Hip Reconstruction in Children with Cerebral Palsy: Comparing Treatment Plans Derived from Pelvic Radiographs Versus...

Background/Objectives: Hip displacement is a common problem in children with cerebral palsy (CP). Typically, the recommended hip surveillance imaging for these children consists of an anteroposterior pelvic radiograph, from which we calculate the migration percentage (MP) to determine treatment plans (conservative/preventive therapy, femoral osteotomy, femoral and pelvic osteotomies, and salvage surgery). However, little is known about the accuracy of MP for treatment planning. We aim to compare treatment plans based on MP thresholds with plans determined by an orthopedic surgeon following review of the hip CTs. Methods: We retrospectively identified hip CTs performed in children who were ≤18 years old with CP (11/2018-07/2024). The inclusion criteria were: (1) a pelvic radiograph performed 6 months prior to the hip CT; and (2) no surgeries between the pelvic radiograph and the hip CT. These hip CTs were randomized and blindly reviewed by an orthopedic surgeon to determine each child's treatment plan (CT-treatment). Separately, a pediatric radiologist blindly reviewed the randomized pelvic radiographs and measured each hip's MP to determine each child's treatment plan (XR-treatment). We used kappa-agreement and Bland-Altman analyses to compare XR- and CT-treatments. Results: Our study cohort consisted of 139 children (mean age = 9.3 ± 3.8 years; male = 90) with 278 hips. The proportion of agreement and unweighted kappa between XR- and CT-treatment were both low: 0.532 (148/278) and 0.339, respectively. Bland-Altman analyses showed that XR-treatment and CT-treatment were exchangeable when MP ≤ 10% but were not exchangeable otherwise. Conclusions: We should be cautious about relying exclusively on pelvic radiographs and subsequent MP calculation in making treatment decisions for hip displacement in children with CP since many anatomic details become evident on 3D imaging.