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Primary surgery to prevent hip dislocation in children with cerebral palsy in Sweden : a minimum 5-year follow-up by the national surveillance program (CPUP)

Kiapekos, Nikolaos; Broström, Eva; Hägglund, Gunnar LU and Åstrand, Per (2019) In Acta Orthopaedica
Abstract

Background and purpose — Children with cerebral palsy (CP) have an increased risk of hip dislocation. Outcome studies after surgery to prevent hip dislocation in children with CP are usually retrospective series from single tertiary referral centers. According to the national CP surveillance program in Sweden (CPUP), hip surgery should preferably be performed at an early age to prevent hip dislocation. Preventive operations are performed in 12 different Swedish hospitals. We compared the outcomes between soft tissue release and femoral osteotomy in children with CP treated in these hospitals. Patients and methods — 186 children with CP underwent either adductor–iliopsoas tenotomy (APT) or femoral osteotomy (FO) as the primary,... (More)

Background and purpose — Children with cerebral palsy (CP) have an increased risk of hip dislocation. Outcome studies after surgery to prevent hip dislocation in children with CP are usually retrospective series from single tertiary referral centers. According to the national CP surveillance program in Sweden (CPUP), hip surgery should preferably be performed at an early age to prevent hip dislocation. Preventive operations are performed in 12 different Swedish hospitals. We compared the outcomes between soft tissue release and femoral osteotomy in children with CP treated in these hospitals. Patients and methods — 186 children with CP underwent either adductor–iliopsoas tenotomy (APT) or femoral osteotomy (FO) as the primary, preventive surgery because of hip displacement. They were followed for a minimum of 5 years (mean 8 years) regarding revision surgery and hip migration. A good outcome was defined as the absence of revision surgery and a migration percentage (MP) < 50% at the latest follow-up. Logistic and Cox regression analysis were used to investigate the influence of age, sex, preoperative MP, Gross Motor Function Classification System (GMFCS) level, and CP subtype. Results — APT was performed in 129 (69%) children. After 5 years, the reoperation rate was 43%, and 2 children (2%) had an MP > 50%. For the 57 children who underwent FO, the corresponding figures were 39% and 9%. Of the potential risk factors studied, the outcome was statistically significantly associated with preoperative MP only in children who underwent APT, but not in those who underwent FO. None of the other factors were significantly associated with the outcome in the 2 procedure groups. Interpretation — Reoperation rates after preventive surgery are high and indicate the importance of continued postoperative follow-up. Age, sex, GMFCS level, and CP subtype did not influence the outcome significantly.

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epub
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in
Acta Orthopaedica
publisher
Taylor & Francis
external identifiers
  • scopus:85067630036
ISSN
1745-3674
DOI
10.1080/17453674.2019.1627116
language
English
LU publication?
yes
id
6ef4c3b9-27f3-4a4a-9a24-d87ca56bf9f5
date added to LUP
2019-07-05 13:02:13
date last changed
2019-07-30 05:06:09
@article{6ef4c3b9-27f3-4a4a-9a24-d87ca56bf9f5,
  abstract     = {<p>Background and purpose — Children with cerebral palsy (CP) have an increased risk of hip dislocation. Outcome studies after surgery to prevent hip dislocation in children with CP are usually retrospective series from single tertiary referral centers. According to the national CP surveillance program in Sweden (CPUP), hip surgery should preferably be performed at an early age to prevent hip dislocation. Preventive operations are performed in 12 different Swedish hospitals. We compared the outcomes between soft tissue release and femoral osteotomy in children with CP treated in these hospitals. Patients and methods — 186 children with CP underwent either adductor–iliopsoas tenotomy (APT) or femoral osteotomy (FO) as the primary, preventive surgery because of hip displacement. They were followed for a minimum of 5 years (mean 8 years) regarding revision surgery and hip migration. A good outcome was defined as the absence of revision surgery and a migration percentage (MP) &lt; 50% at the latest follow-up. Logistic and Cox regression analysis were used to investigate the influence of age, sex, preoperative MP, Gross Motor Function Classification System (GMFCS) level, and CP subtype. Results — APT was performed in 129 (69%) children. After 5 years, the reoperation rate was 43%, and 2 children (2%) had an MP &gt; 50%. For the 57 children who underwent FO, the corresponding figures were 39% and 9%. Of the potential risk factors studied, the outcome was statistically significantly associated with preoperative MP only in children who underwent APT, but not in those who underwent FO. None of the other factors were significantly associated with the outcome in the 2 procedure groups. Interpretation — Reoperation rates after preventive surgery are high and indicate the importance of continued postoperative follow-up. Age, sex, GMFCS level, and CP subtype did not influence the outcome significantly.</p>},
  author       = {Kiapekos, Nikolaos and Broström, Eva and Hägglund, Gunnar and Åstrand, Per},
  issn         = {1745-3674},
  language     = {eng},
  month        = {06},
  publisher    = {Taylor & Francis},
  series       = {Acta Orthopaedica},
  title        = {Primary surgery to prevent hip dislocation in children with cerebral palsy in Sweden : a minimum 5-year follow-up by the national surveillance program (CPUP)},
  url          = {http://dx.doi.org/10.1080/17453674.2019.1627116},
  year         = {2019},
}