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Risk Factors for Avascular Necrosis in Children With Cerebral Palsy Following Varus Derotation Osteotomy
Sam P Wimmer1, Tishya A L Wren1,2, Robert M Kay1,2
1Children's Orthopaedic Center, Children's Hospital Los Angeles.
Journal of Pediatric Orthopedics
|July 14, 2025
Summary
Pelvic osteotomy (PO) is a significant risk factor for avascular necrosis (AVN) after varus derotation osteotomy (VDRO) in children with cerebral palsy (CP). Surgeons should consider this risk when performing VDRO, prioritizing hip sphericity for better outcomes.
Area of Science:
- Pediatric Orthopedics
- Cerebral Palsy Research
- Surgical Complications
Background:
- Varus derotation osteotomy (VDRO) is standard for displaced hips in children with cerebral palsy (CP).
- Avascular necrosis (AVN) is a concerning postoperative complication following VDRO, impacting patient outcomes.
- Existing data on AVN incidence and risk factors after VDRO is limited.
Purpose of the Study:
- To determine the incidence of AVN in a large cohort of children with CP undergoing VDRO.
- To identify patient-specific and surgical risk factors associated with AVN development post-VDRO.
Main Methods:
- Retrospective analysis of 316 children with CP undergoing 593 VDRO procedures.
- Inclusion criteria: hip subluxation or dislocation; data collected on patient demographics, GMFCS level, and surgical details.
- Statistical analysis included Fisher exact test and univariate/multivariate logistic regressions to identify risk factors.
Main Results:
- The overall incidence of AVN was 1.7% (10 of 593 hips).
- Univariate analysis identified Reimers MP, bilateral surgery, and pelvic osteotomy (PO) as significant risk factors.
- Multivariate analysis revealed PO as the sole significant risk factor for AVN (P<0.01).
Conclusions:
- Pelvic osteotomy (PO) is a significant risk factor for AVN after VDRO in children with CP.
- While overall AVN incidence is low, the elevated risk associated with PO warrants careful surgical consideration.
- Focusing on sphericity preservation, alongside AVN risk assessment, is crucial for optimal long-term hip health in this population.
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