Timely Surgical Intervention Leads to Better Sustained Coverage after Reconstructive Hip Surgery in Patients with Cerebral Palsy

Children, vol. 11, pp. 272

Abstract

Background: In up to 45–90% of non-ambulatory patients with cerebral palsy (CP), progressive hip migration can be observed. The goal of this study was to determine whether the implementation of a national hip surveillance guideline affected the outcome of hip reconstructions. Methods: We reviewed 48 primary hip reconstructions at a median follow-up of 4.4 years. Surgical outcome was evaluated based on complication rates and radiographic evaluation postoperatively and at follow-up. Radiographic measurements included the migration percentage (MP), head–shaft angle and acetabular index. The impact of preoperative MP, postoperative MP, tone management, Gross Motor Function Classification System (GMFCS) classification and age on MP at follow-up were examined using a mixed model analysis. Results: A decrease in preoperative MP was noted, from a median of 75.0% (2014) to 39.0% (2020). Lower preoperative MP showed a significant correlation to lower MP postoperatively (p = 0.012). Postoperative MP was a significant independent predictor of a lower MP at follow-up (p = 0.002). Conclusions: This study shows an improvement in the timing of hip reconstruction in patients with CP after implementation of the hip surveillance guideline. A reduction in preoperative MP resulted in improved postoperative outcomes. A lower postoperative MP was the most important predictor for sustained containment of the hip.

Authors 6

1. Renée Anne van Stralen

   Erasmus MC · Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Department of Orthopedics and Sports Medicine, Erasmus Medical Center Rotterdam—Sophia Children’s Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

2. Dagmar R. J. Kempink Aachen Department of Orthopedics, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center · Erasmus MC · Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Department of Orthopedics and Sports Medicine, Erasmus Medical Center Rotterdam—Sophia Children’s Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

   Department of Orthopedics, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands

3. Alexandra Frederika Titulaer

   Rijndam Revalidatiecentrum

   Affiliation as printed

   Department of Rehabilitation Medicine, Rijndam Revalidatie, 3015 CN Rotterdam, The Netherlands

4. Denise E. Eygendaal

   Erasmus MC · Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Department of Orthopedics and Sports Medicine, Erasmus Medical Center Rotterdam—Sophia Children’s Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

5. Max Reijman

   Erasmus MC · Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Department of Orthopedics and Sports Medicine, Erasmus Medical Center Rotterdam—Sophia Children’s Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

6. Jaap Johannes Tolk

   Erasmus MC · Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Department of Orthopedics and Sports Medicine, Erasmus Medical Center Rotterdam—Sophia Children’s Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands