title: Risk factors and complications in hip reconstruction for nonambulatory patients with cerebral palsy.
abstract: BACKGROUND
  Hip dysplasia is prevalent in nonambulatory children with cerebral palsy, and may contribute to a decreased quality of life (Lonstein in J Pediatr Orthop 6:521-526, 1). Reconstructive procedures such as a femoral varus derotation osteotomy with or without a pelvic osteotomy are commonly employed with the goal of achieving and maintaining well reduced hips.
  
  
  OBJECTIVE
  The goals of this study are both to characterize the complications of reconstructive procedures and to identify risk factors that may contribute to these complications.
  
  
  METHODS
  A retrospective analysis was conducted among 61 nonambulatory children (93 hips) with cerebral palsy who underwent a femoral varus derotation osteotomy, with or without an open reduction and/or pelvic osteotomy, from 1992 through 2008 at our institution. The average patient age was 8.1 years (2.6-14.7) and the mean follow-up time was 5.9 years (2.1-15.9).
  
  
  RESULTS
  The cumulative complication rate per patient including failures to cure was 47.6 %. Spica casting was found to be a risk factor for all complications (P = 0.023); whereas patients younger than 6 years old (P = 0.013) and children with a tracheostomy (P = 0.004) were found to be risk factors for resubluxation following surgery.
  
  
  CONCLUSIONS
  Although reported complication rates of hip reconstructive procedures performed upon children with cerebral palsy have varied considerably, those with more severe disease have experienced more complications. We report our tertiary referral center's complication rate and our institutional experiences with risk factors for complications and failures to cure.
  
  
  METHODS
  IV, Retrospective case series.
authors.affiliation: Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 2nd Floor Wood Building, 34th and Civic Center Blvd, Philadelphia, PA 19104 USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Ruzbarsky
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454 USA.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Beck
authors.affiliation: Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 2nd Floor Wood Building, 34th and Civic Center Blvd, Philadelphia, PA 19104 USA.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Baldwin
authors.affiliation: Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 2nd Floor Wood Building, 34th and Civic Center Blvd, Philadelphia, PA 19104 USA.
authors.forename: Wudbhav N
authors.initials: WN
authors.lastname: Sankar
authors.affiliation: Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 2nd Floor Wood Building, 34th and Civic Center Blvd, Philadelphia, PA 19104 USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Flynn
authors.affiliation: Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 2nd Floor Wood Building, 34th and Civic Center Blvd, Philadelphia, PA 19104 USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Spiegel
keywords: Cerebral palsy; Complications; Hip surgery; Nonambulatory