Salvage procedures for the painful chronically dislocated hip in cerebral palsy

Hwang, Jihye; Varte, Lalhruaitluanga; Kim, Hyun Woo; Lee, D. H.; Park, Hoon

doi:10.1302/0301-620x.98b1.35202

Cited by 29 publications

(35 citation statements)

References 39 publications

(43 reference statements)

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“…Hwang et al [9] reported that asymptomatic HO occurred in three patients of their pediatric cohort, but they did not mention whether they employed post-operative HO prophylaxis and, if they did, what the protocol consisted of. Six of the children in our study sustained HO (50%) with an average Brooker grading of 1.4 (Fig.…”

Section: Discussionmentioning

confidence: 99%

Proximal femur prosthetic interposition arthroplasty for painful dislocated hips in children with cerebral palsy

Silverio

Nguyen

Schlechter

et al. 2016

Journal of Children's Orthopaedics

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PurposeChildren with cerebral palsy often have musculoskeletal disorders involving the hip. There are several procedures that are commonly used to treat these disorders. Proximal femur prosthetic interposition arthroplasty (PFIA) is an option for non-ambulatory children with cerebral palsy who have a painful, spastic dislocated hip. The purpose of our study was to evaluate the results of PFIA by examining treatment outcomes, complications, and overall effects on the child and their caregiver.MethodsCharts were reviewed over a 5-year period at our institution. The focus of the data collection was pain, range of motion (ROM), and overall clinical outcome. Clinical outcome was graded as excellent, good, fair, and poor. Length of follow-up, presence of heterotopic ossification, femoral prosthesis migration, and information provided by competed caregiver questionnaires were analyzed.ResultsA total of 16 hips in 12 patients met the inclusion criteria. Average age at time of surgery was 12 years 1.2 months. Average follow-up was 40.4 months. Three hips required revision surgery. Average time before revision surgery was 16 months. Overall outcomes were excellent/good for seven hips and fair/poor for nine. Pain outcomes were excellent/good for nine hips and fair/good for seven. ROM outcomes were excellent/good for nine hips and fair/poor for seven. The majority of caregivers surveyed would recommend this procedure.ConclusionClinical evaluation of the effectiveness of PFIA yielded variable results with this cohort of children with regards to pain and range of motion. Despite these varied results, the majority of caregivers were satisfied with the outcome and would recommend PFIA. PFIA is a salvage option for the painful, spastic dislocated hip, but significant evidence to prove its effectiveness over other salvage procedures is lacking. Based on our results, we conclude that PFIA has the ability to benefit children with cerebral palsy with an acceptable risk profile similar to that reported in recent publications.Level of evidence IV; retrospective case-series.

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Section: Discussionmentioning

confidence: 99%

Proximal femur prosthetic interposition arthroplasty for painful dislocated hips in children with cerebral palsy

Silverio

Nguyen

Schlechter

et al. 2016

Journal of Children's Orthopaedics

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“…The increased incidence of HRA performed in the less than 65 years old cohort may be explained by the utilization of HRA in young patients with neuromuscular disease and severely dislocated hips 6 that cause difficulty with sitting, perineal hygiene, and decubitus ulcers. 26 A recent systematic review by Kolman et al notes that HRA reliably relieves pain among this patient population and has the lowest overall complication rate compared with other salvage procedures, including valgus osteotomy, THA, and hip arthrodesis. 27 However, there is a lack of data evaluating trends in surgical management of patients with dysplastic hips secondary to neuromuscular disease to confirm this assertion.…”

Section: Discussionmentioning

confidence: 99%

Trends in Hip Resection Arthroplasty in the Medicare Patient Population from 2005 to 2012

et al. 2017

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Hip resection arthroplasty (HRA) is a relatively uncommon, yet viable surgical procedure originally developed by Girdlestone for osteomyelitis of the proximal femur. Currently, HRA is primarily indicated as a salvage procedure after a failed total hip arthroplasty. Despite a continuous rise in the rates of primary and revision hip arthroplasty, there is a lack of published evidence regarding the extent of HRA's current use and its recent trends. We sought to provide an epidemiological description of the recent utilization patterns of HRA in the United States. A level of evidence IV, retrospective case series review of the entire Medicare files between 2005 and 2012 was conducted through the use of current procedural terminology codes and International Classification of Disease ninth edition codes. Linear regressions and chi-square tests were used for analysis. Subgroup analysis was performed by patient age. The total number of HRAs performed between 2005 and 2012 significantly decreased from 4,248 to 3,872 (p = 0.025). There was a significant increase in the annual incidence of HRA among patients younger than 65 years (p = 0.027; 9% increase) and patients 65 to 69 years old (p = 0.007; 22% increase), constituting 43% of the total patients. There was a significant decrease in HRA incidence among patients 80 to 84 years old (p = 0.001; 32% decrease) and patients 85 years old and over (p = 0.002; 24% decrease). Geographic analysis demonstrated the most HRA procedures were performed in the South, whereas gender focused analysis demonstrated a statistically significant decrease in HRA incidence for females (p = 0.003; 6% decrease) and a significant increase in incidence for males (p = 0.003; 7% increase). The overall annual incidence of HRA performed in the Medicare patient population has significantly decreased in recent years. However, this conceals an increased incidence among the relatively younger patient population. Potential causes for these opposing trends include changes in rates of revision surgery, alternative indications for surgery, advances in hardware, and surgeon expertise. This was a level of evidence IV, retrospective case series study.

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“…Orthopedic surgery can roughly be divided into tendon lengthening, tendon transfer, osteotomy, and arthrodesis. The indications include fixed contracture, joint deformity, joint dislocation, and subluxation that affect function or cause pain [18][19][20][21][22]. Furthermore, the purpose of surgery is to improve motor function, prevent deformity, relieve pain, and modify the appearance of patients [23,24].…”

Section: Surgical Managementmentioning

confidence: 99%

Orthopedic treatment of the lower limbs in spastic paralysis

Deng

Zeng

et al. 2020

Brain Science Advances

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Spastic paralysis of the limb mainly results from the central lesion, in which spastic cerebral palsy is the common cause. Due to durative muscle spasm in spastic cerebral palsy, it is often accompanied by the formation of secondary musculoskeletal deformities, resulting in limb motor disability. Based on its pathogenesis, surgical treatment is currently applied: selective posterior rhizotomy (SPR) or orthopedic surgery. The primary purpose of early orthopedic surgery was simply to correct limb deformities, which usually led to the recurrence of deformity as a result of the presence of spasticity. With the application of SPR, high muscle tone was successfully relieved, but limb deformity was still present postoperatively. Therefore, this study aimed to elaborate on the management of orthopedic surgery, common deformities of the lower limb, and orthopedic operative methods; discuss the relationship between SPR and orthopedic procedure for limb deformity; and focus on the indications, timing of intervention, and postoperative outcome of different surgical methods.

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Salvage procedures for the painful chronically dislocated hip in cerebral palsy

Abstract: Salvage surgery can be of benefit to patients with CP with chronic painful hip dislocation, but should be limited to selected patients considering complications.

Cited by 29 publications

References 39 publications

Proximal femur prosthetic interposition arthroplasty for painful dislocated hips in children with cerebral palsy

Proximal femur prosthetic interposition arthroplasty for painful dislocated hips in children with cerebral palsy

Trends in Hip Resection Arthroplasty in the Medicare Patient Population from 2005 to 2012

Orthopedic treatment of the lower limbs in spastic paralysis

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