Intraoperative Hip Arthrography to Guide Decision-Making in Cerebral Palsy Hip Reconstruction

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Cerebral Palsy Management

Background:

• Hip reconstruction surgery is vital for nonambulatory children with cerebral palsy (CP).
• The decision for concomitant pelvic osteotomy (PO) with proximal femoral varus derotational osteotomy (VDRO) is often subjective.
• Intraoperative hip arthrography (IHA) may refine decision-making for PO during hip reconstruction in CP.

Purpose of the Study:

• To evaluate if intraoperative hip arthrography (IHA) can reduce the need for pelvic osteotomy (PO) during hip reconstruction in children with cerebral palsy (CP).
• To assess if using IHA affects midterm outcomes and failure rates after hip reconstruction in CP patients.
• To determine the capability of IHA in guiding intraoperative decisions for hip reconstruction in children with CP.

Main Methods:

• Retrospective analysis of 154 children with CP (204 hips) undergoing hip reconstruction.
• Comparison between patients who had IHA during surgery (2016-2024) and those who did not (NIHA: 2011-2016).
• IHA guided PO decisions based on labrum orientation and dye pooling; outcomes analyzed using GEE and PSM.

Main Results:

• IHA significantly reduced PO rates from 82% to 48% (P=0.001).
• Upsloping labrums and medial dye pooling on IHA correlated with PO, while downsloping labrums indicated VDRO alone.
• Failure rates at a median of 6 years were similar between IHA and NIHA groups (6.3% vs. 8.7%, P=0.59) and between PO and VDRO alone groups (6.9% vs. 8.0%, P=0.81).

Conclusions:

• Intraoperative hip arthrography (IHA) effectively reduces pelvic osteotomy (PO) use in CP hip reconstruction without compromising midterm outcomes.
• Failure rates in hip reconstruction for CP were not associated with IHA use or concomitant PO.
• Other factors like hypertonia and spinal deformity may be more significant contributors to hip instability and failure in CP.