Abstract
Background and purpose — Operative treatment of hip displacement in cerebral palsy (CP) includes adductor–psoas lengthening (APL) or varus derotation osteotomy (VDRO) of the proximal femur, sometimes combined with pelvic osteotomy. After both operations, there is a significant risk of relapse and need for reoperation. We used the migration percentage (MP) to compare the development of hip displacement after APL and VDRO. Patients and methods — All reported MP measurements for children treated with APL (n = 158) or VDRO (n = 94) and followed ≥ 3 years were obtained from the Swedish Surveillance Programme for CP. In children treated with bilateral surgery, the hip with the highest preoperative MP was analyzed. A mixed-effects model was used to estimate the development of MP with age for each child and the population mean. Results — The 104 hips that underwent APL without reoperation showed a gradually reduced MP postoperatively. The 54 hips that underwent a 2nd surgery with APL or VDRO because of redisplacement had a higher displacement rate preoperatively and continued displacement postoperatively but at a slower rate. The 94 hips that underwent VDRO showed an instantaneous decrease in MP postoperatively followed by a rate of increasing displacement. The 15 hips that underwent a 2nd VDRO had a higher rate of displacement both pre- and postoperatively. Interpretation — After APL, hip displacement either decreases or continues to increase but at a slower rate. After VDRO, the MP decreases momentarily but then gradually increases. The risk of reoperation is higher in children with a high preoperative displacement velocity and a high preoperative MP.
Highlights
Patients and methods — All reported migration percentage (MP) measurements for children treated with adductor–psoas lengthening (APL) (n = 158) or varus derotation osteotomy (VDRO) (n = 94) and followed ≥ 3 years were obtained from the Swedish Surveillance Programme for cerebral palsy (CP)
Patients and methods — All reported MP measurements for children treated with APL (n = 158) or VDRO (n = 94) and followed ≥ 3 years were obtained from the Swedish Surveillance Programme for CP
The study was based on 1,589 radiographs from 252 children: 158 children (96 boys) were treated with APL at age 5.3 years (1.5–12) and 94 children (54 boys) with VDRO at age 6.7 years (2.1–12.0)
Summary
The 104 hips that underwent APL without reoperation showed a gradually reduced MP postoperatively. The 54 hips that underwent a 2nd surgery with APL or VDRO because of redisplacement had a higher displacement rate preoperatively and continued displacement postoperatively but at a slower rate. The 94 hips that underwent VDRO showed an instantaneous decrease in MP postoperatively followed by a rate of increasing displacement. The 15 hips that underwent a 2nd VDRO had a higher rate of displacement both pre- and postoperatively. Interpretation — After APL, hip displacement either decreases or continues to increase but at a slower rate. There are different opinions about when and the type of surgery needed, especially in relation to the child’s age, degree of displacement, and gross motor function level. Regardless of the surgical procedure, there is a high risk that repeat surgery is needed during the child’s remaining growth period [6,7,8,9,10]
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