The aim of this study was to identify if perioperative outcomes were different in patients with cerebral palsy undergoing unilateral or bilateral hip reconstruction. All consecutive hip reconstructions for cerebral palsy performed by the senior author (FNT) within a tertiary-referral centre were identified between January 2012 and July 2016. Patients were stratified by age, gender, GMFCS and side of procedure. Length of surgery, pre- and post- operative haemoglobin, length of stay and immediate post-operative complications were measured.Purpose
Method
The purpose of this paper is to describe the outcomes of major hip surgery for children with cerebral palsy and communication difficulties using a validated health related quality of life measure and a validated pain score. Children with hypertonic bilateral cerebral palsy (CP) GMFCS levels IV and V, 2–15 years old, having femoral +
/- acetabular osteotomies for hip displacement were included if their ability to communicate necessitated the use of the CPCHILD (Caregiver Priorities and Child Health Index of Life with Disabilities) and PPP (Paediatric Pain Profile). The underlying indication for surgery was a hip migration index of more than 40%
. CPCHILD and PPP questionnaires were completed face-to-face with the parents or carers at baseline, at 3 months after surgery and at 6 months after surgery.Purpose
Method
The disadvantages of hip spica casts following hip surgery for cerebral palsy include fractures, plaster sores, soiling and general inconvenience. In this series, 56 hips in 31 children aged 4 to 16 years (mean 8) were treated for hip displacement in keeping with the recommendations of others (eg Miller et al 1997) between 2005 and 2008 by one consultant. There were 29 open reductions for a Reimer's migration index (RMI) greater than 50%. A blade plate was used for the femoral osteotomy, and an acetabuloplasty was performed for 22 hips. No casting or immobilisation of any sort was used. The average length of stay was 5 days. The results at 5 the year follow-up were chosen so that all patients were at the same stage. The average RMI pre-operatively for displaced hips was 76.9 +/− 21.3. At follow-up it was 18.8 +/− 19.7. 18 patients had pain prior to hip surgery; 6 had pain during follow-up, and 4 of these responded to removal of metal; and one required a proximal femoral resection. There were 3 complications: one re-dislocation in the immediate post-operative period, one mal-union because the blade plate cut out; and one of the three walking children fractured below the blade plate 2 ½ months after surgery. There were no infections. The radiographic and clinical outcomes of hip reconstruction without hip spica immobilisation are good, reproducible and long-lasting. The child may be nursed free post-operatively and discharged in his or her own chair. As a result of studying these patients, since 2009 we have introduced locking plates for better fixation, and pre- and post-operative Paediatric Pain Profiles and CPCHILD questionnaires.
Proximal femoral resection (PFR) is a proven
pain-relieving procedure for the management of patients with severe cerebral
palsy and a painful displaced hip. Previous authors have recommended
post-operative traction or immobilisation to prevent a recurrence
of pain due to proximal migration of the femoral stump. We present
a series of 79 PFRs in 63 patients, age 14.7 years (10 to 26; 35
male, 28 female), none of whom had post-operative traction or immobilisation. A total of 71 hips (89.6%) were reported to be pain free or to
have mild pain following surgery. Four children underwent further
resection for persistent pain; of these, three had successful resolution
of pain and one had no benefit. A total of 16 hips (20.2%) showed
radiographic evidence of heterotopic ossification, all of which
had formed within one year of surgery. Four patients had a wound
infection, one of which needed debridement; all recovered fully.
A total of 59 patients (94%) reported improvements in seating and
hygiene. The results are as good as or better than the historical results
of using traction or immobilisation. We recommend that following
PFR, children can be managed without traction or immobilisation,
and can be discharged earlier and with fewer complications. However,
care should be taken with severely dystonic patients, in whom more
extensive femoral resection should be considered in combination
with management of the increased tone. Cite this article:
