Related Experiment Video
Updated: Sep 18, 2025
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Guarded Outcomes After Hip Hemiarthroplasty in Patients with Cerebral Palsy: Highlighting a Personalized Medicine
Ahmed Nageeb Mahmoud1,2, Nicholas R Brule1, Juan D Bernate1
1Geisinger Musculoskeletal Institute, Geisinger Medical Center, Danville, PA 17822, USA.
Insights
Hip hemiarthroplasty for femoral neck fractures in cerebral palsy (CP) patients shows guarded outcomes. All patients developed heterotopic ossification, necessitating a precision medicine approach for management and prophylaxis.
Area of Science:
- Orthopedic Surgery
- Rehabilitation Medicine
- Precision Medicine
Background:
- Femoral neck fractures in individuals with cerebral palsy (CP) are uncommon, with limited data on hip hemiarthroplasty effectiveness.
- CP presents complex neuromuscular challenges impacting surgical outcomes and recovery.
Purpose of the Study:
- To document outcomes and complications of hip hemiarthroplasty for femoral neck fractures in CP patients.
- To explore the role of precision medicine in managing this specific patient population.
Main Methods:
- Retrospective review of six male CP patients undergoing hip hemiarthroplasty for displaced femoral neck fractures.
- Analysis of clinical and radiographic outcomes, including complications and long-term follow-up.
Main Results:
- All patients (100%) developed significant heterotopic ossification (HO) post-surgery.
- One patient experienced dislocation and femoral stem loosening; another developed acetabular protrusion, impacting mobility.
- Four patients deceased at a mean of 86.5 months post-surgery.
Conclusions:
- Hip hemiarthroplasty outcomes in CP patients are guarded, with a high incidence of HO.
- A precision medicine framework, including HO prophylaxis and personalized risk assessment, is recommended.
- Informed patient/caregiver expectations regarding outcomes and risks are crucial.
Abstract:
Background: The effectiveness of hip hemiarthroplasty in managing femoral neck fractures in individuals with cerebral palsy has seldom been reported. Objectives: Given the complex neuromuscular issues associated with cerebral palsy (CP), this retrospective study aims to document the outcomes and characterize the complications of hip hemiarthroplasty for fractures of the femoral neck in a series of patients with CP, emphasizing the role of precision medicine in management. Methods: Six cases of hip hemiarthroplasty in six male patients with cerebral palsy and displaced femoral neck fractures have been reviewed in this study. The patients' mean age at the time of surgery was 55.6 ± 14.1 years (range, 33-71). All the patients were independent indoor ambulators before their femoral neck fracture and had various medical comorbidities. Five patients had intellectual disabilities. Results: The mean clinical and radiographic follow-ups for the patients included in this series were 91.5 and 71.3 months, respectively. All the patients developed significant heterotopic ossification (HO) around the operated hip, which was observed as early as the second week postoperatively on radiographs. HO progressed throughout the follow-up for all the patients. One patient had an early postoperative dislocation with femoral stem loosening, which was managed by implant revision. Another patient had an acetabular protrusion, leading to the loss of their weight-bearing ability and mobility due to pain. Four patients were deceased at a mean of 86.5 months after the index surgery. Conclusions: After considering the preliminary evidence provided with this small case series, this study suggests the overall guarded outcomes of hip hemiarthroplasty in patients with CP. Given the 100% rate of heterotopic ossification, a precision medicine framework with consideration for HO prophylaxis may be recommended after hip hemiarthroplasty in patients with CP. It may also be reasonable to scrutinize a personalized risk assessment approach in this patient subset regarding decision making, surgical approach, and rehabilitation program. The clinical outcomes and the risks of complications following hemiarthroplasty should be sensibly presented to patients with cerebral palsy and their caregivers to achieve reasonable postoperative expectations.
