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Published on: February 17, 2023
An Analysis of Reoperations Following Proximal Femoral Varus Derotational Osteotomy in Children with Cerebral Palsy
Sam P Wimmer1, Natalie L Zusman1, Tishya A L Wren1,2
1Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, California.
Insights
Children with cerebral palsy (CP) undergoing proximal femoral varus derotational osteotomy (VDRO) have a 29.2% reoperation rate. Younger age (<6 years), bilateral procedures, and left hip operations are significant risk factors for reoperation.
Area of Science:
- Pediatric Orthopedics
- Cerebral Palsy Research
- Surgical Outcomes
Background:
- Hip displacement is a common complication in children with cerebral palsy (CP).
- Existing research primarily focuses on the longevity of native hips in CP patients.
- This study evaluates the reoperation-free rate after proximal femoral varus derotational osteotomy (VDRO) in pediatric CP patients.
Purpose of the Study:
- To determine the reoperation-free rate of hips in children with cerebral palsy (CP) following index proximal femoral varus derotational osteotomy (VDRO).
- To identify significant risk factors associated with reoperation after VDRO in this population.
Main Methods:
- Retrospective cohort study of 289 children (518 hips) with CP undergoing VDRO between 2004 and 2022.
- Minimum 2-year follow-up post-index surgery.
- Reoperation defined as any return to the operating room for a same-site procedure (excluding elective hardware removal).
- Logistic regression and Cox proportional hazard models used for analysis.
Main Results:
- A 29.2% reoperation rate was observed across 518 hips.
- Significant risk factors for reoperation included age <6 years at index surgery (46.0% vs 23.1%), bilateral VDRO procedures (OR 3.68), and left hip operations (OR 1.24).
- No significant difference in reoperation rates was found across Gross Motor Function Classification System (GMFCS) levels.
Conclusions:
- The reoperation rate following VDRO in children with CP is substantial (29.2%).
- Younger age at surgery, bilateral procedures, and left-sided operations are key predictors of reoperation.
- Findings aid in optimizing patient and family counseling regarding subsequent surgical needs.
Background:
Hip displacement is common in children with cerebral palsy (CP). The existing literature has focused on native-hip longevity in patients with CP. This study investigated the reoperation-free rate of hips in children with CP following index proximal femoral varus derotational osteotomy (VDRO).
Methods:
We conducted a retrospective cohort study of patients with CP who were <18 years of age and underwent VDRO surgery at a tertiary referral center between January 2004 and January 2022, and who were followed for at least 2 years after the index surgery. Two hundred and eighty-nine patients (518 hips) met the inclusion criteria. Any return to the operating room for a same-site procedure counted as a reoperation, apart from elective hardware removal undertaken while the patient underwent a distinctly separate procedure. Reoperation rates and odds ratios (ORs) were calculated. Analyses were carried out using logistic regression and Cox proportional hazard models.
Results:
We found a 29.2% rate of reoperation (151 reoperations among 518 hips). The reoperation rate was greatest for patients functioning at Gross Motor Function Classification System (GMFCS) level V (32.2% for level V, 27.8% for level IV, and 25.5% for level II/III), although the difference did not reach significance (p = 0.73). Hips in patients ≥6 years of age were significantly less likely to require reoperation than in those <6 years of age (23.1% versus 46.0%; p < 0.01). Bilateral index procedures (OR, 3.68 [95% confidence interval (CI), 1.68 to 8.04]; p < 0.01) significantly increased the risk of reoperation, regardless of operative side (31.1% right versus 32.3% left; p = 0.84). Additionally, operations on the left hip (OR, 1.24; 95% CI, 1.04 to 1.48; p = 0.02) had an increased risk of reoperation compared with those on the right.
Conclusions:
The frequency of reoperation in this large cohort was 29.2%, which is similar to previously published rates. An age of <6 years at the index surgery, operation on the left hip, and bilateral VDRO were the only significant risk factors for reoperation; however, there was a nonsignificant stepwise increase in the reoperation rate with increasing GMFCS level. These findings enhance a surgical team's ability to optimize counseling for families and patients with CP regarding the frequency and timing of additional hip surgery.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
