Remodelling of femoral head deformity after hip reconstructive surgery in patients with cerebral palsy

Jae Jung Min, Soon-Sun Kwon, Ki Hyuk Sung, Kyoung Min Lee, Chin Youb Chung, Moon Seok Park, Jae Jung Min, Soon-Sun Kwon, Ki Hyuk Sung, Kyoung Min Lee, Chin Youb Chung, Moon Seok Park

Abstract

Aims: Hip displacement, common in patients with cerebral palsy (CP), causes pain and hinders adequate care. Hip reconstructive surgery (HRS) is performed to treat hip displacement; however, only a few studies have quantitatively assessed femoral head sphericity after HRS. The aim of this study was to quantitatively assess improvement in hip sphericity after HRS in patients with CP.

Methods: We retrospectively analyzed hip radiographs of patients who had undergone HRS because of CP-associated hip displacement. The pre- and postoperative migration percentage (MP), femoral neck-shaft angle (NSA), and sphericity, as determined by the Mose hip ratio (MHR), age at surgery, Gross Motor Function Classification System level, surgical history including Dega pelvic osteotomy, and triradiate cartilage status were studied. Regression analyses using linear mixed model were performed to identify factors affecting hip sphericity improvement.

Results: A total of 108 patients were enrolled. The mean preoperative MP was 58.3% (SD 31.7%), which improved to 9.1% (SD 15.6%) at the last follow-up. NSA and MHR improved from 156.5° (SD 11.5°) and 82.3% (SD 8.6%) to 126.0° (SD 18.5°) and 89.1% (SD 9.0%), respectively. Factors affecting the postoperative MHR were preoperative MP (p = 0.005), immediate postoperative MP (p = 0.032), and history of Dega osteotomy (p = 0.046).

Conclusion: We found that hip sphericity improves with HRS. Preoperative MP, reduction quality, and acetabular coverage influence femoral head remodelling. We recommend that surgeons should consider intervention early before hip displacement progresses and that during HRS, definite reduction and coverage of the femoral head should be obtained. Cite this article: Bone Joint J 2021;103-B(1):198-203.

Keywords: CP hip displacement; Cerebral palsy; Femoral head deformity; Hip reconstructive surgery; Mose hip ratio.

Figures

Fig. 1
Fig. 1
Flowchart of patient inclusion and exclusion and available data for analysis. CP, cerebral palsy; GMFCS, Gross Motor Function Classification System; MP, migration percentage; NSA, neck-shaft angle; MHCAC, Melbourne hip classification for adolescents with cerebral palsy.
Fig. 2
Fig. 2
Anteroposterior (AP) hip supine radiographs of an eight-year-old male patient. a) On the right hip, the Mose hip ratio (MHR) was defined as the percentage ratio between radii of two concentric circles (the inner A) and outer cortices (B) of femoral head ). b) On the left hip, the migration percentage (MP) was calculated by dividing the width of the femoral head lateral to the Perkin’s line (A) by the total width of the femoral head (B).
Fig. 3
Fig. 3
Radiographs of an 11-year-old female patient with Gross Motor Function Classification System level V who underwent hip reconstructive surgery (HRS) because of bilateral cerebral palsy (CP) hip displacement. a) Preoperative radiograph of the right hip shows the migration percentage (MP) (100%) and Mose Hip Ratio (MHR) (64%), along with head destruction. b) Immediate postoperative radiograph after HRS consisting of bilateral open reduction, femoral varization and derotational osteotomy, Dega osteotomy, and soft tissue release. c) Radiograph at last follow-up (four years after HRS). Head deformity has improved to a MHR of 71% and MP of 13%. The patient is currently pain-free.

References

    1. Cooke PH, Cole WG, Carey RP. Dislocation of the hip in cerebral palsy. natural history and predictability. J Bone Joint Surg Br. 1989;71-B(3):441–446.
    1. Lins LAB, Watkins CJ, Shore BJ. Natural history of spastic hip disease. J Pediatr Orthop. 2019;39(Issue 6, Supplement 1 Suppl 1):S33–S37.
    1. Terjesen T. Development of the hip joints in unoperated children with cerebral palsy: a radiographic study of 76 patients. Acta Orthop. 2006;77(1):125–131.
    1. Wordie SJ, Robb JE, Hägglund G, Bugler KE, Gaston MS. Hip displacement and dislocation in a total population of children with cerebral palsy in Scotland. Bone Joint J. 2020;102-B(3):383–387.
    1. Bax M, Goldstein M, Rosenbaum P, et al. . Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. 2005;47(8):571–576.
    1. DiFazio R, Shore B, Vessey JA, Miller PE, Snyder BD. Effect of hip reconstructive surgery on health-related quality of life of Non-Ambulatory children with cerebral palsy. J Bone Joint Surg Am. 2016;98-A(14):1190–1198.
    1. Dohin B. The spastic hip in children and adolescents. Orthop Traumatol Surg Res. 2019;105(1S):S133–S141.
    1. Boldingh EJ, Bouwhuis CB, van der Heijden-Maessen HCM, Bos CF, Lankhorst GJ. Palliative hip surgery in severe cerebral palsy: a systematic review. J Pediatr Orthop B. 2014;23(1):86–92.
    1. Kolman SE, Ruzbarsky JJ, Spiegel DA, Baldwin KD. Salvage options in the cerebral palsy hip: a systematic review. J Pediatr Orthop. 2016;36(6):645–650.
    1. Braatz F, Eidemüller A, Klotz MC, Beckmann NA, Wolf SI, Dreher T. Hip reconstruction surgery is successful in restoring joint congruity in patients with cerebral palsy: long-term outcome. Int Orthop. 2014;38(11):2237–2243.
    1. Chung CY, Choi IH, Cho T-J, Yoo WJ, Lee SH, Park MS. Morphometric changes in the acetabulum after Dega osteotomy in patients with cerebral palsy. J Bone Joint Surg Br. 2008;90(1):88–91.
    1. Park MS, Chung CY, Kwon DG, Sung KH, Choi IH, Lee KM. Prophylactic femoral varization osteotomy for contralateral stable hips in non-ambulant individuals with cerebral palsy undergoing hip surgery: decision analysis. Dev Med Child Neurol. 2012;54(3):231–239.
    1. Robin J, Graham HK, Baker R, et al. . A classification system for hip disease in cerebral palsy. Dev Med Child Neurol. 2009;51(3):183–192.
    1. Mose K. Methods of measuring in Legg-Calvé-Perthes disease with special regard to the prognosis. Clin Orthop Relat Res. 1980;150:103–109.
    1. Reimers J. The stability of the hip in children. A radiological study of the results of muscle surgery in cerebral palsy. Acta Orthop Scand Suppl. 1980;184:1–100.
    1. Cuomo AV, Fedorak GT, Moseley CF. A practical approach to determining the center of the femoral head in subluxated and dislocated hips. J Pediatr Orthop. 2015;35(6):556–560.
    1. Lee KM, Lee J, Chung CY, et al. . Pitfalls and important issues in testing reliability using intraclass correlation coefficients in orthopaedic research. Clin Orthop Surg. 2012;4(2):149–155.
    1. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86(2):420–428.
    1. Bonett DG. Sample size requirements for estimating intraclass correlations with desired precision. Stat Med. 2002;21(9):1331–1335.
    1. Braatz F, Staude D, Klotz MC, Wolf SI, Dreher T, Lakemeier S. Hip-Joint congruity after Dega osteotomy in patients with cerebral palsy: long-term results. Int Orthop. 2016;40(8):1663–1668.
    1. Sawilowsky SS, et al. New effect size rules of thumb. Journal of Modern Applied Statistical Methods. 2008;8(2):597–599.
    1. Cooperman DR, Bartucci E, Dietrick E, Millar EA. Hip dislocation in spastic cerebral palsy: long-term consequences. J Pediatr Orthop. 1987;7(3):268–276.
    1. Rutz E, Vavken P, Camathias C, Haase C, Jünemann S, Brunner R. Long-Term results and outcome predictors in one-stage hip reconstruction in children with cerebral palsy. J Bone Joint Surg Am. 2015;97-A(6):500–506.
    1. Ippolito E, Tudisco C, Farsetti P. The long-term prognosis of unilateral Perthes' disease. J Bone Joint Surg Br. 1987;69-B(2):243–250.
    1. Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1981;63-A(7):1095–1108.
    1. Siebenrock KA, Anwander H, Zurmühle CA, Tannast M, Slongo T, Steppacher SD. Head reduction osteotomy with additional containment surgery improves sphericity and containment and reduces pain in Legg-Calvé-Perthes disease. Clin Orthop Relat Res. 2015;473(4):1274–1283.

Source: PubMed

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