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Factors Influencing Outcomes of the Dysplastic Hip in Nonambulatory Children With Cerebral Palsy
Kristen L Carroll1,2, Alan K Stotts1,2, Glen O Baird3
1Motion Analysis Center, Shriners Hospitals for Children.
Insights
Pelvic osteotomy improves hip surgery success in nonambulatory children with cerebral palsy (CP). Varus rotational osteotomy is recommended for severe hip dysplasia, but capsulorrhaphy should be avoided to maximize positive outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Cerebral Palsy Research
Background:
- Hip dysplasia is common in nonambulatory children with cerebral palsy (CP), often requiring surgical intervention.
- Current evidence lacks clarity on optimal surgical strategies and timing for hip subluxation in this population.
- Outcomes of surgical interventions for less severe hip subluxation in CP patients are not well understood.
Purpose of the Study:
- To identify factors influencing long-term success in hip surgery for subluxation in nonambulatory children with CP.
- To evaluate the impact of surgical techniques and patient factors on hip surgery outcomes.
- To provide evidence-based recommendations for surgical management of hip dysplasia in nonambulatory CP.
Main Methods:
- Retrospective comparative study of 183 nonambulatory CP subjects with a minimum 2-year follow-up.
- Analysis of varus rotational osteotomy of the femur, with or without pelvic osteotomy (PO), capsulorrhaphy, and soft tissue releases.
- Comparison of outcomes for severely subluxated (SS) hips (>50% migration) versus nonsevere hips, assessing success as <25% migration at follow-up.
Main Results:
- Overall success rates were 60% for SS hips and 68% for nonsevere hips.
- Addition of pelvic osteotomy (PO) was the only concomitant procedure significantly improving outcomes, particularly in SS hips (2.5 times more likely to succeed).
- Capsulorrhaphy negatively impacted success rates (odds reduced to 0.8), while age and other factors were not significant.
Conclusions:
- Pelvic osteotomy (PO) should be added to varus rotational osteotomies for severe hip subluxation in nonambulatory CP patients.
- Surgery for severe hip dysplasia in this population is recommended regardless of patient age.
- Capsulorrhaphy does not enhance, and may decrease, the success rate of hip surgery in nonambulatory CP.
Background:
Hip dysplasia in the nonambulatory child with spastic cerebral palsy (CP) is a common condition not always effectively treated with conservative measures even when recognized early. Optimal surgical intervention strategies and timing are not clear from previous studies. Contralateral hips with less severe subluxation in these patients also often undergo surgery and little is known of outcomes of these less severe hips. This study aims to clarify treatment factors related to long term success following hip surgery for subluxation in nonambulatory children with CP.
Methods:
A total of 183 nonambulatory subjects with CP and a minimum of 2-year follow-up were included. All subjects underwent varus rotational osteotomy of the femur; other surgical factors considered were addition of pelvic osteotomy (PO), capsulorrhaphy, and soft tissue releases. Additional factors studied were age at index surgery, sex, and unilateral versus bilateral surgery. Severely subluxated (SS) hips, defined as having >50% migration, were studied separately from contralateral nonsevere hips. Surgeries were deemed successful if final follow-up indicated a migration of <25%; patients with any revision surgeries or >25% migration were categorized as failures.
Results:
A 60% success rate was found in SS hips and a 68% success rate in nonsevere hips. Age at index surgery did not influence success rates in SS hips. In the nonsevere hips, success was associated with index surgery at older age. The addition of a PO was the only concomitant procedure demonstrated to improve outcomes. In SS hips, those with a successful outcome were 2.5 times more likely to have had a PO. The addition of capsulorrhaphy had a negative effect on the entire group, reducing odds of success to 0.8. No other factors were significant.
Conclusions:
The findings from this multicenter retrospective study suggest that PO be added to varus rotational osteotomies in patients with severe hip subluxation. Surgery should be undertaken for severe dysplasia without concern for age. The addition of capsulorrhaphy does not improve rate of success.
Level Of Evidence:
Level III-retrospective comparative study.
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