Orthopedic surgical procedures in 3,305 children and young adults with cerebral palsy: a register-based cohort study

Abstract

Background and purpose: Few reports have described the panorama of orthopedic surgeries that children with cerebral palsy (CP) undergo. We analyzed the risk of a first surgery, and describe the frequency of orthopedic surgeries in terms of age, sex, anatomical location, and Gross Motor Function Classification System (GMFCS) level in children and young adults with CP.Patients and methods: This was a register-based cohort study of 3,305 individuals followed until 2–25 years of age. We used data from 2 national Swedish registers: the CPUP CP surveillance program and the Swedish National Patient Register. Kaplan–Meier survival curves were calculated to describe the risk of undergoing a first orthopedic surgery, related to age.Results: We included data for 3,311 orthopedic operations in 1,717 surgical sessions. The percentage of children operated on before age 15 years increased from 22% (95% CI 19–26) for GMFCS level I to 70% (CI 64–75) for level V. Ankle and foot surgery was predominant as first surgery for GMFCS I–II, and hip and femur surgery for GMFCS IV–V. Spinal surgery occurred almost exclusively for GMFCS IV–V. Descriptive data showed repeated surgical sessions to be frequent for higher GMFCS levels.Interpretation: The risk of having a first orthopedic surgical treatment increased with increasing GMFCS level and was initiated at younger age in children with higher GMFCS level.

A National Observational Study From 2010 to 2021 of the Trends in the Timing of Hip Surgery in Children With Cerebral Palsy: Is Surgery Being Performed Earlier?

“…While this is congruent with our study, it is important to note that the European study had a much smaller population size of patients that underwent surgical intervention compared to our study, and the mean age of operation in the Swedish group was 5.7 years old, while our youngest age group only went to age four. A larger study also conducted in Sweden including 3,305 children and adolescents similarly demonstrated that those less than 15 years of age more frequently underwent surgical procedures and had lower gross motor function scores, corroborating the early intervention seen in our study [ 18 ].…”

Changes in foot posture evaluated with dynamic pedobarography over the course of childhood in ambulatory youth with cerebral palsy

“…The optimal timing of surgical intervention in children with CP is difficult to determine. [16][17][18][19] With a lack of knowledge on the evolution of foot posture during childhood, it is a challenge to predict improvement or progression of deformity. Poorly timed surgery poses a threat of deformity recurrence or overcorrection with the potential need for revision surgery.…”

“…Surgical intervention can have a dramatic impact on foot deformities in children with CP. 15 , 32 Telléus et al 18 describe foot and ankle surgeries as the most common procedures in people with CP between the ages of 2 and 25 years, accounting for 49% of procedures in those classified as GMFCS level I, 54% of people classified as level II, and 40% in those classified as level III. Our study shows comparable results where 35% of surgeries in children classified as level I, 29% classified as level II, and 40% as level III included foot correction procedures.…”

“…7 The timing of surgical treatment is inconsistent among studies. [16][17][18][19] Although reports demonstrate the frequency of foot deformity and short-term effects of treatment, there is limited evidence describing changes over the entire course of childhood. Longitudinal change in gross motor function, 20 gait, 21 and passive range of motion 22 has been evaluated in children with CP.…”

News in paediatric orthopaedic surgery: an overview of the latest advances in paediatric orthopaedics and traumatology (2020–2023)

“…Ankle and foot surgery was predominant as the first surgery in GMFCS I-II patients, hip and femur surgery in GMFCS IV-V patients, while spine surgery was mainly performed in GMFCS IV-V patients. Overall, it was found that the risk of undergoing first orthopaedic surgical treatment increased with increasing GMFCS level, and it was performed at a younger age in children with a higher GMFCS level [ 52 ].…”