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Satisfactory long-term functional and radiological outcomes following hip reconstructive surgery in children with
Kathleen Montpetit1, Souad Rhalmi1, Mathieu Lalumiere1
1Shriners Hospitals for Children - Canada, Montreal, Canada.
Insights
Hip reconstructive surgery significantly improved long-term function and radiological outcomes for children with cerebral palsy (CP). Caregivers reported satisfaction with improved health, function, and reduced pain, enhancing overall quality of life.
Area of Science:
- Pediatric Orthopedics
- Rehabilitative Medicine
- Biomedical Engineering
Background:
- Cerebral palsy (CP) often involves hip instability, leading to pain and functional limitations.
- Hip reconstructive surgery aims to improve joint stability, function, and quality of life in children with CP.
Purpose of the Study:
- To evaluate long-term functional and radiological outcomes of hip reconstructive surgery in children with CP.
- To assess parents' perception of change and overall satisfaction following the surgery.
Main Methods:
- Retrospective review of medical charts for 44 children (60 hips) with CP (GMFCS I-V) aged 2-18 years.
- Surgical procedures performed between 1993 and 2014 by a single surgeon.
- Long-term follow-up included clinical evaluation, patient-reported outcomes (Care and Comfort Questionnaire, Lower Extremity Parent-Rated Change Form), and radiological assessments (pelvic radiographs).
Main Results:
- 74-79% of caregivers reported no post-operative pain or discomfort.
- 58-76% of caregivers noted improvements in overall health, leg function, activity level, and pain.
- Radiological outcomes showed significant improvements: 36.7% increase in migration percentage, 62.2% increase in hip location, 46.7% improvement in acetabular coverage, and 66.7% improvement in Shenton's line integrity (p < 0.001).
Conclusions:
- Hip reconstructive surgery leads to significant long-term improvements in functional and radiological outcomes for children with CP.
- The surgery positively impacts quality of life, with high caregiver satisfaction regarding perceived changes.
- Assessing pain, function, and satisfaction is crucial for understanding the impact of hip reconstructive surgery on daily life.
Abstract:
PurposeThis study aimed to evaluate long-term functional and radiological outcomes as well as parents' perception of change and overall satisfaction following hip reconstructive surgery in children with cerebral palsy (CP).MethodsMedical charts of children between three and 18 years of age with CP who had surgery between 1993 and 2014 by the same surgeon were reviewed. The study sample consisted of 44 children (Gross Motor Function Classification System levels I-V) aged 2-18 years representing 60 hips. Mean follow-up was 8.4 years [1.8-17.5]. A final follow-up evaluation was held to obtain post-operative anteroposterior pelvic radiographs and administer patient-reported outcomes to the caregivers.ResultsCare and Comfort Hypertonicity Questionnaire scores showed that 74-79% of caregivers reported no difficulty post-surgery in terms of child's pain or discomfort during position changes, when participating in general activities, or during sleep. The Lower Extremity Parent-Rated Change Form showed that 58-76% of caregivers reported a better status in their child's overall health, leg function, activity level, and pain post-surgery. Seventy-six percent of the caregivers indicated satisfaction with the overall changes since the surgery. For the 45 hips with both pre-operative and follow-up radiological outcomes, migration percentage improved significantly (p < 0.001) by 36.7%, and there was a 62.2% increase in the number of hips that were located post-operatively compared to pre-operatively. Acetabular coverage improved significantly (p < 0.001) from non-covered to covered in 46.7% of the hips and Shenton's line improved significantly (p < 0.001) from non-intact to intact in 66.7% of the hips.ConclusionHip reconstructive surgery improved long-term functional and radiological outcomes, as well as quality of life for children and caregivers, while changes were perceived as satisfactory to the families. Evaluating pain, function, and satisfaction is important to measure the impact of hip reconstructive surgery on daily life.
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