Timely Surgical Intervention Leads to Better Sustained Coverage after Reconstructive Hip Surgery in Patients with Cerebral Palsy

Abstract

Background: In up to 45–90% of non-ambulatory patients with cerebral palsy (CP), progressive hip migration can be observed. The goal of this study was to determine whether the implementation of a national hip surveillance guideline affected the outcome of hip reconstructions. Methods: We reviewed 48 primary hip reconstructions at a median follow-up of 4.4 years. Surgical outcome was evaluated based on complication rates and radiographic evaluation postoperatively and at follow-up. Radiographic measurements included the migration percentage (MP), head–shaft angle and acetabular index. The impact of preoperative MP, postoperative MP, tone management, Gross Motor Function Classification System (GMFCS) classification and age on MP at follow-up were examined using a mixed model analysis. Results: A decrease in preoperative MP was noted, from a median of 75.0% (2014) to 39.0% (2020). Lower preoperative MP showed a significant correlation to lower MP postoperatively (p = 0.012). Postoperative MP was a significant independent predictor of a lower MP at follow-up (p = 0.002). Conclusions: This study shows an improvement in the timing of hip reconstruction in patients with CP after implementation of the hip surveillance guideline. A reduction in preoperative MP resulted in improved postoperative outcomes. A lower postoperative MP was the most important predictor for sustained containment of the hip.

Keywords

• hip surveillance
• cerebral palsy
• orthopedic surgery