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Related Experiment Video

Updated: Oct 30, 2025

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Can Adding BMP2 Improve Outcomes in Patients Undergoing the SUPERhip Procedure?

Dror Paley1, Claire E Shannon1, Monica Nogueira2

  • 1Paley Orthopedic and Spine Institute, St. Mary's Hospital, West Palm Beach, FL 33407, USA.

Children (Basel, Switzerland)
|July 2, 2021
PubMed
Summary

The SUPERhip procedure for congenital femoral deficiency (CFD) can be improved with fixed angle devices to prevent varus deformity and BMP2 to promote femoral neck ossification, reducing complications.

Keywords:
bone morphogenic protein 2 (BMP2)congenital femoral deficiency (CFD)coxa varaendochondral ossificationproximal focal femoral deficiency (PFFD)

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Area of Science:

  • Orthopedic Surgery
  • Pediatric Orthopedics
  • Limb Reconstruction

Background:

  • Congenital femoral deficiency (CFD) Paley type 1b presents with severe upper femur deformity and hip contractures.
  • The Systematic Utilitarian Procedure for Extremity Reconstruction of the hip (SUPERhip) was developed to correct CFD.
  • Early SUPERhip procedures using non-fixed angle devices had high rates of delayed ossification and varus deformity.

Purpose of the Study:

  • To evaluate if fixed angle internal fixation and bone morphogenetic protein 2 (BMP2) reduce late complications in SUPERhip procedures for CFD Paley type 1b.
  • To assess the efficacy of specific modifications in preventing recurrent varus and delayed ossification.

Main Methods:

  • Retrospective review of 106 SUPERhip procedures (72 primary, 34 revisions) for Paley type 1b CFD (1997-2012).
  • Comparison of outcomes between procedures with and without BMP2, and with fixed angle versus non-fixed angle internal fixation.
  • Analysis of complication rates including recurrent varus and delayed femoral neck ossification.

Main Results:

  • Fixed angle devices significantly reduced recurrent varus compared to non-fixed angle devices.
  • BMP2 insertion significantly decreased persistent delayed ossification of the femoral neck.
  • The combination of fixed angle fixation and BMP2 demonstrated the lowest incidence of recurrent coxa vara and delayed ossification.

Conclusions:

  • The SUPERhip procedure effectively addresses CFD Paley type 1b pathoanatomy.
  • Fixed angle internal fixation is crucial for preventing recurrent coxa vara.
  • BMP2 application is essential for inducing femoral neck ossification and preventing delayed ossification.