Percutaneous Subtrochanteric Osteotomy for Painful Dislocated Hips in Patients With Cerebral Palsy
Maximilian Martinez1, Seung-Ju Kim, Sanjeev Sabharwal
1Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ.
Insights
Percutaneous subtrochanteric valgus osteotomy (SVO) with external fixation (EF) improved hip abduction and quality of life in nonambulatory children with cerebral palsy (CP). This surgical technique offers a viable alternative for managing painful, dislocated hips in this challenging patient group.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Cerebral palsy management
Background:
- Treating painful, chronically dislocated hips in nonambulatory cerebral palsy (CP) patients presents significant challenges.
- Limited patient-centered outcome data exists for surgical interventions in this population.
Purpose of the Study:
- To evaluate the effectiveness of percutaneous subtrochanteric valgus osteotomy (SVO) using external fixation (EF).
- To assess the impact of SVO with EF on hip abduction, radiographic parameters, and quality of life (QOL) in nonambulatory CP patients.
Main Methods:
- Fifteen nonambulatory CP patients with chronically dislocated hips underwent SVO with EF and adductor tenotomy.
- Hip abduction, radiographic angles, and caregiver-reported QOL measures (including pain and nursing care ease) were assessed pre- and post-surgery.
- The modified Child Health Index of Life with Disabilities (CPCHILD) survey was utilized.
Main Results:
- A majority of patients (9/11) showed improvements in pain, sitting tolerance, ease of transfers, and perineal care.
- Significant improvements were observed in hip abduction (from -7 to 24 degrees) and the modified CPCHILD score (27.2 to 16.23).
- Average valgus osteotomy correction was 48.2 degrees, with improvements in pelvic femoral shaft angle; 3 major complications occurred (20%).
Conclusions:
- Percutaneous SVO with EF demonstrates potential for improving QOL in nonambulatory CP patients with dislocated hips.
- This technique is a viable alternative to open osteotomy with internal fixation, despite potential complications.
- Further comparative studies are recommended to establish optimal salvage techniques.
Background:
Treatment of a painful, chronically dislocated hip in nonambulatory children with cerebral palsy (CP) is challenging and controversial. Although many surgical options have been described, there is limited information, including patient-centered outcomes, following treatment. The purpose of our study was to evaluate the effect of a percutaneous subtrochanteric valgus osteotomy (SVO) using external fixation (EF) on hip abduction, radiographic parameters, and quality of life (QOL) measures in such patients.
Methods:
Fifteen nonambulatory patients (8 male, 7 female) with CP with 19 chronically dislocated hips underwent SVO using EF and adductor tenotomy at an average age of 14.3 years (range, 10.7 to 26.8 y). Changes in hip abduction and radiographic angular correction following surgery were assessed. Caregivers completed 2 surveys detailing differences in the patient's QOL measures, including severity and duration of pain and ease of nursing care, and the modified Child Health Index of Life with Disabilities (CPCHILD).
Results:
Caregivers of 11 patients completed both surveys at an average follow-up of 50 months (range, 17 to 119 mo) after fixator removal. There was improvement in pain, sitting tolerance, ease of transfers, and perineal care in the majority (9/11) of patients. The modified CPCHILD (possible score, 10 to 50) improved from 27.2 to 16.23 (P=0.05). Hip abduction improved from -7 degrees (range, -32 to 5 degrees) to 24 degrees (range, 0 to 40 degrees) (P<0.0001). The average valgus osteotomy correction was 48.2 degrees (range, 2.2 to 93.2 degrees). The pelvic femoral shaft angle improved from -15.2 degrees (range, -47.7 to 7.4 degrees) to 15.4 degrees (-44.3 to 44.6 degrees). There was some correlation of both, change in hip abduction (R=0.55) and osteotomy angle (R=0.60), with improvement in QOL measures. There were 3 major complications (20%) in 15 patients.
Conclusions:
On the basis of preliminary results, percutaneous SVO stabilized with EF improves QOL in the majority of nonambulatory CP patients despite untoward events and is a viable alternative to open osteotomy with internal fixation. More robust comparative studies are needed to further assess the optimal salvage technique in this patient population.
Level Of Evidence:
Level IV.
