Abstract
Objective: To use the measurement of migration percentage (MP) to evaluate the long-term radiographic results of soft tissue surgery as the first treatment for hip displacement in spastic bilateral cerebral palsy. A secondary objective was to identify predictive factors of stability (i.e., less than 30% of MP in the long term), after surgical correction. Methods: In this longitudinal cohort study, we reviewed the electronic medical records and radiographs of all consecutive patients with cerebral palsy operated for the correction of hip displacement between 1984 and 2013 in a referral orthopedic public hospital in Brazil. Patients were included if they had received, as the first surgical procedure, soft-tissue release. All surgeries were bilateral and symmetrical. We used the available radiographs to evaluate the migration percentage (MP), acetabular index (AI), pelvic obliquity (PO) angle, head-shaft angle (HSA), congruence and femoral head sphericity, and function using the GMFCS (Gross Motor Function Classification System). Results: we included 93 patients, all operated before being 12 years old, with follow-up of 10 years in average, 73 (78%) of them with good results (MP < 30%). We found association between preoperative MP ≤ 40%, AI ≤ 25°, and postoperative symmetry with good results, with a cut-off value of 38% of MP and 27° of acetabular index being predictive. Discussion: The role of soft tissue releases remains controversial owing to small sample sizes, heterogeneity, variety range of ages, definitions used for outcome, and lack of statistical quality. Our results were better in combined tenotomies, in diparetic patients aged more than six years, and in patients with lower initial values of MP and AI. Radiographic variables had good correlation with each other and association with results, with cut-off values for MP and AI PRE.
Highlights
The incidence of hip dislocation has been reported in 2.6–34% of children with cerebral palsy, resulting in pain and in quality-of-life reduction [1]
We evaluated the association of the mean migration percentage (MP), acetabular index (AI), head-shaft angle (HSA), pelvic obliquity (PO) measurements with the good or bad results (Table 1)
The inclusion criteria adopted in our study provided a homogeneous sample of children of the same age range, all with spastic bilateral cerebral palsy, and submitted to soft tissue surgery as the first procedure
Summary
The incidence of hip dislocation has been reported in 2.6–34% of children with cerebral palsy, resulting in pain and in quality-of-life reduction [1]. The basis for surgical treatment of hip dislocation in these cases is obtaining balance of the pelvis. Detection of hip displacement is advocated, but it is not safe through clinical examination alone or by evaluating other risk factors [3]. Different limit values have been adopted as radiographic parameters in the literature, depending on the objective of the treatment and the type of evaluation. The available studies are retrospective cohorts with patients of different age groups, radiographic and functional preoperative statuses and categories, length of follow-up, clinical subtypes, and evaluation criteria, leading to results that are difficult to compare [4]. Few studies have been published with a long follow-up time [5,6,7]
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