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Reconstructive hip surgery short-term outcomes and redislocation rate in non-ambulatory children with spastic
Ahmed S Nagy1, Mazen S Aboulesaad2, Ahmed M Saied2
1Department of Orthopaedic Surgery, Mansoura University Hospitals, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt. ahmednagt745@mans.edu.eg.
Insights
Reconstructive hip surgery significantly improved hip stability and quality of life in non-ambulatory children with spastic cerebral palsy. Combining VDRO with Dega pelvic osteotomy showed lower redislocation rates compared to VDRO alone.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Cerebral palsy research
Background:
- Hip displacement is a significant issue causing pain and reduced quality of life in non-ambulatory children with spastic cerebral palsy.
- Reconstructive hip surgery aims to improve hip stability, comfort, and care.
- This study evaluates outcomes of hip surgery in this population.
Purpose of the Study:
- To evaluate short-term radiographic and caregiver-reported outcomes after reconstructive hip surgery.
- To compare outcomes of varus derotational osteotomy (VDRO) alone versus VDRO with Dega pelvic osteotomy.
- To determine the 12-month redislocation rate.
Main Methods:
- Prospective cohort study of 40 non-ambulatory children with spastic cerebral palsy (50 hips).
- Procedures included VDRO alone or VDRO with Dega pelvic osteotomy based on preoperative findings.
- Measured migration percentage, acetabular index, redislocation rate, and caregiver-reported quality of life (CPCHILD) over 12 months.
Main Results:
- Significant improvements in migration percentage and acetabular index at 12 months (p < 0.001).
- VDRO + Dega group showed lower 12-month redislocation rates (5.4%) compared to VDRO alone (46.2%).
- Caregiver-reported quality of life (CPCHILD scores) improved significantly in both groups.
Conclusions:
- Reconstructive hip surgery improves short-term radiographic and caregiver-reported outcomes in non-ambulatory children with spastic cerebral palsy.
- VDRO combined with Dega pelvic osteotomy demonstrated a lower redislocation rate at 12 months.
- Limitations include non-randomized design and short follow-up, limiting comparative inference.
Background:
Hip displacement is a major cause of pain and reduced quality of life in non-ambulatory children with spastic cerebral palsy. Reconstructive hip surgery aims to restore stable femoral head containment, improve comfort, and facilitate daily care. This study evaluated short-term radiographic and caregiver-reported outcomes after reconstructive hip surgery in non-ambulatory children with spastic cerebral palsy, including exploratory subgroup analyses of varus derotational osteotomy (VDRO) alone and VDRO combined with Dega pelvic osteotomy, and the 12-month redislocation rate.
Methods:
This prospective cohort study included 40 non-ambulatory children with spastic cerebral palsy (50 hips; mean age 6.54 ± 1.07 years). Procedure selection was based on preoperative radiographic findings and intraoperative hip stability. Thirteen hips underwent VDRO alone, and 37 hips underwent VDRO combined with Dega pelvic osteotomy for acetabular dysplasia (acetabular index > 25°) or intraoperative posterolateral instability. Primary aim was to measure migration percentage and acetabular index preoperatively and during 12-months follow-up. Secondary aim was to assess 12-month redislocation rate and caregiver-reported quality of life using the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire at baseline and 12 months. Analyses used generalized estimating equation models (GEE) to account for bilateral hips and repeated measures.
Results:
In the overall cohort, migration percentage improved from 88.12 to 20.64 and acetabular index from 30.65 to 25.01 at 12 months (both p < 0.001). In exploratory subgroup analyses, 12-month migration percentage decreased from 70.83 to 33.15 after VDRO alone and from 93.94 to 15.99 after VDRO + Dega. Redislocation occurred in 8 of 50 hips (16.0%) overall, including 46.2% after VDRO alone and 5.4% after VDRO + Dega. CPCHILD total scores improved significantly in both groups, with no significant between-group difference in change.
Conclusions:
Reconstructive hip surgery was associated with short-term radiographic improvement and improved caregiver-reported outcomes in this cohort of non-ambulatory children with spastic cerebral palsy. Although 12-month redislocation was lower after VDRO + Dega, the non-randomized design, baseline imbalance, and short follow-up limit comparative inference.
