Bilateral hip reconstruction improve hip stability, pelvic balance and mobility function 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

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The Value of Tranexamic Acid in Reducing Blood Loss following Hip Reconstruction in Children with Cerebral Palsy

Journal of Blood Transfusion ◽

10.1155/2015/827027 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

I. Majid ◽

S. Alshryda ◽

B. Somanchi ◽

E. Morakis ◽

A. Foster

Keyword(s):

Cerebral Palsy ◽

Blood Loss ◽

Tranexamic Acid ◽

Controlled Trial ◽

Statistical Significance ◽

Transfusion Rate ◽

Hip Reconstruction ◽

Children With Cerebral Palsy ◽

Paediatric Orthopaedic ◽

Randomised Controlled

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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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.

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

Pediatric Physical Therapy ◽

10.1097/pep.0b013e31821933da ◽

2011 ◽

Vol 23 (2) ◽

pp. 158 ◽

Cited By ~ 1

Author(s):

Claudia Senesac ◽

Jenna Lammers ◽

Cathy Algood

Keyword(s):

Cerebral Palsy ◽

Weight Bearing ◽

Hip Stability ◽

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 ◽

◽

G.M. Chibirov ◽

A.D. Tomov Tomov ◽

◽

...

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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