Fascia Iliaca Pain Block Results in Lower Overall Opioid Usage and Shorter Hospital Stays than Epidural Anesthesia After Hip Reconstruction in Children With Cerebral Palsy

This is a retrospective study of 51 consecutive hip reconstructions in children with cerebral palsy performed between 2011 and 2013. Tranexamic acid (TXA) was used in 14 hip reconstructions only. Transfusion rate was higher, postoperative Hb was lower, and patients stayed longer in the TXA group. This did not reach a statistical significance (P = 0.75, 0.5, and 0.71, resp.). More than half of the patients who had TXA underwent bilateral hip reconstructions in comparison with 27% only in the non-TXA group. Bilateral hip reconstructions mean more surgery, more blood loss, and more blood transfusion. The patients who had TXA were significantly more disabled as evident by the higher proportions of patient with worse GMFCS levels. Although we have not been able to demonstrate the value of TXA in reducing blood loss and transfusion rate in children with CP who underwent hip reconstruction, it is hoped that an interest in exploring the value of TXA in paediatric orthopaedic surgery is generated. Ideally this should be explored further in an adequately powered, randomised controlled trial where risk of bias is minimized.

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Bilateral hip reconstruction improve hip stability, pelvic balance and mobility function in children with cerebral palsy

Pediatric Dimensions ◽

10.15761/pd.1000146 ◽

2017 ◽

Vol 2 (2) ◽

Author(s):

Thamkunanon Verasak

Keyword(s):

Cerebral Palsy ◽

Hip Reconstruction ◽

Mobility Function ◽

Hip Stability ◽

Children With Cerebral Palsy

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Unilateral Hip Reconstruction in Children With Cerebral Palsy

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0b013e31827d0b73 ◽

2013 ◽

Vol 33 (2) ◽

pp. 175-181 ◽

Cited By ~ 18

Author(s):

Pinak Y. Shukla ◽

Sarabdeep Mann ◽

Stuart V. Braun ◽

Purushottam A. Gholve

Keyword(s):

Cerebral Palsy ◽

Hip Reconstruction ◽

Children With Cerebral Palsy

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Reconstruction surgery for dislocated hips in children with cerebral palsy

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-4-481-486 ◽

2021 ◽

Vol 27 (4) ◽

pp. 481-486

Author(s):

D.A. Popkov ◽

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G.M. Chibirov ◽

A.D. Tomov Tomov ◽

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...

Keyword(s):

Cerebral Palsy ◽

Hip Dislocation ◽

Holistic Approach ◽

Optimal Time ◽

Long Term Outcomes ◽

Hip Reconstruction ◽

Reconstruction Surgery ◽

Children With Cerebral Palsy ◽

Orthopaedic Society

Introduction The article is a literature review focusing on reconstruction surgery for dislocated hips in children with cerebral palsy (CP). Material and methods Publications in Scopus, PubMed, RSCI indexed journals over the past 20 years were reviewed for hip dislocation in children with CP. Results and discussion The article discusses the prevalence of the orthopaedic complication of cerebral palsy, pathogenesis, diagnosis, indications to surgery, choice of surgical technique, early rehabilitation and long-term outcomes. A report made for the first educational meeting of the European Pediatric Orthopaedic Society held in Russia at the Ilizarov Center in 2021 was used for the contribution. Conclusion Surgical treatment is indicated for hip dislocation in children with CP using holistic approach and principles of single-event multilevel surgery that suggest hip reconstruction, addressing contractures and deformities of the subjacent segments and creating conditions for postoperative postural management. Standardized indications, patient selection and optimal time for intervention are to be carefully considered for the procedure with the use of customized orthopaedic implants and techniques.

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Cerebral palsy with dislocated hip and scoliosis: what to deal with first?

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.190099 ◽

2020 ◽

Vol 14 (1) ◽

pp. 24-29 ◽

Cited By ~ 2

Author(s):

Ilkka J. Helenius ◽

Elke Viehweger ◽

Rene M. Castelein

Keyword(s):

Cerebral Palsy ◽

Early Identification ◽

Hip Dislocation ◽

Pelvic Obliquity ◽

Neuromuscular Scoliosis ◽

Function Score ◽

Hip Reconstruction ◽

Surveillance Programme ◽

Children With Cerebral Palsy ◽

Similar Programme

Purpose Hip dislocation and scoliosis are common in children with cerebral palsy (CP). Hip dislocation develops in 15% and 20% of children with CP, mainly between three and six years of age and especially in the spastic and dyskinetic subtypes. The risk of scoliosis increases with age and increasing disability as expressed by the Gross Motor Function Score. Methods A hip surveillance programme and early surgical treatment have been shown to reduce the hip dislocation, but it remains unclear if a similar programme could reduce the need for neuromuscular scoliosis. When hip dislocation and neuromuscular scoliosis are co-existent, there appears to be no clear guidelines as to which of these deformities should be addressed first: hip or spine. Results Hip dislocation or windswept deformity may cause pelvic obliquity and initiate scoliosis, while neuromuscular scoliosis itself leads to pelvic obliquity and may increase the risk of hip dislocation especially on the high side. It remains unclear if treating imminent hip dislocation can prevent development of scoliosis and vice versa, but they may present at the same time for surgery. Current expert opinion suggests that when hip dislocation and scoliosis present at the same time, scoliosis associated pelvic obliquity should be corrected before hip reconstruction. If the patient is not presenting with pelvic obliquity the more symptomatic condition should be addressed first. Conclusion Early identification of hip displacement and neuromuscular scoliosis appears to be important for better surgical outcomes.

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