Fate of hips complicated by avascular necrosis of the femoral head following reconstructive surgery in nonambulatory patients with cerebral palsy

Park, Byoung Kyu; Park, Hoon; Park, Kun-Bo; Rhee, Isaac; Kim, Sung-Min; Kim, Hyun Woo

doi:10.1038/s41598-022-16023-7

Cited by 2 publications

(4 citation statements)

References 44 publications

(48 reference statements)

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“…There are many cohort studies which report a high success rate in terms of improved hip morphology at medium- to long-term follow-up. However, many studies report high rates of complications including mortality [ 28 , 29 , 62 , 63 , 64 , 65 , 66 ]. In one study, the mortality rate was 4% and the overall complication rate was 25%, rising to 68% in children with gastrostomies or tracheostomies [ 62 ].…”

Section: Bony Reconstructive Surgery For Cphdmentioning

confidence: 99%

“…Recurrent hip displacement and avascular necrosis are two of the most disappointing late outcomes after reconstructive surgery [ 28 , 62 , 63 , 64 , 65 , 66 ]. Earlier studies of AVN after hip reconstruction in children with CP used or adapted the classifications for AVN in DDH [ 64 , 65 ].…”

Section: Bony Reconstructive Surgery For Cphdmentioning

confidence: 99%

“…Earlier studies of AVN after hip reconstruction in children with CP used or adapted the classifications for AVN in DDH [ 64 , 65 ]. In contrast, Park and colleagues devised a new classification and reported a prevalence of 43% [ 66 ]. They reported both risk factors and outcomes.…”

Section: Bony Reconstructive Surgery For Cphdmentioning

confidence: 99%

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Hip Surveillance and Management of Hip Displacement in Children with Cerebral Palsy: Clinical and Ethical Dilemmas

Howard

Willoughby

Thomason

et al. 2023

JCM

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Hip displacement is the second most common musculoskeletal deformity in children with cerebral palsy. Hip surveillance programs have been implemented in many countries to detect hip displacement early when it is usually asymptomatic. The aim of hip surveillance is to monitor hip development to offer management options to slow or reverse hip displacement, and to provide the best opportunity for good hip health at skeletal maturity. The long-term goal is to avoid the sequelae of late hip dislocation which may include pain, fixed deformity, loss of function and impaired quality of life. The focus of this review is on areas of disagreement, areas where evidence is lacking, ethical dilemmas and areas for future research. There is already broad agreement on how to conduct hip surveillance, using a combination of standardised physical examination measures and radiographic examination of the hips. The frequency is dictated by the risk of hip displacement according to the child’s ambulatory status. Management of both early and late hip displacement is more controversial and the evidence base in key areas is relatively weak. In this review, we summarise the recent literature on hip surveillance and highlight the management dilemmas and controversies. Better understanding of the causes of hip displacement may lead to interventions which target the pathophysiology of hip displacement and the pathological anatomy of the hip in children with cerebral palsy. We have identified the need for more effective and integrated management from early childhood to skeletal maturity. Areas for future research are highlighted and a range of ethical and management dilemmas are discussed.

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Section: Bony Reconstructive Surgery For Cphdmentioning

confidence: 99%

Section: Bony Reconstructive Surgery For Cphdmentioning

confidence: 99%

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Hip Surveillance and Management of Hip Displacement in Children with Cerebral Palsy: Clinical and Ethical Dilemmas

Howard

Willoughby

Thomason

et al. 2023

JCM

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“…Several studies have shown how hip surveillance programs improve the outcome of HD in terms of rate of dislocated hips and salvage surgery [ 18 , 34 , 35 ]. However, this strategy may be difficult to pursue in some cases given the fragility and/or the limited life expectancy of many of these patients [ 36 ], the need for invasive surgery even in asymptomatic children with the possibility of parental refusal, the high rate of complications after hip surgery [ 37 , 38 , 39 , 40 ], and the frequent need for repeated surgeries before reaching skeletal maturity [ 31 ]. Moreover, an older age at the time of reconstructive surgery is associated with a reduced need for surgical revision [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Study Confirms Safety and Effectiveness of Intra-Articular Glucocorticoids for Painful Hip Dislocation in Children and Young Adults with Neurologic Impairment

et al. 2023

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Background: Hip dislocation is a common source of pain in children with neurologic impairment. When medical interventions fail, orthopedic surgery does not guarantee a definitive result as the displacement may continue postoperatively and a second operation is often required. Methods: Retrospective analysis of data regarding the safety and effectiveness of an intra-articular corticosteroid injection (IACI) in 11 patients, aged 15 ± 5 years old, collected through a telephonic questionnaire administered to parents. Results: 21 IACIs were performed, a mean number of 1.9 ± 1.5 times for each patient, at a mean age (of the first IACI) of 13.5 ± 5 years. According to the parents, the IACI significantly lowered the number of participants experiencing pain (82% reduction) and using analgesics (60% reduction). There was also a significant improvement in the children’s hip mobility (63% reduction in patients experiencing stiffness), decubitus (90% reduction in obligated positioning), behavior (80% reduction in lamenting or crying patients), sleep quality (87.5% reduction in patients awakening every night), and caregivers’ quality of life (91% reduction in worried parents). The mean reported duration of the IACIs’ benefit was 5.4 ± 2.4 months (range 1–9), with a positive correlation with the number of IACIs (r = 0.48; p-value = 0.04) and a negative correlation with the age at the first injection (r = −0.71; p-value = 0.02). The only reported adverse event was mild local swelling in one child. Conclusions: the IACI could represent a safe and effective intervention for painful hip dislocation, both before and after surgery, with a long-lasting benefit which seems to increase as multiple IACIs are performed.

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Fate of hips complicated by avascular necrosis of the femoral head following reconstructive surgery in nonambulatory patients with cerebral palsy

Cited by 2 publications

References 44 publications

Hip Surveillance and Management of Hip Displacement in Children with Cerebral Palsy: Clinical and Ethical Dilemmas

Hip Surveillance and Management of Hip Displacement in Children with Cerebral Palsy: Clinical and Ethical Dilemmas

Study Confirms Safety and Effectiveness of Intra-Articular Glucocorticoids for Painful Hip Dislocation in Children and Young Adults with Neurologic Impairment

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