The Evolution of Proximal Femur Hemiepiphysiodesis in Children with Cerebral Palsy

Hip displacement is a common and progressive musculoskeletal complication in children with cerebral palsy (CP), often driven by coxa valga, muscle imbalance, and spasticity. While proximal femoral and pelvic osteotomies remain the standard treatment for advanced deformity, proximal femoral guided growth (temporary medial hemiepiphysiodesis) has emerged as a minimally invasive alternative for selected patients with remaining growth potential. This narrative review summarizes the current evidence regarding indications, surgical technique, radiographic outcomes, complications, and future directions for proximal femoral guided growth in CP. The literature, consisting primarily of retrospective case series and one systematic review, consistently demonstrates improvements in migration percentage, head–shaft angle, and acetabular index, particularly when treatment is performed early in children with migration percentages below 50% and combined with soft tissue release. Younger age and less severe hip displacement are associated with more favorable outcomes. The most common complication is screw migration as the physis grows off the implant, frequently necessitating revision, although serious complications are uncommon. Concerns remain regarding premature physeal closure and potential femoral head deformity at skeletal maturity. Current evidence supports proximal femoral guided growth as a valuable intermediate treatment that may delay or reduce the need for reconstructive osteotomy in appropriately selected patients; however, high-quality prospective studies are needed to define better its long-term safety, efficacy, and optimal role in treatment algorithms.