Risk factors and complications in hip reconstruction for nonambulatory patients with cerebral palsy

Abstract

Background Hip dysplasia is prevalent in nonambulatory children with cerebral palsy, and may contribute to a decreased quality of life (Lonstein in J Pediatr Orthop 6:521-526, 1). Reconstructive procedures such as a femoral varus derotation osteotomy with or without a pelvic osteotomy are commonly employed with the goal of achieving and maintaining well reduced hips. Purposes The goals of this study are both to characterize the complications of reconstructive procedures and to identify risk factors that may contribute to these complications. Patients and methods A retrospective analysis was conducted among 61 nonambulatory children (93 hips) with cerebral palsy who underwent a femoral varus derotation osteotomy, with or without an open reduction and/or pelvic osteotomy, from 1992 through 2008 at our institution. The average patient age was 8.1 years (2.6-14.7) and the mean follow-up time was 5.9 years (2.1-15.9). Results The cumulative complication rate per patient including failures to cure was 47.6 %. Spica casting was found to be a risk factor for all complications (P = 0.023); whereas patients younger than 6 years old (P = 0.013) and children with a tracheostomy (P = 0.004) were found to be risk factors for resubluxation following surgery.Conclusions Although reported complication rates of hip reconstructive procedures performed upon children with cerebral palsy have varied considerably, those with more severe disease have experienced more complications. We report our tertiary referral center's complication rate and our institutional experiences with risk factors for complications and failures to cure. Level of evidence IV, Retrospective case series.

Perioperative Outcomes Following Surgical Treatment of the Neuromuscular Hip: An Analysis of the National Surgical Quality Improvement Program—Pediatrics

“…[5]- [16]. Ruzbarsky et al [16] performed a review of the literature, identifying 16 articles including 851 patients.…”

“…Ruzbarsky et al [16] performed a review of the literature, identifying 16 articles including 851 patients. The cumulative complication rate from their systematic review was 38%, which increased to 54% when failure to cure was included.…”

“…NSQIP-P is a multi-institutional pediatric (age less than 18) surgical outcomes database containing preoperative, surgical, and 30-day outcome variables collected based upon a systematic sampling process to ensure proportional diversity in selection using an 8-day sampling cycle from over 60 pediatric institutions [17]- [22]. NSQIP-P data are continuously audited, validated, and are compiled into Participant User Files (PUFs) for use in quality improvement and sur- [16], age was stratified into patients 6 years of age and younger or older than 6 years.…”

“…Many studies have evaluated the perioperative complications and risk factors of neuromuscular hip dysplasia corrective procedures at the single institutional level [5]- [16]. Complications can include unplanned readmission, unplanned reoperation, infection, wound complications, pneumonia, nerve injury, implant failure, and blood transfusion.…”

“…Complications can include unplanned readmission, unplanned reoperation, infection, wound complications, pneumonia, nerve injury, implant failure, and blood transfusion. Current knowledge of risk factors for increased complication rate includes presence of tracheostomy or gastrostomy, spica casting, age less than six years, and higher Gross Motor Function Classification System (GMFCS) score, indicating higher severity of disease [16]. However, these risk factors primarily assess the long-term complications as they reflect the risk of recurrent subluxation/dislocation at single institutions.…”