Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Hip development after surgery to prevent hip dislocation in cerebral palsy : a longitudinal register study of 252 children

Wagner, Philippe LU and Hägglund, Gunnar LU (2021) In Acta Orthopaedica 93. p.45-50
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... (More)

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.

(Less)
Please use this url to cite or link to this publication:
author
and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
93
pages
45 - 50
publisher
Taylor & Francis
external identifiers
  • scopus:85117336823
  • pmid:34662250
ISSN
1745-3674
DOI
10.1080/17453674.2021.1989563
language
English
LU publication?
yes
id
41341591-12ad-478b-bd64-1ce958d57020
date added to LUP
2022-01-31 18:15:45
date last changed
2024-06-17 03:28:35
@article{41341591-12ad-478b-bd64-1ce958d57020,
  abstract     = {{<p>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.</p>}},
  author       = {{Wagner, Philippe and Hägglund, Gunnar}},
  issn         = {{1745-3674}},
  language     = {{eng}},
  pages        = {{45--50}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Orthopaedica}},
  title        = {{Hip development after surgery to prevent hip dislocation in cerebral palsy : a longitudinal register study of 252 children}},
  url          = {{http://dx.doi.org/10.1080/17453674.2021.1989563}},
  doi          = {{10.1080/17453674.2021.1989563}},
  volume       = {{93}},
  year         = {{2021}},
}