06).
Conclusions:
Predictors of contralateral hip subluxation included lack of contralateral soft-tissue release, reversal of pelvic obliquity angle, and larger initial contralateral hip FMI (> 25%). The only predictor of ipsilateral failure was persistence or worsening of preoperative pelvic obliquity.
