Race Is Associated With Risk of Salvage Procedures and Postoperative Complications After Hip Procedures in Children With Cerebral Palsy

Brown, Lauryn; Cho, Kevin; Tarawneh, Omar; Quan, Theodore; Malyavko, Alisa; Tabaie, Sean

doi:10.1097/bpo.0000000000002216

Cited by 4 publications

(4 citation statements)

References 32 publications

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“…There are few comparative studies and follow-up has generally been short- to medium-term. The majority of studies lack adequate documentation of pain before and after surgery as well as valid patient reported outcome measures (PROMS) [ 43 , 77 , 78 , 79 , 80 ]. A notable exception was the study by Koch et al [ 79 ].…”

Section: Palliation Of Cphd and The Role Of Salvage Surgerymentioning

confidence: 99%

“…The recent publication of a study which reported racial disparities in both the risk of requiring a salvage procedure and the rate of post-operative complications points to yet another clinical and ethical dilemma in the management of CPHD which, to date, has gone unrecognised and unreported [ 80 ]. As this is the first report of this important ethical issue, further studies are required.…”

Section: Palliation Of Cphd and The Role Of Salvage Surgerymentioning

confidence: 99%

See 1 more Smart Citation

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: Palliation Of Cphd and The Role Of Salvage Surgerymentioning

confidence: 99%

Section: Palliation Of Cphd and The Role Of Salvage Surgerymentioning

confidence: 99%

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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“…Анализ литературных данных показывает, что изменение уровня исследуемых сывороточных маркеров воспаления при ограничении в специфичности и в чувствительности может быть связано и с наличием сопутствующего заболевания [53], а также с излишней травматизацией костной и окружающих мягких тканей [54]. При этом предложенная нами методика хирургического доступа для эндопротезирования тазобедренного сустава при диспластическом коксартрозе у основной группы пациентов может считаться вполне обоснованным и эффективным методом по причине сравнительно более раннего улучшения биохимических показателей, функциональной способности и купирования болевого синдрома.…”

Section: Discussionunclassified

Surgical Tactics for Optimizing Total Hip Arthroplasty Technology

Насирли¹

2022

Хирургия. Восточная Европа

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Введение. Результаты исследований показывают преимущества артропластики тазобедренного сустава с применением миниинвазивного доступа перед стандартными хирургическими вмешательствами, что подтверждается более высоким уровнем физической активности и выраженным снижением интенсивности болевого синдрома в послеоперационном периоде. Цель. Оценить отдаленные результаты тотального эндопротезирования тазобедренного сустава с использованием малоинвазивного хирургического доступа. Материалы и методы. Проведен сравнительный анализ течения болезни у 55 пациентов с диспластическим коксартрозом до и после эндопротезирования тазобедренного сустава. Средний возраст пациентов составил 51,6±0,55 и 50,3±0,71 года соответственно в контрольной группе, где использовалась традиционная техника хирургического доступа (n=25), и в основной группе, где внедрялся предложенный нами миниинвазивный метод (n=30). Пациентам с целью определения эффективности методов хирургического доступа выполнялся общий анализ крови, проведено определение сывороточных концентраций уровня СОЭ и С-реактивного белка (СРБ), а также оценивалась степень выраженности болевого синдрома в суставе с использованием визуальной аналоговой шкалы боли (ВАШ). Результаты. В ходе выполненного исследования разработан и научно обоснован предложенный эффективный метод малоинвазивного хирургического доступа при тотальном эндопротезировании пациентов с диспластическим коксартрозом тазобедренного сустава, в основе которого лежит обеспечение достаточного обзора операционной зоны и значительное сокращение реабилитационного периода на фоне снижения травматизма оперативного приема за счет меньшего разреза и сокращения длины раны мягких тканей, более щадящего воздействия на мышечные ткани, профилактики повреждений сосудисто-нервных образований и инфекционных осложнений. По результатам клинико-лабораторной оценки эффективности предложенной методики хирургического доступа для эндопротезирования тазобедренного сустава при диспластическом коксартрозе ВАС, СОЭ и СРБ (снижение с 8,4±0,26 до 5,4±0,11 мг/л) достигли более выраженного в сравнении с группой контроля снижения количественных показателей по сравнению с первоначальными показателями (р<0,001), что позволяет значительно уменьшить вероятность возникновения и развития осложнений воспалительного генеза и повысить качество жизни пациентов. Заключение. Преимущества предложенной методики хирургического доступа: минимально инвазивно, низкий уровень риска инфицирования; низкая травматичность, сокращение периода реабилитации; существенное снижение показателей по шкале боли ВАШ. Introduction. The results of the studies reveal the advantages of hip arthroplasty with minimally invasive approach over standard surgical interventions, as confirmed by a higher level of physical activity and a pronounced decrease in pain intensity in the postoperative period. Purpose. To evaluate the long-term results of total hip arthroplasty with minimally invasive surgical approach. Materials and methods. A comparative analysis of the course of disease in 55 patients with dysplastic coxarthrosis before and after hip arthroplasty was carried out. The average age of patients was 51.6±0.55 and 50.3±0.71 years, respectively, in the control group, where the traditional surgical approach technique was used (n=25), and in the main group, where our proposed minimally invasive method was introduced (n=30). In order to determine the effectiveness of surgical access methods, patients underwent a complete blood count, determination of serum concentrations of ESR and C-reactive protein (CRP), and the severity of pain in the joint was assessed using a visual analog pain scale (VAS). Results. In the course of the study, the proposed effective method of minimally invasive surgical access for total arthroplasty in patients with dysplastic coxarthrosis of the hip joint based on providing a sufficient overview of the operating area and a significant reduction in the rehabilitation period against the background of reduced traumatism of surgical admission due to a smaller incision and a shorter soft tissue wound length, as well as a more gentle effect on muscle tissue and prevention of neurovascular injuries and infectious complications was developed and scientifically substantiated. According to the results of clinical and laboratory evaluation of the effectiveness of the proposed method of surgical access for hip arthroplasty in dysplastic coxarthrosis, VAC, ESR and CRP (decrease from 8.4±0.26 to 5.4±0.11 mg/l) reached a more pronounced reduction in quantitative indicators than in the control group, as compared with baseline indicators (p<0.001), which could significantly reduce the occurrence and development of complications of inflammatory genesis and improve patients’ quality of life. Conclusion. The proposed method of surgical access offers the following advantages: minimally invasive, low risk of infection, low traumatism, shortened rehabilitation period, significant decrease in VAS pain scale.

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“…A review of patients with GMFCS IV and V undergoing a surgical procedure found an almost 50% rate of osteonecrosis associated with a greater MP at the time of intervention 45 . A database review of almost 4,000 patients with cerebral palsy found that race was an independent risk factor for undergoing a salvage compared with a hip reconstruction procedure 46 .…”

Section: Cerebral Palsymentioning

confidence: 99%

What’s New in Pediatric Orthopaedics

Andras

Sanders²,

Goldstein

et al. 2022

Journal of Bone and Joint Surgery

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This pediatric orthopaedic update represents a review of articles predominantly from October 2021 to October 2022. Spine Adolescent Idiopathic ScoliosisAs we strive toward optimal adolescent idiopathic scoliosis treatment that will serve patients well into adulthood, longterm follow-up studies are of particular importance. Lander et al. reported on a series of 134 patients treated with Harrington instrumentation with a minimum 40-year follow-up. Patients with a lowest instrumented vertebra (LIV) at L3 or proximal had a lower likelihood of undergoing additional surgical procedures at 13% compared with patients with an LIV at L4 or distal at 36%, but, aside from this, the groups were similar with regard to health-related quality of life and their scores were not different from normal age-based means 11 . Also encouraging was the report on 115 patients with a 25year follow-up that showed that the serum levels of cobalt and chromium ions were similar in the patients treated with Harrington instrumentation compared with a control group of patients treated with bracing 12 . However, questions with regard to the long-term effect of retained implants continue to generate concern as titanium levels were found to be persistently elevated to 5 times the preoperative level at the 2-year follow-up in a series with more contemporary implants 13 . The impact of this remains unknown but warrants continued study.There remains continued interest in leveraging technology to achieve optimal pedicle screw placement safely and consistently. In a systematic review and meta-analysis by Baldwin et al., screws placed with intraoperative computed tomographic (CT) navigation were determined to be one-third Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H355).

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Race Is Associated With Risk of Salvage Procedures and Postoperative Complications After Hip Procedures in Children With Cerebral Palsy

Cited by 4 publications

References 32 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

Surgical Tactics for Optimizing Total Hip Arthroplasty Technology

What’s New in Pediatric Orthopaedics

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