Timely Surgical Intervention Leads to Better Sustained Coverage after Reconstructive Hip Surgery in Patients with Cerebral Palsy
Abstract
:1. Introduction
2. Methods
2.1. Patient Selection
2.2. Data Extraction
2.3. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Surgical Data
3.3. Hip Development
3.3.1. Head–Shaft Angle Stratified by Year of Surgery
3.3.2. Migration Percentage Stratified by Year of Surgery
3.3.3. Risk Factors Impacting Hip Development
3.4. Melbourne Cerebral Palsy Hip Classification System
3.5. Postoperative Complications
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Median Age (IQR *) at Time of Surgery, Years | 8.0 (IQR 7.0; 9.6) |
---|---|
Male: Female | 29: 19 |
GMFCS ‡ level, n (%) | |
I | 0 |
II | 1 (2.1%) |
III | 2 (4.2%) |
IV | 26 (54.2%) |
V | 19 (39.6) |
CP type, n (%) | |
Spastic | 45 (93.8%) |
Dystonic | 3 (6.3%) |
CP extent, n (%) | |
Hemiplegia | 1 (2.1%) |
Diplegia | 14 (29.2%) |
Quadriplegia | 33 (68.8%) |
Tone management, n (%) | |
Missing/unknown | 1 (2.1%) |
None | 32 (66.7%) |
Oral Baclofen | 14 (29.2%) |
Baclofen pump | 1 (2.1%) |
Median follow-up of all primary reconstructive hip surgeries, years (IQR) | 4.4 (3.6; 6.1) |
Median follow-up of all primary hip surgeries, including salvage procedures, years (IQR) | 4.2 (2.8; 5.3) |
Surgical Data | n (%) |
---|---|
Varus derotation osteotomy | 48 hips (100%) |
+ adductor tenotomies | 36 hips (75%) |
+ pelvic osteotomy | 30 hips (62.5%) |
Dega pelvic osteotomy | 28 hips (58.3%) |
Pemberton type osteotomy | 1 hip (2.1%) |
Salter type osteotomy | 1 hip (2.1%) |
Median blood loss, ml (IQR °) | 190 mL (IQR 100; 250) |
Median surgical time, minutes (IQR) | 178 min (IQR 161; 222) |
Preoperative | Postoperative | Final Follow-Up | |
---|---|---|---|
MP, % | 57.5 | 11.0 | 23.0 |
(40.5; 74.0) | (0.0; 24.8) | (13.0; 42.3) | |
HSA, degrees | 165.0 | 121.5 | 140.1 |
(157.3; 169.0) | (114.0; 135.3) | (114.0; 153.6) | |
AI, degrees | 28.5 | 21.0 | * |
(22.0; 32.0) | (15.5; 27.5) | ||
MCPHCS, grades | IV | III | |
(IV; IV) | (III; IV) |
Beta | 95% Confidence Interval | p Value | |
---|---|---|---|
Age at time of surgery | 2.13 | −0.87 to 5.12 | p = 0.157 |
GMFCS ‡ II-III vs. IV-V | −2.03 | −25.10 to 20.91 | p = 0.855 |
Single vs. Double surgeon | −8.58 | −20.28 to 3.11 | p = 0.144 |
Tone management | −14.10 | −26.90 to −1.30 | p = 0.032 |
Postoperative MP | 0.46 | 0.17 to 0.75 | p = 0.002 |
Total available follow-up | 1.43 | −1.46 to 4.32 | p = 0.319 |
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van Stralen, R.A.; Kempink, D.R.J.; Titulaer, A.F.; Eygendaal, D.; Reijman, M.; Tolk, J.J. Timely Surgical Intervention Leads to Better Sustained Coverage after Reconstructive Hip Surgery in Patients with Cerebral Palsy. Children 2024, 11, 272. https://doi.org/10.3390/children11030272
van Stralen RA, Kempink DRJ, Titulaer AF, Eygendaal D, Reijman M, Tolk JJ. Timely Surgical Intervention Leads to Better Sustained Coverage after Reconstructive Hip Surgery in Patients with Cerebral Palsy. Children. 2024; 11(3):272. https://doi.org/10.3390/children11030272
Chicago/Turabian Stylevan Stralen, Renée Anne, Dagmar Raymond Jacques Kempink, Alexandra Frederika Titulaer, Denise Eygendaal, Max Reijman, and Jaap Johannes Tolk. 2024. "Timely Surgical Intervention Leads to Better Sustained Coverage after Reconstructive Hip Surgery in Patients with Cerebral Palsy" Children 11, no. 3: 272. https://doi.org/10.3390/children11030272