Radiographic outcome of soft-tissue surgery for hip subluxation in non-ambulatory children with cerebral palsy

Bowen, Richard E.; Kehl, Douglas K.

doi:10.1097/01.bpb.0000191867.93022.88

Cited by 11 publications

(7 citation statements)

References 28 publications

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“… 13 ) reported that patients with lack of preoperative coverage > 50% were at risk for femoral head coverage deterioration despite adductor release. Bowen and Kehl 14 ) also reported that hips with a preoperative MP of 30–49% had a normal MP (< 15%) in 18 of 21 cases (81%) postoperatively, whereas those with a preoperative MP > 50% had a normal MP in three of seven (43%) cases postoperatively. They reported that soft-tissue release surgery alone, even in cases of moderate hip subluxation, could result in long-term radiographic hip stability.…”

Section: Discussionmentioning

confidence: 93%

Soft-tissue release for hip subluxation and dislocation in cerebral palsy

et al. 2017

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Objective: This study aimed to evaluate the effectiveness of soft-tissue release on hip subluxation and dislocation in cerebral palsy as well as activities of daily living after surgery.Patients and Methods: Soft-tissue release was performed in 13 patients (19 hips) with cerebral palsy. Of them, 10 had spastic quadriplegia and three had spastic diplegia. Mean ages were 8.6 years at surgery and 13.8 years at the last investigation. The mean follow-up period was 5.2 years. Hip subluxation and dislocation severities were analyzed before and after surgery and at the final investigation as migration percentage on radiographs. Postoperative activities of daily living were also evaluated in 12 patients.Results: Seven hips classified as mild and moderate preoperatively were classified as good, mild, and moderate at the last investigation. Nine of 12 hips classified as severe preoperatively continued to be severe at the last investigation. However, three of 12 hips classified as severe preoperatively improved at the last investigation. There was a positive correlation between preoperative migration percentage and that at the last investigation. Daily activities improved postoperatively in 12 patients.Conclusions: Early treatment is necessary to prevent hip dislocation and improve hip subluxation. However, several patients with severe subluxation might experience improvement with soft-tissue release alone. Soft-tissue release is effective for treating hip dislocation and subluxation in cerebral palsy and improving daily activities.

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Section: Discussionmentioning

confidence: 93%

Soft-tissue release for hip subluxation and dislocation in cerebral palsy

et al. 2017

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“…For 63 (68%) patients with initial subluxated hips (MP > 25%) it was good, and for 30 patients with "hips at risk" (MP 25%) it was 100% good shows the value of the initial MP as a predictive factor. Bowen and Kehl [12] consider it necessary to identify precisely which hips will subluxate without treatment (studies show 26-78%), however, without more complete knowledge of the natural history of each hip, or the impossibility of close monitoring, most surgeons will intervene in smaller MPs, as in our study patients.…”

Section: Discussionmentioning

confidence: 95%

“…Adductor tenotomies, and surgeries involving the psoas and hamstrings (16%), or those that associate hamstrings had better results compared to adductor surgery alone or with psoas, with statistical significance. Kalen and Bleck [1], found better results including the psoas than with isolated adductor tenotomies, and other authors include the psoas release frequently [6,12].…”

Section: Discussionmentioning

confidence: 97%

Soft tissue surgery as an initial treatment for hip displacement in spastic cerebral palsy

Silva

Fucs²

2020

SICOT-J

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Objective: To use the measurement of migration percentage (MP) to evaluate the long-term radiographic results of soft tissue surgery as the first treatment for hip displacement in spastic bilateral cerebral palsy. A secondary objective was to identify predictive factors of stability (i.e., less than 30% of MP in the long term), after surgical correction. Methods: In this longitudinal cohort study, we reviewed the electronic medical records and radiographs of all consecutive patients with cerebral palsy operated for the correction of hip displacement between 1984 and 2013 in a referral orthopedic public hospital in Brazil. Patients were included if they had received, as the first surgical procedure, soft-tissue release. All surgeries were bilateral and symmetrical. We used the available radiographs to evaluate the migration percentage (MP), acetabular index (AI), pelvic obliquity (PO) angle, head-shaft angle (HSA), congruence and femoral head sphericity, and function using the GMFCS (Gross Motor Function Classification System). Results: we included 93 patients, all operated before being 12 years old, with follow-up of 10 years in average, 73 (78%) of them with good results (MP < 30%). We found association between preoperative MP ≤ 40%, AI ≤ 25°, and postoperative symmetry with good results, with a cut-off value of 38% of MP and 27° of acetabular index being predictive. Discussion: The role of soft tissue releases remains controversial owing to small sample sizes, heterogeneity, variety range of ages, definitions used for outcome, and lack of statistical quality. Our results were better in combined tenotomies, in diparetic patients aged more than six years, and in patients with lower initial values of MP and AI. Radiographic variables had good correlation with each other and association with results, with cut-off values for MP and AI PRE.

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“…The cutoff value of MP ≥50% is consistent with several studies that consider an MP <50% a good outcome after surgery. 15 , 16 , 24 , 25 Since the 1980s, some authors 26 – 28 have suggested that if soft tissue surgery is executed before MP has reached 50%, further luxation may be prevented. Conversely, preoperative MP >50% has been associated with poor outcome after soft tissue surgery.…”

Section: Discussionmentioning

confidence: 99%

A retrospective cohort study about hip luxation in non-ambulatory cerebral palsy patients: The point of no return

Faccioli

Sassi

Corradini

et al. 2022

Journal of Children's Orthopaedics

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Purpose: The migration percentage is a widely used criterion for surgery in displaced hips. Literature suggests that no hip can spontaneously improve if the migration percentage exceeds 45%, in a mixed population of cerebral palsy children. The aim of the present article was to identify the point of no return of the migration percentage in a selected sample of non-ambulatory cerebral palsy children, being the most exposed to hip luxation. Methods: This single-center retrospective cohort study included patients with spastic or dyskinetic cerebral palsy, Gross Motor Function Classification System level IV or V, age 0–18, having at least three pelvic radiographies, excluding radiographies relative to hips having previously undergone surgery. The following information was collected: sex, cerebral palsy subtype, Gross Motor Function Classification System level, presence of drug-resistant epilepsy, migration percentage, age at assessment, use of walking or standing assistive devices, previous botulinum injection, oral or intrathecal baclofen, and hip pain. Data were analyzed at the level of the individual hips. Descriptive statistics were presented. Receiver operating characteristic curve analysis was conducted to investigate which value of the migration percentage could be adopted as the “point of no return”: that is, the cutoff value beyond which no migration percentage reduction, by more than 5%, could be expected. Results: The optimal cutoff value was identified as migration percentage ≥50%, with a sensitivity of 84.5% and a specificity of 100% (p-value <0.001). Conclusion: Based on the present study, migration percentage ≥50% is the “point of no return” for Gross Motor Function Classification System IV-V cerebral palsy patients, representing the cutoff value beyond which no spontaneous cerebral palsy reduction may be expected, unless addressing surgery. Level of evidence: level II—retrospective study.

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Radiographic outcome of soft-tissue surgery for hip subluxation in non-ambulatory children with cerebral palsy

Cited by 11 publications

References 28 publications

Soft-tissue release for hip subluxation and dislocation in cerebral palsy

Soft-tissue release for hip subluxation and dislocation in cerebral palsy

Soft tissue surgery as an initial treatment for hip displacement in spastic cerebral palsy

A retrospective cohort study about hip luxation in non-ambulatory cerebral palsy patients: The point of no return

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