Outcomes of hip reconstruction in ambulatory patients with cerebral palsy and spastic hip displacement: a retrospective study of 73 hips in 55 consecutive patients

Abstract

Background and purpose - Currently, there is no specific surgical treatment strategy established for spastic hip displacement in ambulatory patients with cerebral palsy. We aimed to evaluate the outcomes of our hip reconstructions, specifically designed to address hip displacement within the context of single-event multilevel surgery (SEMLS). Methods - We conducted a retrospective study on patients with Gross Motor Function Classification System (GMFCS) levels II (n = 27) and III (n = 28). Surgical procedures involved various combinations of open or closed reduction, iliac osteotomy, proximal femoral derotational osteotomy, distal femoral derotational and shortening osteotomy, and proximal femoral varus derotational osteotomy. The overall developmental status of the hip was assessed using the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS) at a mean age of 17.3 years (SD 4.7). Results - 73 hips in 55 patients were included. They underwent hip reconstruction at a mean age of 9.7 years (SD 2.6). 69 of 73 hips achieved successful outcomes. Before surgery, 51 hips had a migration percentage (MP) of 30-60%, 21 had 60-100%, and 1 hip > 100%. At the final follow-up, 12 hips were classified as MCPHCS grade 1 (MP < 10%), 36 as grade 2 (10-15%), 21 as grade 3 (15-30%), 3 as grade 4 (30-60%), and 1 as grade 5 (60-100%). 52 patients either maintained or improved their preoperative GMFCS levels. Conclusion - Within the SEMLS framework, our tailored hip reconstruction achieved satisfactory hip outcomes in 69 of 73 hips and resulted in sustained improvement in hip stability at long-term follow-up.