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The Frequency of AVN Following Reconstructive Hip Surgery in Children With Cerebral Palsy: A Systematic Review
Kim Hesketh1, Lise Leveille, Kishore Mulpuri
1*Department of Orthopedic Surgery, BC Children's Hospital†Faculty of Medicine‡Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada.
Insights
Children with cerebral palsy (CP) undergoing hip surgery face a risk of avascular necrosis (AVN). The true incidence and risk factors for AVN after reconstructive hip surgery remain poorly documented in current literature.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Reconstructive Surgery
Background:
- Children with cerebral palsy (CP) are susceptible to avascular necrosis (AVN) after reconstructive hip surgery.
- Existing literature on AVN following hip surgery in CP patients has variable quality and documentation.
Purpose of the Study:
- To systematically review the frequency of AVN in children with CP undergoing reconstructive hip surgery.
- To assess the available literature quality and identify potential risk factors for AVN.
Main Methods:
- A comprehensive literature search was conducted using EMBASE and MEDLINE databases.
- Twenty-nine studies were included, with study quality assessed using established methodological scales.
- Inclusion criteria focused on studies reporting outcomes of reconstructive hip surgery in CP patients with AVN as a reported outcome.
Main Results:
- The overall reported frequency of AVN ranged from 0% to 46%, with an average of 7.5% across studies.
- Studies where AVN was the primary outcome reported significantly higher frequencies (37% and 46%).
- No statistically significant risk factors, including age, hip subluxation severity, follow-up duration, or surgical technique, were identified.
Conclusions:
- Children with CP undergoing reconstructive hip surgery are at risk for AVN, but its incidence and severity are poorly documented.
- Current evidence does not identify significant risk factors, necessitating further research.
- The true incidence of AVN may be underestimated due to inconsistent reporting and focus in previous studies.
Background:
Children with cerebral palsy (CP) undergoing reconstructive hip surgery are at risk for developing avascular necrosis (AVN). The purpose of this systematic review was to investigate the reported frequency of AVN, the amount and quality of literature available, and possibly identity risk factors for developing AVN following reconstructive surgery for hip displacement in children with CP.
Methods:
We performed a review of the literature using EMBASE and MEDLINE databases. Studies investigating the outcome of reconstructive hip surgery in patients with CP that identified the presence or absence of AVN were included. Study quality was assessed using the Methodological Index for Non-Randomized Studies and the Oxford Centre for Evidence-Based Medicine scale.
Results:
Three hundred and ninety-nine articles were identified using our search strategy. Twenty-nine studies were included for data extraction after full-text review. The frequency of AVN ranged from 0% to 46% with an overall rate across studies of 7.5%. Presence of AVN was the primary outcome in 2 studies. The frequency of AVN in these studies was significantly higher than other studies at 37% and 46%. No statistically significant associations were found between age at surgery, severity of hip subluxation, length of follow-up, or type of surgery (combined varus derotation osteotomy and pelvic osteotomy vs. varus derotation osteotomy alone), and the rate of AVN. The majority of studies did not comment on methods used for determining diagnosis or severity of AVN and clinical significance was not well documented.
Conclusions:
Children with CP undergoing reconstructive hip surgery are at risk of developing AVN. Frequency and severity of this complication is poorly documented in the literature. On the basis of current evidence no significant risk factors were identified; however, it is not possible to draw firm conclusions about them. Incidence of AVN was higher in studies in which AVN was a primary outcome suggesting that the true frequency of AVN may be higher than is currently understood.
