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.
Purposes
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.
Patients and 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.
Level of evidence
IV, Retrospective case series.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs11832-013-0536-1/MediaObjects/11832_2013_536_Fig1_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs11832-013-0536-1/MediaObjects/11832_2013_536_Fig2_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs11832-013-0536-1/MediaObjects/11832_2013_536_Fig3_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs11832-013-0536-1/MediaObjects/11832_2013_536_Fig4_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs11832-013-0536-1/MediaObjects/11832_2013_536_Fig5_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs11832-013-0536-1/MediaObjects/11832_2013_536_Fig6_HTML.gif)
Similar content being viewed by others
References
Lonstein JE, Beck K, Lonstein JE, Beck K (1986) Hip dislocation and subluxation in cerebral palsy. J Pediatr Orthop 6:521–526
Flynn JM, Miller F, Flynn JM, Miller F (2002) Management of hip disorders in patients with cerebral palsy. J Am Acad Orthop Surg 10:198–209
Spiegel DA, Flynn JM, Spiegel DA, Flynn JM (2006) Evaluation and treatment of hip dysplasia in cerebral palsy. Orthop Clin North Am 37:185–196
Brunner R, Baumann JU (1994) Clinical benefit of reconstruction of dislocated or subluxated hip joints in patients with spastic cerebral palsy. J Pediatr Orthop 14:290–294
Gordon JE, Capelli AM, Strecker WB, Delgado ED, Schoenecker PL (1996) Pemberton pelvic osteotomy and varus rotational osteotomy in the treatment of acetabular dysplasia in patients who have static encephalopathy. J Bone Joint Surg Am 78:1863–1871
Hoffer MM, Stein GA, Koffman M, Prietto M (1985) Femoral varus-derotation osteotomy in spastic cerebral palsy. J Bone Joint Surg Am 67:1229–1235
Khalife R, Ghanem I, El Hage S, Dagher F, Kharrat K (2010) Risk of recurrent dislocation and avascular necrosis after proximal femoral varus osteotomy in children with cerebral palsy. J Pediatr Orthop B 19:32–37
Luegmair M, Vuillerot C, Cunin V, Sailhan F, Berard J, Luegmair M, Vuillerot C, Cunin V, Sailhan F, Berard J (2009) Slotted acetabular augmentation, alone or as part of a combined one-stage approach for treatment of hip dysplasia in adolescents with cerebral palsy: results and complications in 19 hips. J Pediatr Orthop 29:784–791
McNerney NP, Mubarak SJ, Wenger DR, McNerney NP, Mubarak SJ, Wenger DR (2000) One-stage correction of the dysplastic hip in cerebral palsy with the San Diego acetabuloplasty: results and complications in 104 hips. J Pediatr Orthop 20:93–103
Miller F, Girardi H, Lipton G, Ponzio R, Klaumann M, Dabney KW (1997) Reconstruction of the dysplastic spastic hip with peri-ilial pelvic and femoral osteotomy followed by immediate mobilization. J Pediatr Orthop 17:592–602
Noonan KJ, Walker TL, Kayes KJ, Feinberg J (2001) Varus derotation osteotomy for the treatment of hip subluxation and dislocation in cerebral palsy: statistical analysis in 73 hips. J Pediatr Orthop B 10:279–286
Root L, Laplaza FJ, Brourman SN, Angel DH (1995) The severely unstable hip in cerebral palsy. Treatment with open reduction, pelvic osteotomy, and femoral osteotomy with shortening. J Bone Joint Surg Am 77:703–712
Sankar WN, Spiegel DA, Gregg JR, Sennett BJ, Sankar WN, Spiegel DA, Gregg JR, Sennett BJ (2006) Long-term follow-up after one-stage reconstruction of dislocated hips in patients with cerebral palsy. J Pediatr Orthop 26:1–7
Shea KG, Coleman SS, Carroll K, Stevens P, Van Boerum DH (1997) Pemberton pericapsular osteotomy to treat a dysplastic hip in cerebral palsy. J Bone Joint Surg Am 79:1342–1351
Song HR, Carroll NC (1998) Femoral varus derotation osteotomy with or without acetabuloplasty for unstable hips in cerebral palsy. J Pediatr Orthop 18:62–68
Stasikelis PJ, Lee DD, Sullivan CM (1999) Complications of osteotomies in severe cerebral palsy. J Pediatr Orthop 19:207–210
Sturm PF, Alman BA, Christie BL (1993) Femur fractures in institutionalized patients after hip spica immobilization. J Pediatr Orthop 13:246–248
Al-Ghadir M, Masquijo JJ, Guerra LA, Willis B (2009) Combined femoral and pelvic osteotomies versus femoral osteotomy alone in the treatment of hip dysplasia in children with cerebral palsy. J Pediatr Orthop 29:779–783
Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Sink EL, Beaule PE, Sucato D, Kim YJ, Millis MB, Dayton M, Trousdale RT, Sierra RJ, Zaltz I, Schoenecker P, Monreal A, Clohisy J (2011) Multicenter study of complications following surgical dislocation of the hip. J Bone Joint Surg Am
Scrutton D, Baird G, Smeeton N (2001) Hip dysplasia in bilateral cerebral palsy: incidence and natural history in children aged 18 months to 5 years. Dev Med Child Neurol 43:586–600
Miller F, Bagg MR (1995) Age and migration percentage as risk factors for progression in spastic hip disease. Dev Med Child Neurol 37:449–455
Canavese F, Emara K, Sembrano JN, Bialik V, Aiona MD, Sussman MD (2010) Varus derotation osteotomy for the treatment of hip subluxation and dislocation in GMFCS level III to V patients with unilateral hip involvement. Follow-up at skeletal maturity. J Pediatr Orthop 30:357–364
Author information
Authors and Affiliations
Corresponding author
Appendix
About this article
Cite this article
Ruzbarsky, J.J., Beck, N.A., Baldwin, K.D. et al. Risk factors and complications in hip reconstruction for nonambulatory patients with cerebral palsy. J Child Orthop 7, 487–500 (2013). https://doi.org/10.1007/s11832-013-0536-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11832-013-0536-1