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Palliative hip surgery in nonambulatory children with cerebral palsy: outcomes of two surgical techniques
Veronica Lodovici1, Giorgio Marrè Brunenghi2, Lorenza Marengo2
1Orthopedic and Trauma Surgery Department, University of Pisa, Pisa.
Insights
Palliative hip surgery in nonambulatory children with cerebral palsy effectively reduces pain and improves quality of life. Both Egermann and Girdlestone resection techniques offer viable options, with individualized selection based on patient needs.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Cerebral Palsy Research
Background:
- Palliative hip surgery (PHS) is utilized for nonambulatory children with cerebral palsy (CP).
- Evaluating outcomes of different PHS techniques is crucial for optimizing patient care.
Purpose of the Study:
- To compare clinical, radiographic, and caregiver-reported outcomes of Egermann resection versus Girdlestone resection in nonambulatory CP patients.
- To assess proximal femoral migration (PFM), pain, quality of life, and complications associated with each PHS technique.
Main Methods:
- Retrospective cohort study of 30 Gross Motor Function Classification System (GMFCS) V children (41 hips).
- Analysis of radiographic PFM, caregiver-reported CP Quality of Life Questionnaire for Children (CP QOL-Child), visual analog scale for pain, and Clavien-Dindo-Sink (CDS) complications.
- Follow-up at immediate post-op, 6-12 months, and final assessment.
Main Results:
- Both PHS techniques provided satisfactory pain relief and improved caregiver-reported quality of life.
- No significant difference in PFM between Egermann and Girdlestone resections at final follow-up.
- Girdlestone resection showed fewer painful heterotopic ossifications requiring revision; overall complication rate was 32%.
Conclusions:
- PHS is an effective palliative intervention for GMFCS V children with CP, offering pain relief and improved quality of life.
- Both Egermann and Girdlestone resections are viable palliative options with distinct complication profiles.
- Individualized surgical decision-making is recommended based on patient anatomy and functional requirements.
Abstract:
This study evaluates the clinical, radiographic, and caregiver-reported outcomes of two palliative hip surgery (PHS) techniques - Egermann resection and Girdlestone resection - in nonambulatory children with cerebral palsy. A retrospective cohort of 30 Gross Motor Function Classification System (GMFCS) V children (41 hips) who underwent PHS between 2014 and 2025 at two tertiary referral centers was reviewed. Proximal femoral migration (PFM) was assessed on anteroposterior pelvic radiographs obtained immediately after surgery, at 6-12 months, and at final follow-up. Clinical outcomes were evaluated using the caregiver-reported Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL-Child), and pain using a visual analog scale. Postoperative complications were recorded and classified according to the Clavien-Dindo-Sink (CDS) system. Both surgical techniques were associated with satisfactory pain relief and caregiver-reported quality of life. At final follow-up, PFM did not reach a statistically significant difference between the two groups (3 ± 20 mm vs 14 ± 18 mm; P > 0.05). Technique 2 was associated with fewer painful heterotopic ossifications requiring surgical revision. The overall complication rate was 32% of hips (13/41), with CDS III complications requiring reintervention in 12% of hips (5/41). Caregiver-reported CP QOL-Child scores were comparable between groups. PHS provides effective pain relief and satisfactory caregiver-reported quality of life in GMFCS V children. Both techniques represent viable palliative options, with distinct profiles of PFM and soft tissue-related complications. Surgical decision-making should be individualized according to patient anatomy and anticipated functional needs.