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Risk factors and complications in hip reconstruction for nonambulatory patients with cerebral palsy
Joseph J Ruzbarsky1, Nicholas A Beck2, Keith D Baldwin1
1Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 2nd Floor Wood Building, 34th and Civic Center Blvd, Philadelphia, PA 19104 USA.
Insights
Hip dysplasia in children with cerebral palsy (CP) has a high complication rate after reconstructive surgery. Younger age and tracheostomy increase the risk of hip resubluxation.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Cerebral palsy research
Background:
- Hip dysplasia is common in nonambulatory children with cerebral palsy.
- It can decrease quality of life.
- Reconstructive surgery aims to achieve and maintain hip reduction.
Purpose of the Study:
- To characterize complications of hip reconstructive procedures in children with CP.
- To identify risk factors contributing to these complications.
Main Methods:
- Retrospective analysis of 61 nonambulatory children (93 hips) with CP.
- Procedures included femoral varus derotation osteotomy with or without pelvic osteotomy.
- Follow-up averaged 5.9 years.
Main Results:
- Cumulative complication rate was 47.6%.
- Spica casting was a risk factor for all complications.
- Younger age (<6 years) and tracheostomy were risk factors for resubluxation.
Conclusions:
- Complication rates vary, with more severe CP cases experiencing more complications.
- This study reports institutional complication rates and risk factors.
- Understanding risk factors can guide surgical decisions.
Background:
Hip dysplasia is prevalent in nonambulatory children with cerebral palsy, and may contribute to a decreased quality of life (Lonstein in J Pediatr Orthop 6:521-526, 1). Reconstructive procedures such as a femoral varus derotation osteotomy with or without a pelvic osteotomy are commonly employed with the goal of achieving and maintaining well reduced hips.
Purposes:
The goals of this study are both to characterize the complications of reconstructive procedures and to identify risk factors that may contribute to these complications.
Patients And Methods:
A retrospective analysis was conducted among 61 nonambulatory children (93 hips) with cerebral palsy who underwent a femoral varus derotation osteotomy, with or without an open reduction and/or pelvic osteotomy, from 1992 through 2008 at our institution. The average patient age was 8.1 years (2.6-14.7) and the mean follow-up time was 5.9 years (2.1-15.9).
Results:
The cumulative complication rate per patient including failures to cure was 47.6 %. Spica casting was found to be a risk factor for all complications (P = 0.023); whereas patients younger than 6 years old (P = 0.013) and children with a tracheostomy (P = 0.004) were found to be risk factors for resubluxation following surgery.
Conclusions:
Although reported complication rates of hip reconstructive procedures performed upon children with cerebral palsy have varied considerably, those with more severe disease have experienced more complications. We report our tertiary referral center's complication rate and our institutional experiences with risk factors for complications and failures to cure.
Level Of Evidence:
IV, Retrospective case series.
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