Effect of Weight-Bearing in Abduction and Extension on Hip Stability in Children With Cerebral Palsy

Purpose This study addresses whether an additional pelvic procedure is superior to a varus derotation osteotomy femur (VDRO) alone in unstable hips in children with cerebral palsy (CP). Methods All patients had unstable hips utilising the Melbourne Cerebral Palsy Hip Classification System (MCPHCS). We compared one group that underwent VDRO alone with one that had a combination of VDRO and Dega osteotomy (VDRO+). Measurements were taken before surgery, postoperatively, two years after surgery and at latest follow-up. Generalised estimating equations were used to account for known and unknown correlations between hips from bilateral cases. Results In total, 74 hips in 57 children fulfilled the inclusion criteria. There was no outcome difference between Gross Motor Function Classification System levels III, IV and V. Age at time of operation ranged from three to 16 years (mean 9.8 years). Mean follow-up was 49.1 months. In the VDRO group (28 hips) migration percentage (MP) changed from 61% preoperative to a final value of 35.7%. In the VDRO+ group (46 hips) the MP changed from 64.4% to 19.3%. At final follow-up 15 hips (54%) were stable in the VDRO group, 37 hips (83%) in the VDRO+ group. The odds ratio (OR) of hip stability at final follow-up was 3.5-times higher in the VDRO+ group versus the VDRO group (OR = 3.9; 95% confidence interval = 1.5 to 9.7; p = 0.004). Conclusion Reconstruction of unstable hips via VDRO + Dega in children with CP provides a higher likelihood of long-term stability than an isolated VDRO. Level of Evidence Level III, retrospective comparative study

Download Full-text

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

Download Full-text

Combined pelvic and femoral reconstruction in children with cerebral palsy

Journal of International Medical Research ◽

10.1177/0300060517723797 ◽

2017 ◽

Vol 46 (1) ◽

pp. 475-484 ◽

Cited By ~ 3

Author(s):

Nabil Alassaf ◽

Neil Saran ◽

Theirry Benaroch ◽

Reggie Cherine Hamdy

Keyword(s):

Cerebral Palsy ◽

Migration Index ◽

Radiographic Outcomes ◽

Hip Stability ◽

Derotational Osteotomy ◽

Children With Cerebral Palsy ◽

Cohort Study Design ◽

The Mean ◽

Femoral Reconstruction

Objective The primary aim of this study was to determine the effect of age, femoral head migration, and ambulatory status on radiographic outcomes after combined pelvic and femoral reconstruction in children with cerebral palsy. The secondary aim was to evaluate the fate of the opposite hip after unilateral reconstruction. Methods A retrospective cohort study design of consecutive patients from 1995–2009 was used. The records were screened for patients who underwent varus derotational osteotomy and modified Dega osteotomy. Results Eighty-five hips in 71 patients were included. The mean age was 8.4 ± 3.2 years and the mean follow-up was 6.6 ± 3.1 years. The final measures were a mean migration index of 20% ± 15.58%, centre edge angle of 28.45° ± 15.98°, and Sharp’s angle of 40.75° ± 8.5°. Those values were not correlated with age and the initial migration index. Nonambulatory status did not negatively affect hip stability. Final measurements of the contralateral hips were similar to the reconstructed hips, and the cumulative incidence for later reconstruction was 5.67%. Conclusions Regardless of age, preoperative displacement, and ambulation, the combined procedure provides durable radiographic improvement. In unilateral cases, there is a low risk of later deterioration of the opposite side.

Download Full-text