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Can Over-containment Prevent Recurrence in Children With Cerebral Palsy and Hip Dysplasia Undergoing Hip
Allyson M Zakrzewski1, Austin J Bryant2, James J McCarthy1
1Departments of Orthopaedics.
Insights
Over-containment in hip reconstruction surgery for children with cerebral palsy (CP) improves radiographic outcomes and reduces failure rates, especially in high-risk cases. This technique should be considered for children with significant hip displacement and early-onset CP.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Cerebral palsy research
Background:
- Hip reconstruction is frequently required for children with cerebral palsy (CP).
- Standard hip reconstruction in CP patients has a high failure rate.
- Over-containment, a surgical technique, deeply seats the hip within the acetabulum.
Purpose of the Study:
- To evaluate the impact of over-containment on radiographic outcomes.
- To assess the effect of over-containment on hip reconstruction failure rates in children with CP.
Main Methods:
- Retrospective chart review of 108 children (197 hips) with CP undergoing hip reconstruction (2010-2019).
- Minimum 2-year radiographic follow-up, recording Migration Percentage (MP), acetabular index (AI), and neck shaft angle (NSA).
- Hips classified as over-contained (MP ≤ 0%) versus non-over-contained (MP > 0%).
Main Results:
- Over-contained hips (Group 1) showed lower MP, AI, and NSA compared to Group 2 at latest follow-up.
- Overall failure rate was 8.1%; trended lower in over-contained hips (6.1% vs. 14.0%).
- Significantly lower failure rates observed with over-containment in GMFCS IV/V, children <6 years, and those with preoperative MP > 50%.
Conclusions:
- Over-containment positively influences radiographic outcomes and failure rates in pediatric CP hip reconstruction.
- Consider over-containment for high-risk hips, particularly in non-ambulatory children with significant early hip subluxation.
- This technique offers a promising approach to improve surgical success in this vulnerable population.
Introduction:
Hip reconstruction is often necessary in children with cerebral palsy (CP) but is associated with high failure rates. Over-containment deeply seats the hip within the acetabulum at the time surgical reconstruction. The goal of this study is to evaluate the effect of over-containment on radiographic outcomes and failure rates in children with CP undergoing hip reconstruction.
Methods:
This study is a retrospective chart review of children with CP that underwent hip reconstruction between 2010 and 2019 with at least 2 years of radiographic follow-up. Migration percentage (MP), acetabular index (AI), and neck shaft angle (NSA) were recorded preoperatively, postoperatively and throughout follow-up. Failures were defined as a MP at latest follow-up ≥30% or need for revision hip reconstruction. Hips were divided into groups based on postoperative MP-group 1 (over-containment group) had a MP≤0% and group 2 had an MP>0%. Radiographic parameters and failure rates were compared across Gross Motor Functional Classification Score (GMFCS) level, age at the time of surgery, and degree of preoperative subluxation.
Results:
A cohort of 108 patients (197 hips) with an average age of 7.3±3.2 years met inclusion criteria with an average follow-up of 49.6 months (range: 24 to 118 mo). There were 147 hips in group 1 and 50 hips in group 2. At latest follow-up, group 1 demonstrated lower MP, AI, and NSA in comparison to group 2. The overall failure rate in our cohort was 8.1% (16 hips). Failure rates trended lowest in hips that were over-contained (6.1% v. 14.0%) although not statistically significant. Over-containment resulted in significantly lower failure rates in GMFCS IV/V hips, children under age 6 at the time of surgery and those with a higher degree of preoperative hip displacement (MP>50%).
Conclusions:
Over-containment at the time of hip reconstruction can positively affect radiographic outcomes and failure rates in children with CP. Over-containment should be considered in hips at high risk of failure, especially non ambulatory children with significant hip subluxation at an early age.
Level Of Evidence:
Level III-retrospective comparative study.
