Treatment of Hip Displacement in Children with Cerebral Palsy : A 5-year Comparison of Proximal Femoral Osteotomy and Combined Femoral-Pelvic Osteotomy in 163 Children
(2024) In Journal of Pediatric Orthopaedics 44(6). p.536-541- Abstract
Background: This study compared the 5-year outcomes of isolated proximal femoral varus osteotomy (FO) and combined proximal femoral varus and pelvic osteotomy (FPO) for the treatment of hip displacement in children with cerebral palsy (CP) in Sweden, focusing on the number of reoperations and residual hip displacement. Methods: The study included 163 children with a 5-year follow-up after FO or FPO in the national Swedish CP surveillance program, CPUP. Descriptive statistics and univariate and multivariate Cox regression analyses were used to identify whether the age at surgery, sex, Gross Motor Function Classification System level, CP dominant symptom, hip migration percentage (MP), type of surgery (unilateral/bilateral), and history... (More)
Background: This study compared the 5-year outcomes of isolated proximal femoral varus osteotomy (FO) and combined proximal femoral varus and pelvic osteotomy (FPO) for the treatment of hip displacement in children with cerebral palsy (CP) in Sweden, focusing on the number of reoperations and residual hip displacement. Methods: The study included 163 children with a 5-year follow-up after FO or FPO in the national Swedish CP surveillance program, CPUP. Descriptive statistics and univariate and multivariate Cox regression analyses were used to identify whether the age at surgery, sex, Gross Motor Function Classification System level, CP dominant symptom, hip migration percentage (MP), type of surgery (unilateral/bilateral), and history of soft tissue hip surgery were related to the 5-year outcomes after surgery. Failure after hip surgery was defined as a skeletal reoperation involving the hip and/or MP >50%. Results: During the period 2001 to 2017, 163 children (65 girls) underwent 246 femoral and/or pelvic osteotomies (154 FO, 47 bilaterally; 92 FPO, 16 bilaterally) and had a 5-year follow-up; 95 and 74 children had ≥1 FO or FPO as the primary skeletal surgery, respectively. The mean preoperative MP (51%±18% for FO and 59%±17% for FPO, P=0.001) and age at surgery (6.2±2.5 years for FO and 7.3±2.8 years for FPO, P=0.014) differed between procedures. At the 5-year follow-up, 5 hips (5%) had reoperations and 5 hips (5%) had radiological failure among the 92 FPOs, and 33 (21%) had reoperations and 14 (9%) radiological failure among the 154 FOs. The difference in outcome failure rate was significant (P<0.001). Multivariate Cox regression analysis showed a lower risk for failure with FPO [hazard ratio (HR)=0.32, 95% CI: 0.15-0.68] compared with FO. A higher preoperative MP increased the risk for outcome failure (HR=1.21, 95% CI: 1.15-1.36 for each 5% increment). Conclusions: FPO had a higher mean preoperative MP but a lower 5-year outcome failure rate compared with FO. A higher preoperative MP was associated with an increased risk of failure. Level of Evidence: Level II - prospective comparative study.
(Less)
- author
- Kiapekos, Nikolaos ; Von Heideken, Johan ; Broström, Eva ; Hägglund, Gunnar LU and Åstrand, Per
- organization
- publishing date
- 2024-07-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- cerebral palsy, children, hip displacement, hip subluxation, reconstructive hip surgery
- in
- Journal of Pediatric Orthopaedics
- volume
- 44
- issue
- 6
- pages
- 536 - 541
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- scopus:85195327768
- pmid:38477355
- ISSN
- 0271-6798
- DOI
- 10.1097/BPO.0000000000002674
- language
- English
- LU publication?
- yes
- id
- 61743969-7e29-480c-8d5f-7cc36d8c09fa
- date added to LUP
- 2024-11-07 12:10:53
- date last changed
- 2025-06-06 05:39:22
@article{61743969-7e29-480c-8d5f-7cc36d8c09fa,
abstract = {{<p>Background: This study compared the 5-year outcomes of isolated proximal femoral varus osteotomy (FO) and combined proximal femoral varus and pelvic osteotomy (FPO) for the treatment of hip displacement in children with cerebral palsy (CP) in Sweden, focusing on the number of reoperations and residual hip displacement. Methods: The study included 163 children with a 5-year follow-up after FO or FPO in the national Swedish CP surveillance program, CPUP. Descriptive statistics and univariate and multivariate Cox regression analyses were used to identify whether the age at surgery, sex, Gross Motor Function Classification System level, CP dominant symptom, hip migration percentage (MP), type of surgery (unilateral/bilateral), and history of soft tissue hip surgery were related to the 5-year outcomes after surgery. Failure after hip surgery was defined as a skeletal reoperation involving the hip and/or MP >50%. Results: During the period 2001 to 2017, 163 children (65 girls) underwent 246 femoral and/or pelvic osteotomies (154 FO, 47 bilaterally; 92 FPO, 16 bilaterally) and had a 5-year follow-up; 95 and 74 children had ≥1 FO or FPO as the primary skeletal surgery, respectively. The mean preoperative MP (51%±18% for FO and 59%±17% for FPO, P=0.001) and age at surgery (6.2±2.5 years for FO and 7.3±2.8 years for FPO, P=0.014) differed between procedures. At the 5-year follow-up, 5 hips (5%) had reoperations and 5 hips (5%) had radiological failure among the 92 FPOs, and 33 (21%) had reoperations and 14 (9%) radiological failure among the 154 FOs. The difference in outcome failure rate was significant (P<0.001). Multivariate Cox regression analysis showed a lower risk for failure with FPO [hazard ratio (HR)=0.32, 95% CI: 0.15-0.68] compared with FO. A higher preoperative MP increased the risk for outcome failure (HR=1.21, 95% CI: 1.15-1.36 for each 5% increment). Conclusions: FPO had a higher mean preoperative MP but a lower 5-year outcome failure rate compared with FO. A higher preoperative MP was associated with an increased risk of failure. Level of Evidence: Level II - prospective comparative study.</p>}},
author = {{Kiapekos, Nikolaos and Von Heideken, Johan and Broström, Eva and Hägglund, Gunnar and Åstrand, Per}},
issn = {{0271-6798}},
keywords = {{cerebral palsy; children; hip displacement; hip subluxation; reconstructive hip surgery}},
language = {{eng}},
month = {{07}},
number = {{6}},
pages = {{536--541}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Journal of Pediatric Orthopaedics}},
title = {{Treatment of Hip Displacement in Children with Cerebral Palsy : A 5-year Comparison of Proximal Femoral Osteotomy and Combined Femoral-Pelvic Osteotomy in 163 Children}},
url = {{http://dx.doi.org/10.1097/BPO.0000000000002674}},
doi = {{10.1097/BPO.0000000000002674}},
volume = {{44}},
year = {{2024}},
}