Unilateral varus osteotomy of the proximal femur in children with cerebral palsy: A five-year follow-up of the development of both hips

Abstract

Background Varus osteotomy of the proximal femur (VOPF) is one treatment option to prevent hip dislocation in children with cerebral palsy (CP). It is questioned whether the osteotomy should be performed in the displaced hip only, or if it should be performed bilaterally to prevent later displacement of the contralateral hip. CPUP is a register and healthcare programme for children with CP that was initiated in 1994 in southern Sweden. In the programme, range-of-motion and radiographic examination of the hips is performed regularly. These data have been analysed preoperatively and for 5 years postoperatively in children treated with unilateral VOPF. Methods Children with CP living in the counties of Skåne and Blekinge in the south of Sweden, who were treated with unilateral VOPF at least 5 years ago, were included in the study. The degree of hip displacement and the range of hip motion were analysed preoperatively and after 5 years. Repeat hip operations after the index operation were recorded. Results Twenty-four children fulfilled the inclusion criteria. Mean age at index operation was 7.6 (2.8-13.2) years. No child died within 5 years postoperatively, and no child was lost from follow-up. At follow-up after 5 years, 2 of the 24 children had been operated on with VOPF in the contralateral hip. The range of motion in both hips decreased, but the difference between the index hip and the contralateral hip did not change significantly. Conclusion Children with CP and unilateral hip displacement have a low risk of later contralateral displacement after being operated on with unilateral VOPF. This supports healthcare programmes that advocate unilateral VOPF in children with unilateral hip displacement.

Femoral and pelvic osteotomies for severe hip displacement in nonambulatory children with cerebral palsy: a prospective population-based study of 31 patients with 7 years’ follow-up

“…Opinion differs with regard to surgical strategy in patients with a normal contralateral hip. Whereas some studies recommended prophylactic, concurrent femoral osteotomy of the contralateral hip to obtain pelvic balance (Barakat et al 2007, Oh et al 2007) others recommended unilateral osteotomy only (Settecerri and Karol 2000, Larsson et al 2012). After unilateral soft-tissue or bony surgery in 27 nonambulatory patients with no subluxation of the contralateral side, deterioration of the contralateral side occurred in 19 hips, leading the authors to caution against unilateral surgery (Noonan et al 2000).…”

“…After unilateral soft-tissue or bony surgery in 27 nonambulatory patients with no subluxation of the contralateral side, deterioration of the contralateral side occurred in 19 hips, leading the authors to caution against unilateral surgery (Noonan et al 2000). When unilateral osteotomy was combined with bilateral soft-tissue releases, the rate of contralateral deterioration was only 8% (Larsson et al 2012). This is in keeping with the present results.…”

Range of hip abduction after preventive and reconstructive surgery in cerebral palsy: a longitudinal registry study of 307 children

“…This varization can reduce the range of abduction and, to compensate for this, VDRO is often combined with APL and shortening of the femur. Opinions differ as to whether VDRO should be performed bilaterally, even in patients with unilateral hip displacement (7)(8)(9). After both APL and VDRO, there is a risk of recurrent hip displacement and the need for repeated surgery (10)(11)(12).…”

Systematic Review of Cerebral Palsy Registries/Surveillance Groups: Relationships between Registry Characteristics and Knowledge Dissemination

“…Twenty-one dual aim articles shared this aim (Planning) with the Resource for CP Research aim (Table S8) and emphasized a variety of health [186–191] and hip issues [192–195], planning for environmental and social needs [196–199] equipment [200–202] financial planning [203,204] predicting outcome [205] and mother’s health [206]. Additional two-aim articles have been previously discussed under Prevention (n=2) and Surveillance (n=1).…”