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

Abstract

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. 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. 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 8.1years (2.6-14.7) and the mean follow-up time was 5.9years (2.1-15.9). 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 6years old (P=0.013) and children with a tracheostomy (P=0.004) were found to be risk factors for resubluxation following surgery. 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. IV, Retrospective case series.