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Adductor Tenotomy to Treat Progressive Hip Migration in Children With Cerebral Palsy: Identifying Predictors of
Merel C R Roelen1, Renée A van Stralen1,2, Melinda M E H Witbreuk3
1Erasmus MC Sophia Children's Hospital, Rotterdam.
Insights
Adductor tenotomies for hip migration in cerebral palsy (CP) had a 51.4% success rate. High preoperative hip migration and omitting psoas release predicted failure, suggesting routine psoas release improves outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Cerebral Palsy Research
Background:
- Cerebral palsy (CP) frequently leads to progressive hip migration in children.
- This migration causes pain and diminishes quality of life.
- Adductor tenotomies are a common surgical intervention to prevent hip migration progression.
Purpose of the Study:
- To evaluate the success rates of adductor tenotomies in treating hip migration in children with CP.
- To identify complications associated with the procedure.
- To determine predictors of surgical failure.
Main Methods:
- Retrospective multicenter cohort study involving 109 hips in 5 Dutch CP centers (2010-2020).
- Included children aged 1-12 years with CP undergoing adductor tenotomies, with or without psoas release.
- Primary outcome: treatment success at 4 years (no re-operation or migration percentage <50%).
Main Results:
- Overall success rate was 51.4%.
- Predictors of failure included higher preoperative migration percentage (MP) and absence of psoas release.
- Hips with preoperative MP >50% had a 75.9% failure rate; success was noted with MP <30%.
Conclusions:
- Adductor tenotomies alone have a limited success rate (51.4%) for hip migration in CP.
- High preoperative MP predicts poor outcomes; avoid surgery if MP >50%.
- Routine psoas release alongside adductor tenotomies may enhance surgical success.
Background:
Cerebral palsy (CP) often causes progressive hip migration in severely affected children, leading to pain and reduced quality of life. Adductor tenotomies are commonly performed to prevent progressive hip migration. This study evaluated success rates, complications, and predictors of failure after adductor tenotomies in 5 national CP centers in the Netherlands.
Methods:
We conducted a retrospective multicenter cohort study of children with CP aged 1 to 12 years who underwent adductor tenotomies, with or without psoas releases, between 2010 and 2020. Patients with prior hip surgery, non-CP diagnoses, or insufficient follow-up (<4 y) were excluded. The primary outcome was treatment success at 4 years of follow-up, defined as the absence of secondary surgery for hip migration or a migration percentage below 50%. Secondary outcomes included predictors of failure, complications, and timing of secondary surgery. Kaplan-Meier survival curves and generalized estimating equation logistic regression were used to evaluate outcomes.
Results:
A total of 109 hips (55 children) were included. Overall, the success rate was 51.4%. The median time to failure was 2.0 years (IQR: 1.3 to 3.3). Preoperative migration percentage (MP) [odds ratio (OR)=1.1, 95% CI: 1.1-1.2] and not performing a psoas release (OR=7.3, 95% CI: 1.8-30.0) were the strongest independent predictors for failure. No failures occurred when the preoperative MP was <30%, although most of these cases were bilateral procedures with a more severely affected contralateral hip. In contrast, hips with a preoperative MP >50% had a 75.9% failure rate, with a median time to failure of 1.4 years (IQR: 0.9 to 2.6). Without a psoas release, the odds of failure increase significantly. The complication rate was 3.7% in this cohort.
Conclusions:
The success rate of adductor tenotomies in the treatment of hip migration was 51.4%. Higher preoperative MP strongly predicted a poorer outcome, and this procedure, as the solitary surgical procedure to manage hip migration, should be avoided when the preoperative MP exceeds 50%. Performing routine psoas release with the adductor tenotomies appears to improve surgical outcomes.
Level Of Evidence:
Level IV.