The effect of hip reconstruction on gross motor function levels in children with cerebral palsy

Area of Science:

• Orthopedic Surgery
• Pediatric Neurology
• Rehabilitation Medicine

Background:

• Cerebral palsy (CP) often involves hip instability, impacting gross motor function.
• Hip reconstruction is a surgical intervention aimed at addressing hip instability in CP.
• Evaluating the impact of hip reconstruction on functional outcomes is crucial for patient management.

Purpose of the Study:

• To assess the effect of hip reconstruction on Gross Motor Function Classification System (GMFCS) levels in patients with CP and hip instability.
• To correlate changes in GMFCS levels with postoperative clinical improvements.

Main Methods:

• A cohort of 30 patients (45 hips) with CP and hip instability underwent surgery, with a minimum 2-year follow-up.
• Hip instability severity was classified using the Migration Index (MI).
• Clinical evaluations included sitting/walking ability, pain, and perineal care; statistical analyses used Wilcoxon T, chi-square, and Spearman tests.

Main Results:

• Mean follow-up was 57 months; most patients (11/30) presented with preoperative GMFCS Level V.
• Postoperative complaints resolved in 25 patients, but GMFCS levels remained largely unchanged (20/30 patients), with no significant difference between pre- and post-operative levels (p=0.052).
• No correlation was found between GMFCS level changes and symptom resolution (p=0.504), though preoperative GMFCS and CP type correlated with MI.

Conclusions:

• Hip reconstruction in children with CP and hip instability can lead to improvement in preoperative symptoms.
• Surgical intervention generally results in stable GMFCS levels, indicating that functional gains are not directly tied to GMFCS level changes.
• The findings suggest that symptom relief and functional classification changes following hip reconstruction operate independently in this patient population.