Risk Profile of Bony Intervention for Hip Displacement in our Youngest Cohort of Children with Cerebral Palsy

Abstract

Background:Children with higher GMFCS level frequently suffer from progressive hip displacement. A common consequence is pain affecting the ability to sit, compromising care and thereby, impairing quality of life. While other treatments often fail, bony reconstructive surgery is able to sufficiently ease pain and restore the range of motion.Our study presents our experience with these bony procedures in our youngest patients. Methods: 76 procedures (41 hip reconstructions, 35 femoral osteotomies) in 39 patients aged 2 to 8 years (median 5) were studied. Surgical procedure duration and blood loss were recorded. Complication rates of the immediate postoperative course as well as the radiological outcomes of this cohort in the short-term 4 to 13 months postoperatively (median 9) are reported. Results:The overall operation time per hip (median 100min) and blood loss per procedure (median 10.4ml/kgBW) was satisfactory, however the complication rate was in total 70% including mild and moderate complications (grades I-III) in 66% (n=27) and severe complications (grades IV and V) in 4% (n=2) of patients according to the modified Clavien-Dindo classification. Radiographs confirmed a favourable reconstruction of bony hip biomechanics especially in combined pelvic and femoral procedures. Conclusions:Reconstructive hip surgery in young CP patients is challenging not only in terms of the procedure but also concerning management in the peri-and postoperative course. Management in an interdisciplinary setting including initial postoperative ICU admission, a low threshold for blood transfusions and an experienced surgeon is required.

Blood loss in hip reconstructive surgery in children with cerebral palsy: when do I need to be prepared for blood transfusion?

“…Our recorded EBL measurements were subjective estimated recorded by attending surgeons. EBL has previously been shown to be an unreliable measurement, particularly when compared to hemoglobin and hematocrit, hemodynamics, and surgeon-performed clinical examination [19]. These limitations may affect the validity of our aforementioned findings.…”

Long-term outcomes of reconstructive treatment for painful dislocations in patients with cerebral palsy

“… 7 , 8 It has been well established that the neurogenic hip reconstruction with femur varus derotational osteotomy (VDRO) and transiliac osteotomies brings satisfactory pain relief and good radiologic outcomes in patients with cerebral palsy (CP) and the hip at risk of displacement. 9 It is, however, unknown whether this type of treatment gives long-lasting pain relief and stable hip long term, especially in primarily painful hips. Therefore, this study aims to present the outcomes of surgical treatment of painful neurogenic hip dislocations with VDRO and Dega transiliac pelvic osteotomy after more than 15 years of follow-up.…”

Long-Term Evolution of the Hip and Proximal Femur after Hip Reconstruction in Non-Ambulatory Children with Cerebral Palsy: A Retrospective Radiographic Review

“…Before surgical intervention is required, bracing, physiotherapy and botulinum toxin A injections to the hip adductors can be considered to prevent or slow down the progression of hip displacement [ 8 , 9 ]. Surgical interventions include preventative soft tissue and bony procedures, including hip reconstruction, which have been shown to result in satisfactory pain relief and good radiological outcomes [ 10 ]. Salvage procedures may be indicated when there is a severe degeneration of the hip joint, but carries a higher risk for ongoing pain and heterotopic ossification [ 11 ].…”