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The hip in children with cerebral palsy. Predicting the outcome of soft tissue surgery
M S Cornell1, N C Hatrick, R Boyd
1Department of Orthopaedics, Guy's Hospital, London, England.
Insights
In children with cerebral palsy, adductor tenotomy effectively reduced hip dislocation. Preoperative hip migration percentage significantly predicted surgical success, while age and surgical approach did not.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Cerebral Palsy Research
Background:
- Cerebral palsy (CP) often leads to hip dysplasia and subluxation.
- Adductor muscle spasticity is a common contributor to hip instability in children with CP.
- Surgical interventions aim to improve hip joint stability and prevent dislocation.
Purpose of the Study:
- To evaluate the effectiveness of adductor tenotomy, alone or with anterior obturator neurectomy, for hip instability in children with cerebral palsy.
- To identify predictors of surgical success in this patient population.
Main Methods:
- Retrospective review of 56 hips in 37 children with cerebral palsy.
- Procedures included adductor tenotomy alone or combined with anterior obturator neurectomy.
- Outcomes assessed based on hip reduction, subluxation, dislocation, and acetabular index, with a mean follow-up of 5.3 years.
Main Results:
- Hips with preoperative migration percentage <40% had an 83% success rate for reduction.
- Hips with preoperative migration percentage ≥40% showed a 77% rate of subluxation or dislocation.
- Surgery was unsuccessful in 13 of 15 hips with an acetabular index >27 degrees.
- Percutaneous adductor tenotomy was as effective as open procedures with neurectomy.
- Age at surgery did not significantly impact outcomes.
Conclusions:
- Preoperative hip migration percentage is the primary predictor of surgical success for hip instability in children with cerebral palsy.
- Adductor tenotomy is an effective surgical option, with percutaneous technique showing comparable results to open procedures.
- Early intervention for hips with migration percentage <40% may improve outcomes.
Abstract:
This study reviewed 56 hips in 37 children with cerebral palsy who had undergone an adductor tenotomy alone or in combination with an anterior obturator neurectomy. The mean review period was 5.3 years. At latest review, 25 of 30 (83%) hips with a preoperative migration percentage of less than 40% were reduced, but 20 of 26 (77%) hips with a preoperative migration percentage of 40% or more were subluxated or dislocated. Surgery was unsuccessful for 13 of 15 hips with an acetabular index of more than 27 degrees. Percutaneous adductor tenotomy alone was as effective as the combination of an open procedure with an anterior obturator neurectomy. The age at the time of surgery did not have a significant effect on the outcome. The preoperative migration percentage was the only significant predictor of outcome in this group of children.