A balanced approach for stable hips in children with cerebral palsy: A combination of moderate VDRO and pelvic osteotomy

Reidy, Kerstin; Heidt, Christoph; Dierauer, Stefan; Huber, H.

doi:10.1007/s11832-016-0753-5

Cited by 11 publications

(11 citation statements)

References 35 publications

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“…Recently, in a study of 57 hips reconstructed with femoral and pelvic osteotomies, Reidy et al. 35 did not find a difference in the final MI between walkers and non-walkers. In the present study, nonambulatory status was not associated with poor radiographic results.…”

Section: Discussionmentioning

confidence: 94%

Combined pelvic and femoral reconstruction in children with cerebral palsy

et al. 2017

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ObjectiveThe 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.MethodsA 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.ResultsEighty-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%.ConclusionsRegardless 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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Section: Discussionmentioning

confidence: 94%

Combined pelvic and femoral reconstruction in children with cerebral palsy

et al. 2017

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“…Also, patients presenting with GMFCS IV or V are known to be associated with the highest rate of hip dislocation [ 29 ]. The outcomes of current hip reconstructive surgeries are hypothesized to be favorable in patients with GMFCS IV or V, especially if these surgeries are carried out in this patient population early during the disease course (early recognition) and not only be considered when patients present with pain [ 30 ]. That being said, it is of great importance to mention that this was not applicable in our patient population because CP patients did not undergo initial surveillance prior to hip surgery, and therefore, the outcomes of the only two surgical procedures (FHR and FCP) conducted at our institution were reported in this manuscript, and that is also why we could not compare between reconstructive and palliative surgery.…”

Section: Discussionmentioning

confidence: 99%

Radiological Outcomes of Femoral Head Resection in Patients with Cerebral Palsy: A Retrospective Comparative Study of Two Surgical Procedures

Horsch¹,

Hahne²,

Ghandour³

et al. 2021

Children

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Background: We conducted this study to compare postoperative radiological outcomes of two surgical procedures (femoral head resection (FHR) and femoral head cap plastic surgery (FCP)) in patients with CP and hip dislocation. Methods: CP patients with Gross Motor Function Classification Score (GMFCS) IV or V, who underwent either FHR or FCP between 2007 and 2018 at Heidelberg University Hospital in Germany, were included. Most participants underwent postoperative traction in an attempt to prevent telescoping. Besides the above-mentioned objectives, we examined the association between telescoping and spasmolytic use, traction weight, and traction duration. Results: Thirty-eight CP patients were included, of whom 15 (25 hips) underwent FHR and 23 (30 hips) underwent FCP. Heterotopic ossification (grades I, II, and III) occurred in 80% and 83.3% of patients in the FHR and FCP groups, respectively. Telescoping occurred in 18.68 and 31.99% of patients in the FHR and FCP groups, respectively (p = 0.999). Other complications were similar between both groups. Conclusions: The postoperative outcomes of FHR and FCP are similar in terms of telescoping, heterotopic ossification, and complications. Although telescoping was encountered more in the FCP group, no significant difference from the FHR group was found. We noted that the weight of traction could reduce the development of telescoping.

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“…Jozwiak et al reported adequate correction of radiological parameters in 25 CP patients (30 hip joints) with changes in the AI from 22° до 23°, MP from 11 % to 23 % and Wiberg angle from 16° to 23° at a long term [18]. Reidy K. et al also reported on changes in MP from preoperative 63.6 % to postoperative 2.7 % at a short term, and to 9.7 % at a longer term [20].…”

Section: Original Articlementioning

confidence: 98%

“…CP children need to continue with follow up to monitor the development and growth of the hip joint after hip reconstruction. Several radiographic measurements have been reported, but the most widely used are Reimer's migration index, centeredge (CE) angle of Wiberg and the acetabular index (AI) with the mean yearly increase in the values [10,[18][19][20]. In the unfavorable scenario, the recurrence of hip displacement or dislocation after reconstructive surgery can range between 5.6 to 25.7 % [18,[21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Roentgenoanatomy of the hip joint following reconstructive intervention in children with spastic cerebral palsy

Tomov¹,

Traumatology²,

Teplenky³

et al. 2020

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Objective Explore changes in roentgenoanatomical parameters of the pediatric hip joint following multilevel reconstructive surgeries performed for CP patients in combination with derotation varus osteotomy (DVO) alone or DVO and acetabuloplasty (AP). Material and methods The study included 49 children (30 GMFCS level IV and 19 GMFCS level V patients). Either DVO (n = 28, 44 joints, mean age 6.98 ± 2.2 years) or DVO and AP (n = 21, 38 oints, mean age 7.0 ± 2.04 years) were produced in combination with multilevel reconstructive surgeries to eliminate contractures of the knee and ankle joints and correct foot deformities. The acetabular angle, the Reimers' index, the acetabular depth ratio (ADR), the Wiberg center-edge angle were measured preoperatively, straight after surgery and at 1, 2, 3 years postsurgery. Results Normal relationship between the femoral head and acetabulum persisted at a long-term follow-up. The parameters evaluating acetabular morphology (Wiberg angle, AI and ADR) were shown to improve or remain stable. The mean annual increase in the Reimers' index was not more than 3 % after DVO and not more than 2% following DVO and AP. A reverse statistically significant correlation was detected between the AI and Wiberg angle after DVO alone or DVO combined with AP throughout the observation period. This sort of correlation facilitated beneficial development of the operated hips at a long term following reconstructive interventions. Moderate correlation was observed in changed AI values after DVO at 3 years postsurgery and changes in the Wiberg angle at three-year observation comparing relative measurement changes and the age when surgery was performed. Age appeared to have a minor effect on the development of the hip following multilevel procedures produced for the cohort of patients. Conclusion Appropriate conditions should be provided for normal development of the hip to address hip dislocation using growth-remaining potential and remodeling the articular ends. Single-event multilevel surgery involving hip reconstruction and addressing knee and ankle contractures is practical for providing favorable conditions for postural management and passive verticalization of patients to maintain axial loading on the limbs.

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A balanced approach for stable hips in children with cerebral palsy: A combination of moderate VDRO and pelvic osteotomy

Cited by 11 publications

References 35 publications

Combined pelvic and femoral reconstruction in children with cerebral palsy

Combined pelvic and femoral reconstruction in children with cerebral palsy

Radiological Outcomes of Femoral Head Resection in Patients with Cerebral Palsy: A Retrospective Comparative Study of Two Surgical Procedures

Roentgenoanatomy of the hip joint following reconstructive intervention in children with spastic cerebral palsy

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