Combined pelvic osteotomy and proximal femoral‐guided growth in children with cerebral palsy and hip displacement
Hsiang‐Chieh Hsieh, Ting‐Ming Wang, Chia‐Che Lee, Chih‐Kai Hong, Sheng‐Chieh Lin, Ken N. Kuo, Kuan‐Wen WuAim
To evaluate radiographic outcomes after combined pelvic osteotomy and proximal femoral‐guided growth in children with cerebral palsy (CP) and hip displacement.
Method
We retrospectively reviewed 32 children (14 males, 18 females) with CP (51 hips) treated with combined pelvic osteotomy and guided growth between 2016 and 2022. Indications were a migration percentage greater than 40%, a head‐shaft angle (HSA) greater than 155°, and an acetabular index (≥ 22°). Mean age at surgery was 6 years (range 4–8 years 6 months) with a minimum 2‐year follow‐up. Gross Motor Function Classification System (GMFCS) levels were: seven in GMFCS level III, 20 in GMFCS level IV, and five in GMFCS level V. Radiographic parameters were assessed serially. Poor outcome was defined as a migration percentage of 50% or greater at the final review.
Results
HSA, acetabular index, and migration percentage improved significantly (−9.5°, −7.2°, −28%; all p < 0.001). Generalized estimating equation models showed progressive decreases in HSA with the follow‐up (−2.9° per interval, p < 0.001) and lower HSA in older children (−3° per year, p < 0.001). The acetabular index showed an early postoperative reduction with smaller longitudinal changes and was higher in children with greater motor impairment (+3.6° per GMFCS level, p = 0.003). The migration percentage improved markedly and continued to decline with the follow‐up (−6% per interval, p < 0.001), but was significantly higher in children classified in higher GMFCS levels (+9.9% per level, p = 0.001). Five hips (9%) had poor outcomes, mostly with a baseline migration percentage of 80% or greater.
Interpretation
While favourable outcomes were generally observed in hips with moderate displacement (approximate migration percentage 40%–60%), those with more severe displacement (e.g. a migration percentage of 80% or more) demonstrated less consistent correction and may ultimately require additional reconstruction.