Outcomes of Isolated Varus Derotational Osteotomy in Children With Cerebral Palsy Hip Dysplasia and Predictors of Resubluxation.
BACKGROUND
The appropriate intervention for hip subluxation or dislocation in children affected by cerebral palsy (CP) remains controversial. The purpose of this retrospective study was to report radiographic and clinical outcomes following isolated femoral varus derotational osteotomy (VDRO) in children with CP hip dysplasia. Risk factors for resubluxation and avascular necrosis (AVN) were also examined.


METHODS
A cohort of 100 patients (199 hips) with CP treated with isolated VDRO between 2003 and 2009 was reviewed. All but 1 patient received bilateral surgery. Patients were followed for an average of 5.4 years (range, 1.03 to 10.20 y). Anteroposterior pelvic radiographs were used to assess migration percentage (MP), Shenton's line, and presence of AVN. Resubluxation was defined as a postoperative break in Shenton's line. Radiographic outcomes and risk analysis was performed in the 91 subjects (179 hips) with radiographic follow-up >1 year.


RESULTS
Significant improvement was observed in MP, and all hips had a reconstituted Shenton's line following surgery. Over the course of follow-up, 16% of hips were noted to have a repeat break in Shenton's line. Univariate risk analysis showed preoperative MP, Gross Motor Function Classification System (GMFCS) level, and age at surgery were risk factors for a recurrent line break. Preoperative MP and GMFCS level were found to be predictors of resubluxation in multivariate analysis. AVN was detected in 10 hips (5.7%). GMFCS level V patients were more at risk for resubluxation, but less at risk for AVN when compared with ambulatory (GMFCS I/II/II) patients and GMFCS level IV patients.


CONCLUSIONS
Performing a VDRO without additional procedures provided a stable and concentrically reduced hip joint in this population of children with CP. Attention should be paid to initial ambulatory status during the postoperative period. Concomitant procedures such as pelvic osteotomy should be considered for patients of GMFCS level IV and V, as these patients were more at risk for recurrent subluxation.


METHODS
Level III-retrospective comparative study.
Departments of Orthopaedic Surgery.|Center for Gait and Movement Analysis, Children's Hospital Colorado.|University of Colorado School of Medicine, Aurora, CO.
Frank M
FM
Chang
Center for Gait and Movement Analysis, Children's Hospital Colorado.
Allison
A
May
Departments of Orthopaedic Surgery.|University of Colorado School of Medicine, Aurora, CO.
Leonard W
LW
Faulk
Center for Gait and Movement Analysis, Children's Hospital Colorado.
Katherine
K
Flynn
Departments of Orthopaedic Surgery.|University of Colorado School of Medicine, Aurora, CO.
Nancy H
NH
Miller
Departments of Orthopaedic Surgery.|Center for Gait and Movement Analysis, Children's Hospital Colorado.|University of Colorado School of Medicine, Aurora, CO.
Jason T
JT
Rhodes
Pediatrics.
Pan
P
Zhaoxing
Departments of Orthopaedic Surgery.|University of Colorado School of Medicine, Aurora, CO.
Eduardo N
EN
Novais
D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000601:surgery; D006618:Hip Dislocation, Congenital / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D011184:Postoperative Period; D011859:Radiography / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors