Related Experiment Video
Updated: Dec 20, 2025
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Comparison of Staged Versus Same-day Bilateral Hip Surgery in Nonambulatory Children With Cerebral Palsy
Craig R Louer1, Jason Nunez2, James D Bomar3
1University of North Carolina at Chapel Hill, Chapel Hill, NC.
Insights
For severe cerebral palsy (CP) hip dysplasia, single-event bilateral hip reconstruction is linked to fewer major complications than staged surgery. Both methods show acceptable safety, with no permanent disability or death reported.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Cerebral palsy management
Background:
- Bilateral hip reconstructions with osteotomies are common for severe cerebral palsy (CP) with hip dysplasia.
- Surgical options include staged procedures (weeks/months apart) or single-event bilateral surgery.
- Optimal timing for these procedures remains undetermined.
Purpose of the Study:
- To retrospectively compare major complications between staged and single-event bilateral hip reconstruction approaches.
- To evaluate secondary outcomes including minor complications, readmissions, reoperations, and resource utilization.
Main Methods:
- Retrospective review of medical records for nonambulatory CP patients (GMFCS IV-V) undergoing bilateral hip osteotomies.
- Patients with at least one pelvic osteotomy and 1-year follow-up were included.
- Complications were stratified using the Modified Clavien-Dindo Classification; major complications were defined as grade ≥3.
Main Results:
- The staged surgery group (30 patients) exhibited a significantly higher rate of major complications per patient (0.30 vs. 0; P=0.013) compared to the single-event group (35 patients).
- Unplanned readmissions and reoperations were also increased in the staged group.
- Minor complication rates were similar between groups (3.27 vs. 2.91 per patient; P=0.952), as were total length of stay and operating room time.
Conclusions:
- The staged approach for bilateral hip reconstruction in nonambulatory CP patients is associated with a higher incidence of major complications compared to the single-event approach.
- Minor complications were comparable between both surgical strategies.
- Both single-event and staged bilateral hip reconstruction can offer an acceptable safety profile, with no grade 4 or 5 complications observed in this study.
Background:
Bilateral hip reconstructions with osteotomies are commonly required in patients with severe cerebral palsy (CP) and dysplasia. These procedures can be performed by staging each hip surgery, separated by weeks to months, or by addressing both hips in a single-event surgery. The optimal timing of such surgery is yet to be determined. The purpose of this study was to retrospectively compare major complications between the staged and single-event approaches.
Methods:
Medical records of patients who underwent bilateral hip osteotomies, with at least one side including a pelvic osteotomy, were retrospectively reviewed. Subjects were identified who had a diagnosis of nonambulatory CP (defined by Gross Motor and Functional Classification System level IV or V), and at least 1 year of clinical follow-up. All hips were treated by 1 of 7 surgeons: 2 surgeons who always performing single-event surgery and 5 who always perform staged surgeries. Complications were stratified by the Modified Clavien-Dindo Classification (grades 1 to 5). The primary outcome was major complications (grade ≥3), while minor complications, readmissions, reoperations, and resource utilization outcomes were investigated secondarily.
Results:
Sixty-five patients met our inclusion criteria: 35 received single-event surgery and 30 received staged surgery. The staged group had a higher rate of major complications per patient (0.30 vs. 0; P=0.013). Unplanned readmissions and reoperations were likewise increased in the staged group. Minor complication rates were high in both groups, with no differences observed between staged and single-event approaches (3.27 per patient vs. 2.91; P=0.952). There were no complications causing permanent disability or death. The total length of stay (6.2 vs. 4.0 d; P<0.001) and mean nonsurgical operating room time (65.7 vs. 45.6 min; P<0.001) were increased in the staged group versus the single-event group.
Conclusions:
The staged approach to bilateral hip reconstructions in the nonambulatory CP population was associated with a higher rate of major complications compared with a single-event approach. Minor complications were similar for both approaches. Both approaches can have an acceptable safety profile with no observed grade 4 or 5 complications.
Level Of Evidence:
Level III.
