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Outcome and Femoral Head Deformity Following Hip Guided Growth in Children With Cerebral Palsy at Skeletal Maturity
Kevin Chun-Kai Chiu1,2, Chia-Che Lee3,4, Kuan-Wen Wu3,4
1Department of Medical Education, National Taiwan University.
Insights
Guided growth surgery for coxa valga in cerebral palsy (CP) improved hip alignment long-term. However, complications like screw migration and early physeal closure occurred, particularly in nonambulatory patients.
Area of Science:
- Pediatric Orthopedics
- Skeletal Dysplasias
- Cerebral Palsy Management
Background:
- Proximal femur guided growth is a minimally invasive technique for coxa valga in cerebral palsy (CP).
- Short-term outcomes are promising, but long-term data until skeletal maturity are limited due to physeal growth alteration.
Purpose of the Study:
- To evaluate the long-term radiographic outcomes and complications of proximal femur guided growth in children with spastic CP until skeletal maturity.
- To compare outcomes between ambulatory and nonambulatory patients and analyze factors influencing physeal closure and femoral head deformity.
Main Methods:
- Retrospective study of 29 children (53 hips) with spastic CP undergoing proximal femur guided growth (2012-2017).
- Radiographic parameters (HSA, HEA, AI, MP, α angle) were measured until physeal closure.
- Outcomes compared based on ambulatory status (GMFCS I-III vs. IV-V) and soft tissue release. Factors for early closure and deformity analyzed.
Main Results:
- Guided growth significantly improved radiographic parameters (P<0.001).
- Procedure failure occurred in 11.3% (more in GMFCS IV-V).
- Screw migration (epiphysis off screw) occurred in 53.2%, requiring reinsertion in 40.4% (higher in nonambulatory). Cumulative screw duration correlated with earlier closure and increased α angle.
Conclusions:
- Guided growth effectively improved hip alignment in CP, even in nonambulatory patients, though less so in severe dysplasia.
- Concerns include screw migration, reinsertion necessity, premature physeal closure, and potential femoral head deformity.
Background:
Guided growth of the proximal femur, a minimally invasive procedure for coxa valga, shows promising short-term outcomes in cerebral palsy (CP). However, as it alters physis growth, existing studies lack comprehensive long-term analysis until skeletal maturity.
Methods:
This retrospective study included children with spastic CP who underwent proximal femur-guided growth surgery between 2012 and 2017, followed until physeal closure. Radiographic measurements included head-shaft angle (HSA), Hilgenreiner-epiphyseal angle (HEA), acetabular index (AI), Reimer's migration percentage (MP), and α angle. Outcomes were compared between ambulatory/nonambulatory (GMFCS I-III/IV, V) and with/without soft tissue release. Factors associated with earlier physeal closure and femoral head deformity were analyzed.
Results:
Among 29 patients (53 hips) with guided growth studied at skeletal maturity, 4 patients (6 hips, 11.3%) experienced procedure failure and required varus osteotomy due to severe deformities. It was more common in GMFCS IV-V patients (27.3%, 3/11) than in GMFCS I-III (5.6%, 1/18). In the remaining 25 patients (47 hips), 7 hips (14.9%) received concomitant pelvic osteotomy with AI and MP evaluated separately. All radiographic parameters improved significantly ( P <0.001). Epiphysis grew off the screw in 25 hips (53.2%), requiring reinsertion in 19 (40.4%), with a higher rate in nonambulatory children (73.3% vs. 25%, P =0.002). Changes of the parameters showed no difference between ambulatory/nonambulatory (GMFCS I-III/IV, V) and with/without soft tissue release. The cumulative duration of screw crossing the physis was a key factor for earlier closure ( P <0.001) and correlated with increased α angle ( P =0.039).
Conclusion:
Guided growth successfully improved outcomes in both ambulatory and nonambulatory groups, although less effective in severe dysplasia. This minimally invasive procedure has some concerns, including the epiphysis growing off the screw, reinsertion need, earlier physeal closure, and femoral head deformity.
Level Of Evidence:
Level IV, therapeutic study.
