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Cahill PJ, Narayanan U, Bowen M, Sarkar S, Pahys JM, Miyanji F, Yaszay B, Shah SA, Sponseller PD. Impact of Spinal Deformity and Surgery on Health-Related Quality of Life in Cerebral Palsy: A Multicenter Prospective Controlled Trial. J Pediatr Orthop 2024:01241398-990000000-00621. [PMID: 39077879 DOI: 10.1097/bpo.0000000000002774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND Spinal fusion for scoliosis associated with cerebral palsy (CP) is challenging to study because specialized outcome measures are needed. Therefore, evidence in favor of the benefits of surgery has not been firmly established. This study aimed to determine if corrective spinal fusion improves health-related quality of life (HRQoL) in children with CP scoliosis at 2 years. METHODS Children with CP and scoliosis who met the criteria for posterior spinal fusion were offered enrollment at 16 US and Canada centers. Participants' families selected either operative intervention (OP) or nonoperative treatment (NON) in discussion with their surgeon with no influence by the decision to participate in the research study. Demographic, clinical data (function level, magnitude of deformity, comorbidities), and HRQoL (CPCHILD Questionnaire) were collected at baseline and 2 years. Change (from baseline) in total CPCHIL scores was the primary outcome. RESULTS Three hundred one OP and 34 NON subjects had complete baseline and 2-year data. At baseline, both groups were comparable in function level, comorbid status, and CPCHILD scores (52.1 ±15.3 vs. 53.4 ±14.5; P=0.66). The OP group had a larger spinal deformity magnitude (84.5˚ ± 21.8˚ vs. 66.3˚ ± 18.1˚) (P=0.001). The total CPCHILD score improved in the OP group by 6.6 points (P<0.001). NON scores were unchanged (+1.2; P=0.65) during follow-up. There were also significant score increases in the OP group for 5 of 6 CPCHILD domains. The change in CPCHILD scores from enrollment to 2 years was more significant in the OP group (P=0.05). CONCLUSION For children with CP who undergo spinal fusion, HRQoL improved over preoperative levels and an unchanged nonoperative control group. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Patrick J Cahill
- Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania, Philadelphia, PA
| | - Unni Narayanan
- University of Toronto, Division of Orthopaedic Surgery, Toronto, ON, Canada
| | | | | | | | - Firoz Miyanji
- British Columbia Children's Hospital, Vancouver, BC, Canada
| | | | - Suken A Shah
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Paul D Sponseller
- Division of Pediatric Orthopaedics, Johns Hopkins Hospital, Baltimore, MD
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Koch A, Kasprzyk M, Musielak B, Jóźwiak M. Long-term outcomes of reconstructive treatment for painful dislocations in patients with cerebral palsy. J Child Orthop 2024; 18:315-321. [PMID: 38831856 PMCID: PMC11144373 DOI: 10.1177/18632521241233165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/31/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose This report presents the long-term results of the hip joint reconstruction in patients with spastic hip disease through open reduction, proximal femur varus derotation osteotomy, and Dega transiliac osteotomy. Methods We analyzed retrospectively patients diagnosed with a spastic form of bilateral cerebral palsy with painful hip subluxation or dislocation. All patients underwent the same surgical procedure. The minimum follow-up time was 15 years. The study group comprised 15 patients (22 hips), classified with the Gross Motor Function Classification System as levels IV and V. The hip joint range of motion and anteroposterior X-ray examination at the final follow-up visit were compared with pre-operative data. The pain level was evaluated using the Visual Analogue Scale (VAS), and the femoral head shape was assessed using the Rutz classification. The patients' caregivers answered questions regarding pain during sitting, personal hygiene activities, and at rest. The caregivers' satisfaction with the treatment was also assessed with the Caregiver Priorities and Child Health Index of Life with Disabilities questionnaire. Results We observed a significant reduction of the hip joint pain and improvement in both radiological hip stability parameters and range of motion at the final follow-up visit. Based on the Rutz classification, one hip remained type B, while the other joints became type A. Reduced pain was reported in all three positions, with the most pronounced improvement during sitting and personal hygiene activities. Interestingly, patients with unilateral hip reconstruction were more prone to pain after reconstruction than those operated bilaterally. Conclusion Primary reconstruction of the painful hip joint neurogenic dislocation results in a stable joint reduction, pain decrease, and improved quality of life in patients with cerebral palsy. Level of evidence IV case series.
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Affiliation(s)
| | - Maciej Kasprzyk
- Maciej Kasprzyk, Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, ul. 28 Czerwca 1956r. nr 135/147, 61-545 Poznań, Poland.
| | - Bartosz Musielak
- Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznań, Poland
| | - Marek Jóźwiak
- Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznań, Poland
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Abuomira IESA, El-Alfy B, Seddik M, Mohammed Ahmed K, Khashaba AS, Al-Kot A. A modified angled plate for fixation of proximal femoral varus osteotomy in neuromuscular hip dislocation: Mechanical and clinical study. Orthop Traumatol Surg Res 2024; 110:103674. [PMID: 37666326 DOI: 10.1016/j.otsr.2023.103674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Proximal femoral osteotomy is an important step in the management of paralytic hip dislocation. Fixation by the angled plate is demanding and carries the risk of many complications. In this study, we made certain modifications for the angled plate. Does this plate provide a stable fixation for proximal femoral varus osteotomy? The main objective of this study was to assess the results of the modified plate in fixation of proximal femoral varus osteotomy in patients with neuromuscular hip dislocation. HYPOTHESIS This new system would offer significant advantages over the existing systems in terms of easy application and stable fixation. MATERIAL AND METHODS Twenty patients with paralytic hip dislocation were included in this study. The ages ranged from 5 to 15 years with a mean of 8.88±2.92 years. There were 12 boys and 8 girls. Seventeen patients had cerebral palsy and 3 had meningocele disease. Preoperative radiographs were done, and the migration percentage (MP), acetabular index (AI), and neck-shaft angle (NSA) were measured. All patients were treated with open reduction, pelvic osteotomy, and proximal femoral varus osteotomy. The femoral osteotomy was fixed by the modified angled plate in all cases. RESULTS The osteotomy sites united in all patients and the mean time of union was 2.9±0.65 months. The acetabular index, migration percentage, and neck-shaft angle were reduced postoperatively. This reduction was statistically significant. The hips remained stable throughout the period of follow-up in all patients. No cases were complicated by non-union or implant failure. CONCLUSION The modified angled plate (canulated interlocking blade Plate 90°) is a good method for the fixation of proximal femoral varus osteotomy in the management of neuromuscular hip dislocation. It provides a stable fixation. LEVEL OF EVIDENCE IV; case series.
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Affiliation(s)
| | - Barakat El-Alfy
- Orthopedics and Traumatology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mahmoud Seddik
- Orthopedics and Traumatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Khamis Mohammed Ahmed
- Orthopedics and Traumatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
| | - Ahmed Sayed Khashaba
- Orthopedics and Traumatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Amer Al-Kot
- Orthopedics and Traumatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
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Seltzer RA, Langner JL, Javier NM, Kaur J, Shafau AL, Ezeonu T, Bryson X, Hastings K, Tileston K, Vorhies JS. Cannabidiol Use Patterns and Efficacy for Children Who Have Cerebral Palsy. Orthopedics 2024; 47:52-56. [PMID: 37216564 DOI: 10.3928/01477447-20230517-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Cannabidiol (CBD)-containing supplements are used by children with cerebral palsy (CP), but the prevalence and efficacy of their use have not been studied. We sought to describe CBD use patterns and perceived efficacy in the pediatric population with CP, evaluating any association between CBD use and health-related quality of life. Patients with CP were prospectively enrolled, and caregivers were offered the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) Questionnaire and a survey assessing CBD use. Of 119 participants, 20 (16.8%) endorsed CBD use (CBD+) and 99 (83.2%) denied it (CBD-). Participants in the CBD+ group had worse functional status (85% Gross Motor Function Classification System level IV-V for CBD+ vs 37.4% for CBD-, P<.001) and lower health-related quality of life (mean CPCHILD score of 49.3 for CBD+ vs 62.2 for CBD-, P=.001). Spasticity was the rationale most cited for CBD use (29%), followed by pain and anxiety (both 22.6%). CBD was perceived to be most effective for improving emotional health, spasticity, and pain. Fifty percent of the patients in the CBD+ group underwent surgery in the previous 2 years and most endorsed a general benefit in the postoperative setting. The most common side effects noted were fatigue and increased appetite (both 12%). Most participants endorsed no side effects (60%). CBD may serve as a useful adjunct for some children with CP, especially those with worse disease severity. Caregivers perceive CBD as offering some benefits, particularly in the domains of emotional health, spasticity, and pain. We found no evidence of severe adverse events in our small cohort. [Orthopedics. 2024;47(1):52-56.].
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Jarrett DY, Stamoulis C, Shore BJ, Tsai A. Pelvis radiographs in children with cerebral palsy: effects of patient positioning on calculating migration percentages. Pediatr Radiol 2023; 53:2662-2671. [PMID: 37833504 DOI: 10.1007/s00247-023-05783-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Hip displacement in children with cerebral palsy (CP) is monitored by measuring migration percentage on anteroposterior pelvis radiographs. However, proper positioning for radiography in children with spasticity is difficult. The reliability and accuracy of migration percentage as a function of patient positioning is unknown. OBJECTIVE To determine the effects of patient positioning on migration percentage measurements in children with CP. MATERIALS AND METHODS We identified children with CP (≤18-year-old) with pelvis CT and anteroposterior pelvis radiograph obtained <6 months apart (10/2018-11/2021). Digitally reconstructed radiographs were generated from each pelvis CT, to simulate nine different patient positions: neutral; 10° and 20° lordosis and kyphosis; and 10° and 20° right rotation and left rotation. Two radiologists measured migration percentages from the simulated and real pelvis radiographs. We used Spearman's rho to assess inter-rater reliability, and Wilcoxon signed rank test to determine statistical significance. RESULTS We studied sixty-three children (male=41; median age=8 years; range=4-18 years). The two radiologists' migration percentage measurements were highly correlated with each other across all simulated and real radiographs (Spearman's rho=0.86-0.99, P<0.01). For both readers and hips, migration percentages measured from real radiographs were significantly different from those measured from neutral simulated radiographs (P<0.01), with median absolute difference=5-6 percentage points (PP) and interquartile range (IQR)=9-12 PP. When comparing migration percentage measurements from neutral simulated radiographs to those in kyphosis/lordosis and right/left rotations, median absolute differences were 2-4 PP (IQR=3-8 PP) and 4-15 PP (IQR=6-17 PP), respectively. CONCLUSION Inter-rater reliability of measured migration percentages is high, but accuracy decreases with patient positional changes.
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Affiliation(s)
- Delma Y Jarrett
- Divisions of Pediatric Radiology and Musculoskeletal Radiology, Weill Cornell Medical School, New York, NY, USA
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Catherine Stamoulis
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin J Shore
- Department of Orthopedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andy Tsai
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
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Angelliaume A, Harper L, Bouty A, Bouteiller C, Deleplanque B, Ravel M, Le Hanneur M, Narayanan UG, Ferdynus C, Pfirrmann C. Validation of the French version of the Caregivers' Priorities and Child Health Index of Life with Disabilities questionnaire. Orthop Traumatol Surg Res 2023:103753. [PMID: 37979675 DOI: 10.1016/j.otsr.2023.103753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION The Caregivers' Priorities and Child Health Index of Life with Disabilities (CPCHILD) is a questionnaire that measures the health-related quality of life (HRQL) of children with cerebral palsy (CP). Though measuring HRQL is challenging in these children, it is a valuable help for medical decision-making. There is no questionnaire to assess HRQL in French-speaking children with severe CP. OBJECTIVE To translate and adapt transculturally the CPCHILD questionnaire into French (CPCHILD-FV). MATERIAL AND METHODS The CPCHILD was translated from English into French by forward and backward translation by independents translators. The questionnaire was then tested on 32 caregivers of patients with CP classified as GMFCS IV or V, remarks of caregivers were analyzed by an expert committee and, if necessary, modifications were performed. Internal consistency of the CPCHILD-FV was assessed using a sample of 32 parents or caregivers and test-retest reliability was assessed on a random sample of 10 patients. RESULTS The translation and transcultural process resulted in a French version of the CPCHILD. Some items of the CPCHILD required careful discussion to ensure that items had the same meaning as in the original. Internal consistencies were over 0.70 for each domain except for health, and 0.97 for the total scores. The ICC for the test-retest reliability of the CHILD-FV total score was 0.98 (95% CI: 0.93-0.99) and ranged from 0.59 to 0.99 for the domains. CONCLUSION The translation and cross-cultural adaptation of the CPCHILD questionnaire provides a French version than can measure the HRQL of children with severe CP. LEVEL OF EVIDENCE IV; prospective study without control group.
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Affiliation(s)
- Audrey Angelliaume
- Department of Pediatric Surgery, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Luke Harper
- Department of Pediatric Surgery, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Aurore Bouty
- Department of Pediatric Surgery, The Royal Children's Hospital, 50, Flemington Road, Parkville, Victoria 3052, Australia
| | - Cécile Bouteiller
- Department of Children Physical and Rehabilitation Medicine, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Brigitte Deleplanque
- Department of Children Physical and Rehabilitation Medicine, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Magaly Ravel
- Department of Children Physical and Rehabilitation Medicine, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Malo Le Hanneur
- Department of Pediatric Orthopaedics, Trousseau University Hospital, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Unni G Narayanan
- Department of Orthopaedic Surgery and Child Health Evaluative Science, Hospital of Sick Children, Toronto, Canada
| | - Cyril Ferdynus
- Methodological Support Unit, University Hospital, allée des Topazes, 97400 Saint-Denis, Reunion Island, France
| | - Clémence Pfirrmann
- Department of Pediatric Surgery, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Ayub A, Graff C, Horvat LM, Maizen C. Hip reconstruction in cerebral palsy: Lessons from a single center and 137 hips. J Child Orthop 2023; 17:469-480. [PMID: 37799318 PMCID: PMC10549701 DOI: 10.1177/18632521231196846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 08/06/2023] [Indexed: 10/07/2023] Open
Abstract
Background This large, retrospective, single-center study aimed to compare the outcomes of unilateral hip reconstruction and bilateral hip reconstruction in children with non-ambulatory cerebral palsy and ascertain risk factors for recurrent instability and reoperation. Method We performed a retrospective review of 137 hip reconstructions performed for patients with cerebral palsy. Preoperative and postoperative clinical and radiological parameters were documented, including hip migration percentage, acetabular index, the Gross Motor Function Classification System, the Melbourne Cerebral Palsy Hip Classification System, hip abduction, and pelvic obliquity. Results Overall, 49 patients underwent bilateral hip reconstruction, and 37 patients underwent unilateral hip reconstruction. In the unilateral hip reconstruction group, the reconstructed hip remained stable (with a migration percentage < 33%) in 59% of patients compared to 74.4% of the more affected hips in the bilateral hip reconstruction group (p = 0.02). Of the unreconstructed hip in the unilateral hip reconstruction group, 74.4% remained stable (with a migration percentage < 33%), compared to 78.8% of the less affected hips in the bilateral hip reconstruction group. A level pelvis was maintained at final follow-up in significantly more patients in the bilateral hip reconstruction group than the unilateral hip reconstruction group (p = 0.002). Further surgical intervention was performed in 41% of the unilateral hip reconstruction group, compared with 11.5% in the bilateral hip reconstruction group (p = 0.001). Surgery performed under the age of 8 years and not performing an acetabular osteotomy were found to be risk factors for recurrent instability in all groups. Conclusion Our series suggests that in terms of recurrent instability after hip reconstruction in cerebral palsy, protective factors against this complication include bilateral hip reconstruction, hip reconstruction after 8 years of age, and the use of an acetabular osteotomy.
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Affiliation(s)
| | - Christy Graff
- The University of Adelaide, Adelaide, SA, Australia
- The Women’s and Children’s Hospital, North Adelaide, SA, Australia
- The Royal Adelaide Hospital, Adelaide, SA, Australia
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Amen J, Perkins O, Kafchitsas K, Reed D, Norman-Taylor F, Kokkinakis M. Bony hip reconstruction for displaced hips in patients with cerebral palsy: Is postoperative immobilization indicated? J Child Orthop 2023; 17:268-275. [PMID: 37288043 PMCID: PMC10242375 DOI: 10.1177/18632521231164983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/02/2023] [Indexed: 06/09/2023] Open
Abstract
Purpose Decisions for postoperative immobilization after bony hip reconstructive surgery in cerebral palsy are controversial in current practice. The aim of this study was to check if choosing not to use any kind of postoperative immobilization is a safe practice. Methods A retrospective cohort study was conducted in a pediatric orthopedic tertiary referral center. The study included 148 patients (228 hips) with cerebral palsy, who had bony hip surgery. Medical records were reviewed for incidence of complications, methods of pain control, and length of hospital stay. Three radiographic measures (neck-shaft angle, Reimers migration index, and acetabular index) were performed on preoperative and postoperative X-rays. X-rays were also checked for mechanical failure of implant, recurrent dislocation/subluxation, and fractures in the first 6 months postoperatively. Results In total, 94 (64%) were male and 54 (36%) were female. Seventy-seven (52%) were Gross Motor Function Classification System V, mean age at surgery was 8.6 years (2.5-18.4 years). Length of hospital stay was 6.25 days (SD 4.64 days). Medical complications that may have prolonged hospital stay occurred in 41 patients (27.7%). Radiological measurements showed significant improvement postoperatively (p = 0.001). Seven patients (4.7%) had another surgery in first 6 months (three for recurrent dislocation/subluxation, three for implant failure, and one for ipsilateral femur fracture). Conclusion Avoiding postoperative immobilization following bony hip surgery in cerebral palsy is a safe practice and associated with reduced rate of medical and mechanical problems compared to the current literature. This approach should be utilized with optimal pain and tone management.
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Affiliation(s)
- John Amen
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Trust, London, UK
| | - Oliver Perkins
- Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Trust, London, UK
| | | | - Daniel Reed
- Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Trust, London, UK
| | | | - Michail Kokkinakis
- Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Trust, London, UK
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Butler LR, Dominy CL, White CA, Mengsteab P, Lin E, Allen AK, Ranade SC. Risk factors for 90-day readmission and prolonged length of stay after hip surgery in children with cerebral palsy. J Orthop 2023; 38:14-19. [PMID: 36925762 PMCID: PMC10011680 DOI: 10.1016/j.jor.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
Objective Spastic hip dysplasia is a common complication of cerebral palsy in children, and surgical intervention is usually warranted. While current literature has primarily analyzed single institution outcomes, this study utilized a national database to describe readmission rates and factors correlated with readmission for children with cerebral palsy undergoing hip surgery in order to treat this population more effectively. Methods This study queried the Nationwide Readmissions Database (2014-2018) for pediatric patients with cerebral palsy who underwent hip surgery. Patient demographics, pre-operative comorbidities, length of stay (LOS), treatment complications, and readmission data were collected for each patient and analyzed with inferential statistics. Results Of the 1225 patients included, the average age was 9.3 ± 3.8 years and 42.8% were female. Approximately 26.3% patients had a prolonged LOS (≥5 days) and 14.2% patients required readmission within 90-days of surgery. Medical complications, cardiac arrhythmias, and iron deficiency anemia were all significantly associated with elongated LOS as well as 90-day readmission. Patients with Medicaid were more frequently associated with an inpatient medical complication and the overall complication rate was 5.5%. Conclusions While current literature has analyzed common risk factors and complications associated with hip surgery in the pediatric cerebral palsy patient, this study identifies a national readmission rate (14.2%) as well as preoperative comorbidities associated with readmission within 90-days and/or elongated LOS. Notably, complications are more frequently associated with patients using Medicaid. These results further exemplify the importance of equitable access to care and thorough selection of pediatric cerebral palsy patients appropriate for hip surgery.
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Affiliation(s)
- Liam R. Butler
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Calista L. Dominy
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Christopher A. White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Paulos Mengsteab
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Elaine Lin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Abigail K. Allen
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Sheena C. Ranade
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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Geyer D, Vessey JA, Chen A, DiFazio RL. Parental Caregiver Expectations and Satisfaction Following Hip Reconstruction and Spinal Fusion in Children With Cerebral Palsy. Orthop Nurs 2023; 42:94-102. [PMID: 36944203 DOI: 10.1097/nor.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Children with severe (Gross Motor Function Classification System [GMFCS] IV-V) cerebral palsy (CP) exhibit profound physical and developmental impairments and require assistance for all activities of daily living. No curative treatments exist although surgical procedures to correct underlying hip and spine deformities can improve their quality of life. Despite the efficacy of these surgeries, little is known regarding parental caregivers' expectations specific to surgical outcomes and their satisfaction with surgical outcomes. The purpose was to explore parental caregiver expectations and satisfaction with hip and spine surgeries that their children with GMFCS IV-V CP underwent. Variations among preoperative expectations, changes in expectations over time, and the relationship of expectations on caregiver satisfaction were examined. A qualitative descriptive approach with conventional content analysis was utilized. Three preoperative caregiver expectation themes were identified: increasing functionality, increasing comfort, and maintaining health and averting crisis. These themes were still present at 5-year follow-up; however, more caregivers refocused their expectations from improving function to providing palliation. A clear relationship between expectations and caregiver satisfaction, however, was not identified. A deeper understanding surrounding caregiver expectation and satisfaction following surgical procedures is needed.
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Affiliation(s)
- David Geyer
- David Geyer, MSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Judith A. Vessey, PhD, MBA, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA; and Medical, Surgical and Behavioral Health Programs, Boston Children's Hospital, Boston, MA
- Anna Chen, BSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Rachel L. DiFazio, PhD, RN, FAAN, Division of Orthopedic Surgery, Boston Children's Hospital, Boston, MA; and Harvard Medical School, Boston, MA
| | - Judith A Vessey
- David Geyer, MSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Judith A. Vessey, PhD, MBA, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA; and Medical, Surgical and Behavioral Health Programs, Boston Children's Hospital, Boston, MA
- Anna Chen, BSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Rachel L. DiFazio, PhD, RN, FAAN, Division of Orthopedic Surgery, Boston Children's Hospital, Boston, MA; and Harvard Medical School, Boston, MA
| | - Anna Chen
- David Geyer, MSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Judith A. Vessey, PhD, MBA, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA; and Medical, Surgical and Behavioral Health Programs, Boston Children's Hospital, Boston, MA
- Anna Chen, BSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Rachel L. DiFazio, PhD, RN, FAAN, Division of Orthopedic Surgery, Boston Children's Hospital, Boston, MA; and Harvard Medical School, Boston, MA
| | - Rachel L DiFazio
- David Geyer, MSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Judith A. Vessey, PhD, MBA, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA; and Medical, Surgical and Behavioral Health Programs, Boston Children's Hospital, Boston, MA
- Anna Chen, BSN, RN, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
- Rachel L. DiFazio, PhD, RN, FAAN, Division of Orthopedic Surgery, Boston Children's Hospital, Boston, MA; and Harvard Medical School, Boston, MA
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Femoral Head Deformity Associated With Hip Displacement in Nonambulatory Cerebral Palsy: Results at Skeletal Maturity. J Pediatr Orthop 2023; 43:156-161. [PMID: 36563091 DOI: 10.1097/bpo.0000000000002333] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Maintaining femoral head shape (FHS) and acetabular sphericity are important goals in preventing long-term osteoarthritis in hips in children with cerebral palsy (CP). As acetabular morphology has been widely studied, our objective was to determine FHS in CP after triradiate cartilage (TRC) closure, a proxy for skeletal maturity, and the risk factors associated with residual deformity and osteoarthritis. METHODS In this retrospective cohort study, patients with CP [Gross Motor Function Classification System (GMFCS) IV to V], minimum 4 yearly hip radiographs after age 10 years, and at least 1 radiograph after age 16 years, were included. Primary outcome was FHS (Rutz), stratified as "less severe" (Rutz A to B) and "more severe" (Rutz C to D). Secondary outcomes included migration percentage (MP), age at TRC closure, previous reconstructive (femoral with/without pelvic osteotomies) surgery, previous intrathecal baclofen, Tönnis osteoarthritis grade, and GMFCS level. Statistical analyses included χ 2 analysis and multiple logistic regression. RESULTS One hundred sixty-three patients (326 hips) met the inclusion criteria, with TRC closure at age 14.0 (SD: 1.8) years. At final follow-up of 4.4 (SD: 2.4) years after TRC closure, 17% (55 hips), had a "more severe" FHS. From TRC closure to final follow-up, the frequencies of "less severe" hips decreased (-10%, P <0.001), while "more severe" increased (+115%, P <0.001). In multiple regression analysis, MP at TRC closure was the only significant risk factor associated with a "more severe" FHS at final follow-up ( P =0.03). Receiver operating characteristic curve analysis determined MP≥30.5% to be associated with a "more severe" FHS at final follow-up ( P <0.009). The FHS was not affected by reconstructive surgery, sex, GMFCS level, or intrathecal baclofen use. "Less severe" hips had lower Tönnis grades (0 to 1) compared with "more severe" hips (Tönnis grades 2 to 3) at final follow-up ( P <0.001). CONCLUSIONS FHS at skeletal maturity was not influenced by prior reconstructive surgery but was negatively affected when MP≥30.5% at the time of TRC closure. The extent of residual femoral head deformity correlated with the severity of osteoarthritis at final follow-up. LEVEL OF EVIDENCE Level III.
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Asma A, Ulusaloglu AC, Shrader MW, Miller F, Rogers KJ, Howard JJ. Hip Displacement After Triradiate Cartilage Closure in Nonambulatory Cerebral Palsy: Who Needs Continued Radiographic Surveillance? J Bone Joint Surg Am 2023; 105:27-34. [PMID: 36575164 DOI: 10.2106/jbjs.22.00648] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Recommendations with regard to the need for continued hip surveillance after skeletal maturity are based on expert opinion rather than evidence. This study aimed to determine the prevalence of and risk factors associated with progressive hip displacement in cerebral palsy (CP) after triradiate cartilage (TRC) closure. METHODS Patients who had spastic nonambulatory CP (Gross Motor Function Classification System IV to V) and hypertonic (spastic or mixed-type) motor type and follow-up of at least 2 years after TRC closure were included. The primary outcome variable was the hip migration percentage (MP). The secondary outcome variables included patient age at the time of TRC closure, prior preventative or reconstructive surgery, a prior intrathecal baclofen pump, history of scoliosis, history of epilepsy, a prior gastrostomy tube, a previous tracheostomy, and gender. An unsuccessful hip outcome was defined as a hip with an MP of ≥40% and/or requiring a reconstructive surgical procedure after TRC closure. RESULTS In this study, 163 patients met the inclusion criteria, with a mean follow-up of 4.8 years (95% confidence interval [CI], 4.4 to 5.1 years) after TRC closure at a mean patient age of 14.0 years (95% CI, 13.7 to 14.3 years). Of these hips, 22.1% (36 of 163) had an unsuccessful hip outcome. In multivariate analysis, the first MP at TRC closure (hazard ratio [HR] per degree, 1.04; p < 0.001) and pelvic obliquity (HR per degree, 1.06; p = 0.003) were independent risk factors for an unsuccessful hip outcome, but gender was not found to be significant (HR for male gender, 1.7 [95% CI, 0.8 to 3.58; p = 0.16]; female gender was the reference). However, the mean survival time for progression to an unsuccessful hip outcome was longer for female patients at 9.2 years [95% CI, 8.1 to 10.2 years]) compared with 6.2 years (95% CI, 5.6 to 6.9 years) for male patients (p = 0.02). There was also a significant improvement in survivorship for prior reconstructive surgical procedures (p = 0.002). The survivorship in patients who underwent reconstructive surgery performed at a patient age of ≥6 years was significantly higher compared with those who underwent surgery performed at <6 years of age (p < 0.05). A first MP at TRC closure of ≥35% was associated with an unsuccessful hip outcome, as determined by receiver operating characteristic (ROC) curve analysis (p < 0.001; area under the ROC curve of 0.891, sensitivity of 81%, and specificity of 94%). CONCLUSIONS The risk factors for the progression of hip displacement after TRC closure in patients with CP included a higher MP and increased pelvic obliquity; there was decreased survivorship for male patients and patients with no prior reconstructive surgery. Patients with these risk factors and/or an MP of ≥35% at TRC closure should have continued radiographic surveillance to detect late hip displacement. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ali Asma
- Nemours Children's Hospital, Wilmington, Delaware
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Bauer JP, Sienko S, Roy D, Nye D, Tarrant S, Price R, Raney E. The incidence of avascular necrosis in children with cerebral palsy after hip containment surgery. J Child Orthop 2022; 16:454-460. [PMID: 36483645 PMCID: PMC9723865 DOI: 10.1177/18632521221137383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To establish the rate of avascular necrosis after hip reconstruction surgery in children with cerebral palsy and to identify risk factors that influence the development of avascular necrosis in this population. METHODS An institutional review board-approved retrospective review was conducted on children with cerebral palsy who underwent hip containment surgery at a single institution. Radiographs were evaluated at three time points. The Reimer's migration percentage, neck shaft angle, epiphyseal shaft angle, acetabular index, center edge angle, and acetabular angle were measured. The presence of avascular necrosis was evaluated and graded by the Bucholz/Ogden and the Kalamchi/MacEwen classification systems. Multivariate logistic regression was performed to identify risk factors associated with the development of avascular necrosis. RESULTS A total of 154 children with cerebral palsy underwent hip containment surgery on 223 hips. Twenty-nine children (18.8%) underwent both pelvic and femoral procedures; 36 children (23.4%) had only femoral procedures; 47 children (30.5%) had femoral and soft tissue; and 42 children (27.3%) had pelvic, femoral, and soft tissue procedures. Using the Bucholz and Ogden or the Kalamchi classifications, the rate of avascular necrosis was 24.7% (38/154). Of the variables evaluated, preoperative Reimers was found to be significant predictors of avascular necrosis. The rate of avascular necrosis was 26.7% for Gross Motor Functional Classification System level III, 24.1% for Gross Motor Functional Classification System level IV, and 27.3% for Gross Motor Functional Classification System level V. CONCLUSION The overall rate of avascular necrosis in children undergoing hip containment surgery was 26.7%. Together, age at surgery, open reduction, previous surgery, preoperative Reimers, and estimated blood loss contributed to the development of postoperative avascular necrosis; however, only preoperative Reimers significantly contributed to the development of avascular necrosis in children with cerebral palsy undergoing hip containment procedures.
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Affiliation(s)
- Jeremy P Bauer
- Shriners Hospitals for Children, Portland, OR, USA,Oregon Health & Science University, Portland, OR, USA,Jeremy P Bauer, Shriners Hospitals for Children, 3101 Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Susan Sienko
- Shriners Hospitals for Children, Portland, OR, USA
| | - Dennis Roy
- Shriners Hospitals for Children, Portland, OR, USA
| | - Deric Nye
- Valley Children’s Healthcare, Fresno, CA, USA
| | - Seth Tarrant
- Department of Orthopaedics, John Hunter Hospital, Newcastle, NSW, Australia
| | - Ryan Price
- Tallahassee Orthopedic Clinic, Tallahassee, FL, USA
| | - Ellen Raney
- Shriners Hospitals for Children, Portland, OR, USA
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Noritz G, Davidson L, Steingass K. Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy. Pediatrics 2022; 150:e2022060055. [PMID: 36404756 DOI: 10.1542/peds.2022-060055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral palsy (CP) is the most common motor disorder of childhood, with prevalence estimates ranging from 1.5 to 4 in 1000 live births. This clinical report seeks to provide primary care physicians with guidance to detect children with CP; collaborate with specialists in treating the patient; manage associated medical, developmental, and behavioral problems; and provide general medical care to their patients with CP.
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Affiliation(s)
- Garey Noritz
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
| | - Lynn Davidson
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Katherine Steingass
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
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Park BK, Park H, Park KB, Rhee I, Kim S, Kim HW. Fate of hips complicated by avascular necrosis of the femoral head following reconstructive surgery in nonambulatory patients with cerebral palsy. Sci Rep 2022; 12:11767. [PMID: 35817817 PMCID: PMC9273671 DOI: 10.1038/s41598-022-16023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 07/04/2022] [Indexed: 11/12/2022] Open
Abstract
The purpose of this study was to evaluate the influence of avascular necrosis of the femoral head (AVN) following hip reconstructions on the future hip development of cerebral palsy (CP) patients. A retrospective study of 394 hips in 205 nonambulatory patients with spastic CP who underwent reconstructive hip surgery was performed. The mean age at surgery was 7.3 ± 2.4 years. The mean follow-up duration was 5.6 ± 2.7 years, and the mean age at the latest follow-up was 12.8 ± 3.4 years. AVN was classified in terms of its severity and location. Femoral head remodelling was assessed by the spherical index and the Mose circle. An unsatisfactory radiological outcome was defined as having a migration percentage of more than 30% at the final follow-up. AVN was observed in 169 (42.9%) hips. Older age at the time of surgery, higher preoperative migration percentage, and open reduction procedures were predictors for the development of AVN. Hips with AVN confined to the lateral epiphysis, and AVN involving the entire epiphysis with preserved height experienced successful remodelling. 27 (65.9%) of the 41 hips with unsatisfactory outcomes experienced AVN. Younger age, higher postoperative migration percentage, and occurrence of AVN were related to unsatisfactory outcomes. The highest incidence of failed remodelling and unsatisfactory outcomes were observed in hips with entire epiphyseal involvement and more than 50% loss of its height. AVN following hip reconstructions is not necessarily associated with poor hip development, however, depending on the severity and location, it is a prognostic factor for unsatisfactory radiological outcomes.
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Affiliation(s)
- Byoung Kyu Park
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Hoon Park
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kun Bo Park
- Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Isaac Rhee
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Australia
| | - Sungmin Kim
- Department of Orthopaedic Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyun Woo Kim
- Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Zakrzewski AM, Bryant AJ, McCarthy JJ. Can Over-containment Prevent Recurrence in Children With Cerebral Palsy and Hip Dysplasia Undergoing Hip Reconstruction? J Pediatr Orthop 2022; 42:300-306. [PMID: 35420583 DOI: 10.1097/bpo.0000000000002160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hip reconstruction is often necessary in children with cerebral palsy (CP) but is associated with high failure rates. Over-containment deeply seats the hip within the acetabulum at the time surgical reconstruction. The goal of this study is to evaluate the effect of over-containment on radiographic outcomes and failure rates in children with CP undergoing hip reconstruction. METHODS This study is a retrospective chart review of children with CP that underwent hip reconstruction between 2010 and 2019 with at least 2 years of radiographic follow-up. Migration percentage (MP), acetabular index (AI), and neck shaft angle (NSA) were recorded preoperatively, postoperatively and throughout follow-up. Failures were defined as a MP at latest follow-up ≥30% or need for revision hip reconstruction. Hips were divided into groups based on postoperative MP-group 1 (over-containment group) had a MP≤0% and group 2 had an MP>0%. Radiographic parameters and failure rates were compared across Gross Motor Functional Classification Score (GMFCS) level, age at the time of surgery, and degree of preoperative subluxation. RESULTS A cohort of 108 patients (197 hips) with an average age of 7.3±3.2 years met inclusion criteria with an average follow-up of 49.6 months (range: 24 to 118 mo). There were 147 hips in group 1 and 50 hips in group 2. At latest follow-up, group 1 demonstrated lower MP, AI, and NSA in comparison to group 2. The overall failure rate in our cohort was 8.1% (16 hips). Failure rates trended lowest in hips that were over-contained (6.1% v. 14.0%) although not statistically significant. Over-containment resulted in significantly lower failure rates in GMFCS IV/V hips, children under age 6 at the time of surgery and those with a higher degree of preoperative hip displacement (MP>50%). CONCLUSIONS Over-containment at the time of hip reconstruction can positively affect radiographic outcomes and failure rates in children with CP. Over-containment should be considered in hips at high risk of failure, especially non ambulatory children with significant hip subluxation at an early age. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Affiliation(s)
| | - Austin J Bryant
- Neurosurgery and Orthopaedics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Zakrzewski AM, Carl JR, McCarthy JJ. Proximal Femoral Screw Hemiepiphysiodesis in Children With Cerebral Palsy Improves the Radiographic Measures of Hip Subluxation. J Pediatr Orthop 2022; 42:e583-e589. [PMID: 35452015 DOI: 10.1097/bpo.0000000000002152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Proximal femoral screw hemiepiphysiodesis (PFSH) is a promising technique for treatment of hip subluxation in children with cerebral palsy (CP). The aim of this study is to report radiographic outcomes of PFSH and to evaluate its role in changing the natural history of hip displacement in children with CP. METHODS This is a single center retrospective chart review of children with CP that underwent PFSH with at least 2 years of radiographic follow-up. Demographic information, surgical details, complications, additional surgical procedures, and need for screw exchange were recorded. Radiographs were assessed for migration percentage (MP), neck shaft angle (NSA), head shaft angle (HSA), and articular trochanter distance preoperatively as well as at 6 months, 1 year, 2 year, and latest follow-up postoperatively. Hips were divided into group 1 (no previous hip surgery) and group 2 (PFSH performed after hip reconstruction). Hips with 2 years of preoperative radiographic data were included in the natural history cohort. RESULTS Twenty-three patients (44 hips) met inclusion criteria with an average age of 7.3±1.7 years and a mean follow-up of 33.5 months. Group 1 and group 2 had 32 and 12 hips, respectively. Group 1 had significant improvement in all parameters (ΔMP=5%, ΔNSA=13 degrees, ΔHSA=15 degrees) group 2 showed improvements in NSA and HSA (ΔNSA=4 degrees ΔHSA=8 degrees) with only HSA reaching significance and MP remaining unchanged. All radiographic measurements worsened in the 2 years before surgery (N=25, natural history group) and improved after PFSH. Screw exchange occurred in 12 hips (27.2%) at an average of 33 months (range 27 to 42 mo) with 2 hips also undergoing pelvic osteotomy at that time. Three hips had a MP >50% at follow-up with 2 hips in group 1 undergoing hip reconstruction. No complications were noted. CONCLUSION PFSH effectively alters proximal femoral growth and can improve hip subluxation in children with CP. Screws often need to be exchanged and hips should be carefully monitored. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Affiliation(s)
- Allyson M Zakrzewski
- Department of Orthopaedics, Cincinnati Children's Hospital Medical Center, Cincinnati OH
| | | | - James J McCarthy
- Department of Orthopaedics, Cincinnati Children's Hospital Medical Center, Cincinnati OH
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Badina A, du Cluzel de Remaurin X, Khouri N. Long-term outcomes of hip reconstruction surgery in children with GMFCS III diplegic cerebral palsy. Orthop Traumatol Surg Res 2022; 109:103344. [PMID: 35660081 DOI: 10.1016/j.otsr.2022.103344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The results of hip reconstruction surgery are known for non-walking (GMFCS IV and V) and walking (GMFCS I and II) patients. Few studies deal with GMFCS III patients in isolation. Their intermediate functional status can be deteriorated by asymmetrical contractures, hip dislocation, multi-level deformities of the lower limbs, leading to motor function degradation, and possibly losing their ability to walk. The aim of our study was to establish whether surgical results were maintained over time and whether the functional status changed. MATERIAL AND METHODS Fifteen patients with GMFCS III spastic diplegia, treated for hip subluxation, were reviewed. The mean age at the time of surgery was 10 years old. The mean follow-up after surgery was 11 years. Reconstructive surgery was performed on 21 hips including pelvic osteotomy in all cases, with associated femoral osteotomy in 19 cases. Clinical (pain, joint mobility, walking aids, walking distance, GMFCS level) and radiological data (Melbourne Cerebral Palsy Hip Classification, standard coxometry) were recorded preoperatively and at the last follow-up. RESULTS Preoperatively, 6 patients were losing their ability to walk due to pain and flexion-adduction contracture. At the last follow-up, no patients had pain and joint mobility was improved in all cases. For one patient, recovery to their previous functional state required a period of two years. In the long term, 14 patients were GMFCS III and only one patient was GMFCS IV due to reasons unrelated to hip surgery. The radiological parameters improved significantly. The Melbourne score was IV preoperatively for all patients. At the last follow-up, 10 hips were grade I, 6 hips were grade II and 5 hips were grade III. DISCUSSION Correction of architectural disorders of the subluxed hip by pelvic osteotomy, in most cases associated with femoral osteotomy, improves functional and radiological status for GMFCS III patients. This improvement is maintained in the long-term. Complementary surgeries correcting the other deformities of the lower limbs were necessary in more than half of the patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alina Badina
- Service de chirurgie orthopédique pédiatrique, Hôpital Necker Enfants Malades, Université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - Xavier du Cluzel de Remaurin
- Service de chirurgie orthopédique pédiatrique, Hôpital Necker Enfants Malades, Université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - Nejib Khouri
- Service de chirurgie orthopédique pédiatrique, Hôpital Necker Enfants Malades, Université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France.
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Oladeji AK, Minaie A, Landau AJ, Hosseinzadeh P. Blood loss in hip reconstructive surgery in children with cerebral palsy: when do I need to be prepared for blood transfusion? J Pediatr Orthop B 2022; 31:175-181. [PMID: 34678853 DOI: 10.1097/bpb.0000000000000926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The hip is the second most common joint involved in pediatric patients with cerebral palsy (CP). Hip reconstructive procedures are performed to improve function and comfort level. Blood loss can occur leading to blood transfusion in close to 1/3 of children with CP undergoing hip reconstruction. The purpose of this study was to report the rate and risk factors for blood transfusion after hip reconstruction in a large cohort of children with CP. We conducted a retrospective chart review of pediatric patients at our tertiary referral children's hospital who underwent reconstructive hip osteotomy over an 8-year period. Binary logistic regression was employed to compare and model differences in transfusion between age greater than 4 or 6 years and the number of osteotomies. A total of 180 patients met our inclusion criteria. Thirty-seven patients (20.6%) received blood transfusion. Incidence of transfusion increased as number of osteotomies increased from 1 to 4 (3.7%, 7.3%, 34.0%, 58.3%, respectively). We did not find a significant effect of age greater than 4 or 6 years on the rate of blood transfusion (P = 0.676 and P = 0.323, respectively). The number of osteotomies was a significant factor in the rate of blood transfusion in both models (P < 0.001). Number of osteotomies and not age was a significant risk factor in the rate of blood transfusion. This data can help the orthopedic surgeons in preoperative planning for the possibility of blood transfusion in these patients.
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Affiliation(s)
- Afolayan K Oladeji
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
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Pisecky L, Großbötzl G, Gahleitner M, Stadler C, Stevoska S, Haas C, Gotterbarm T, Klotz MCM. Foam Splint versus Spica Cast-Early Mobilization after Hip Reconstructive Surgery in Children-Preliminary Data from a Prospective Randomized Clinical Trial. CHILDREN (BASEL, SWITZERLAND) 2022; 9:288. [PMID: 35205008 PMCID: PMC8870114 DOI: 10.3390/children9020288] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Surgical hip joint reconstruction may be the method of choice for children and adolescents with developmental dysplasia of the hip (DDH), as well as neurogenic dislocation of the hip (NDH) and Legg-Calvé-Perthes disease (LCPD). Following pelvic surgery, immobilization using a spica cast is considered to be the gold standard, despite the fact that casting may cause complications, such as hygienic problems, skin lesions, neurological deficits, and rigidity of the adjacent joints. An alternative for postoperative immobilization is a foam splint. The purpose of this randomized controlled trial was to compare spica cast and foam splint immobilization after hip reconstruction in children and adolescents with DDH, NDH, and LCPD. METHODS In a prospective randomized clinical trial, children and adolescents (age: 4-14 years), who received hip reconstructive surgery (osteotomy of the ilium and proximal femur, open reduction, soft tissue techniques) for DDH, NDH, and LCPD were included. Patient recruitment, group allocation, surgery, and aftercare were carried out in a department for orthopaedic surgery in Central Europe. Standardized questionnaires SF-36 (Short Form-36), EQ-5D (Euro Quality of Life 5D and CPCHILD (Caregiver Priorities and Child Health Index of Life with Disabilities) were gathered before, six, and twelve weeks after surgery from each patient. Group one received a spica cast and group two a foam splint for a period of six weeks postoperatively. There was no difference in surgical treatment. RESULTS Twenty-one out of thirty planned patients were enrolled in the study. One patient had to be excluded because of a lack of compliance. All quality of life (QOL) scores showed a significant reduction at the 6-week follow-up compared to the preoperative assessment. After twelve weeks, the scores came back close to the preoperative values. A significant reduction was seen in the spica cast group pre- vs. postoperatively for the variables CPCHILD (81% vs. 64%, p = 0.001), EQ-5d (65% vs. 45%, p = 0.014), and SF-36 (85% vs. 74%, p = 0.004). The corresponding values for the foam splint group also presented a reduction for all scores, but without statistical significance. Complications occurred in five cases. CONCLUSIONS Recent retrospective studies suggest that foam splint immobilization after hip reconstruction surgery is a safe and feasible method, promising fewer complications compared to spica casting. The preliminary results of this prospective randomized clinical trial show an improvement of the scores when using a foam splint compared to the conventionally used spica cast. Benefits for the patients may be fewer adverse events and no need to undergo a second round of anaesthesia for recasting. Data suggest higher patient and caretaker satisfaction in the foam splint group.
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Affiliation(s)
- Lorenz Pisecky
- Department for Orthopaedics and Traumatology, Johannes Kepler University Linz, Kepler University Hospital GmbH, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020 Linz, Austria; (G.G.); (M.G.); (C.S.); (S.S.); (C.H.); (T.G.)
| | - Gerhard Großbötzl
- Department for Orthopaedics and Traumatology, Johannes Kepler University Linz, Kepler University Hospital GmbH, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020 Linz, Austria; (G.G.); (M.G.); (C.S.); (S.S.); (C.H.); (T.G.)
| | - Manuel Gahleitner
- Department for Orthopaedics and Traumatology, Johannes Kepler University Linz, Kepler University Hospital GmbH, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020 Linz, Austria; (G.G.); (M.G.); (C.S.); (S.S.); (C.H.); (T.G.)
| | - Christian Stadler
- Department for Orthopaedics and Traumatology, Johannes Kepler University Linz, Kepler University Hospital GmbH, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020 Linz, Austria; (G.G.); (M.G.); (C.S.); (S.S.); (C.H.); (T.G.)
| | - Stella Stevoska
- Department for Orthopaedics and Traumatology, Johannes Kepler University Linz, Kepler University Hospital GmbH, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020 Linz, Austria; (G.G.); (M.G.); (C.S.); (S.S.); (C.H.); (T.G.)
| | - Christina Haas
- Department for Orthopaedics and Traumatology, Johannes Kepler University Linz, Kepler University Hospital GmbH, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020 Linz, Austria; (G.G.); (M.G.); (C.S.); (S.S.); (C.H.); (T.G.)
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Johannes Kepler University Linz, Kepler University Hospital GmbH, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020 Linz, Austria; (G.G.); (M.G.); (C.S.); (S.S.); (C.H.); (T.G.)
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Ma N, Tischhauser P, Camathias C, Brunner R, Rutz E. Long-Term Evolution of the Hip and Proximal Femur after Hip Reconstruction in Non-Ambulatory Children with Cerebral Palsy: A Retrospective Radiographic Review. CHILDREN 2022; 9:children9020164. [PMID: 35204886 PMCID: PMC8869786 DOI: 10.3390/children9020164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022]
Abstract
Background: Hip displacement in children with cerebral palsy (CP) has a higher prevalence in non-ambulatory children. Progression can lead to pain, pelvic obliquity and difficulty with sitting. This can be addressed with hip reconstruction. Our study aims to report the long-term radiological outcomes after hip reconstruction, in particular the evolution of femoral head deformity. Methods: A total of 58 hips of non-ambulatory children with CP were evaluated retrospectively using pre-operative, early (median 120 days) and late post-operative (median 8.6 years) anteroposterior standardised radiographs. All the hips were treated with femoral shortening varus derotation osteotomy (VDRO), pelvic osteotomy and an open reduction, if indicated. The radiographical indices measured included the migration percentage (MP), sharp angle, acetabular index, centre-edge angle, neck shaft angle, head shaft angle, pelvic obliquity, femoral head sphericity, femoral head deformity (FHD) and growth plate orientation. Results: Improvements in hip congruency and morphology were evident after reconstructive hip surgery. These were maintained at the late post-operative time point. Median MP improved from 56% (IQR 46–85%) to 0% (IQR 0–15%) at early follow-up. This increased to 12% (IQR 0–20%) at late follow-up. Pre-operatively, FHDs of 14 hips (24%) were classified as grade A (spherical femoral head). This increased to 22 hips (38%) at early follow-up and increased further to 44 hips (76%) at late follow-up. Conclusions: Our study shows that hip reconstruction reduces hip displacement in the long term, indicated by decreased post-operative MP maintained at long-term follow-up. Although non-ambulatory children lack weight-bearing forces promoting bone remodelling, improved femoral head morphology after surgery alters the forces between the acetabulum and the femoral head. Mild femoral head deformity (grades A and B) remained stable and even improved after surgery, postulated to be due to severe osteoporosis allowing remodelling.
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Affiliation(s)
- Norine Ma
- Department of Orthopaedics, The Royal Children’s Hospital, Melbourne 3052, Australia;
| | - Peter Tischhauser
- Department of Pediatric Orthopaedics, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland; (P.T.); (R.B.)
| | - Carlo Camathias
- Praxis Zeppelin, 9016 St. Gallen, Switzerland;
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Reinald Brunner
- Department of Pediatric Orthopaedics, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland; (P.T.); (R.B.)
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Erich Rutz
- Department of Orthopaedics, The Royal Children’s Hospital, Melbourne 3052, Australia;
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
- Department of Paediatrics, The University of Melbourne, Melbourne 3010, Australia
- Murdoch Children’s Research Institute, Melbourne 3052, Australia
- Correspondence:
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Kulkarni VA, Kephart DT, Ball MA, Tumber S, Davidson LT, Davids JR. Neuraxial anesthesia for post-operative pain control after hip surgery in children with cerebral palsy and pre-existing intrathecal baclofen pumps. J Pediatr Rehabil Med 2022; 15:3-11. [PMID: 35275572 DOI: 10.3233/prm-210027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study is to describe the efficacy and adverse events of neuraxial anesthesia for post-operative pain control in non-ambulatory children with cerebral palsy with pre-existing intrathecal baclofen (ITB) pumps undergoing hip reconstructive or palliative surgery. METHODS Twelve children (mean age 11.25 years) were included in the study with the following neuraxial anesthesia methods: indwelling epidural catheter (8 patients), neuraxial opioids administered through the side port of the ITB pump (3 patients), and single injection spinal anesthetic (1 patient). Observational pain scores and opioid requirements were quantified for all patients. RESULTS There were no ITB pump or surgical complications at a mean follow-up of 2.2 years. The average length of stay was 6 days. Patients had good post-operative pain control with a mean observational pain score of 0.7 and mean morphine equivalent use of 0.26mg/kg/day. Four patients required anti-emetics to control nausea and three patients had urinary retention requiring repeat catheterization, but all medical complications resolved prior to discharge. CONCLUSION Neuraxial anesthesia can effectively control post-operative pain in children with a pre-existing ITB pump. Utilizing the side port of the ITB pump for administration of neuraxial opioids is an option when epidural or spinal anesthesia is not possible.
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Affiliation(s)
- Vedant A Kulkarni
- Department of Orthopaedic Surgery, Shriners Hospitals for Children - Northern California, Sacramento, CA, USA
| | - Donald T Kephart
- Department of Orthopaedic Surgery, Shriners Hospitals for Children - Northern California, Sacramento, CA, USA
| | - Madeleine A Ball
- Department of Orthopaedic Surgery, Shriners Hospitals for Children - Northern California, Sacramento, CA, USA
| | - Sundeep Tumber
- Department of Anesthesia, Shriners Hospitals for Children - Northern California, Sacramento, CA, USA
| | - Loren T Davidson
- Department of Physical Medicine and Rehabilitation, Shriners Hospitals for Children - Northern California, Sacramento, CA, USA
| | - Jon R Davids
- Department of Orthopaedic Surgery, Shriners Hospitals for Children - Northern California, Sacramento, CA, USA
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23
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Shrader MW, Gross PH, Bailes AF, Whitaker AT. Hip surveillance for patients with cerebral palsy in the United States. J Pediatr Rehabil Med 2022; 15:25-30. [PMID: 35311728 DOI: 10.3233/prm-220013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Paul H Gross
- Cerebral Palsy Research Network, Salt Lake City, UT, USA
| | - Amy F Bailes
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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24
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Wong JSH, Kuong EE, So NLW, Ali A, To MKT, Chow W. Quality of Surgery and Patient Selection Are Keys to Success in Hip Stabilization Surgery in Cerebral Palsy. J Pediatr Orthop 2022; 42:e72-e77. [PMID: 34608041 DOI: 10.1097/bpo.0000000000001961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cerebral palsy patients are at risk of hip instability, to which various soft tissue and bony surgeries are performed should conservative management fail. We aim to identify factors associated with treatment failure to guide surgical management. METHODS Cerebral palsy patients treated at 2 university-affiliated tertiary pediatric orthopaedic referral centers with hip stabilization surgery performed for subluxation in 1998 to 2015 with minimum of 5 years follow-up were reviewed. Failure was defined as reoperation to the same hip because of recurrent subluxation. Age, sex, Gross Motor Function Classification System level, tone abnormality, operation type, Reimer's migration index (RMI), and acetabular index (AI) were assessed. Cut-off values were identified through Youden index on receiver operating characteristic curve. RESULTS Eighty-nine hips from 55 patients with mean follow-up of 12.4 years were analyzed. Revision surgery was performed in 14 hips. Postoperative hip subluxation (P<0.001) and acetabular dysplasia (P=0.001) were predictive of failure, with postoperative RMI conferring an adjusted hazard ratio of 1.13 (95% confidence interval: 1.08-1.19, P<0.001) on multivariable survival analysis. Achieving a postoperative RMI of <27.5% predicts success with 92.9% sensitivity and 72% specificity with area under curve of 0.916 (P<0.001), while postoperative AI of <23.1 degrees predicts success with 92.3% sensitivity and 62.2% specificity with area under curve of 0.796 (P=0.001). In subgroup analysis of soft-tissue-only procedures, RMI >44% preoperative and >32% postoperative were associated with reoperation. In femur-only osteotomies, preoperative RMI >48% and postoperative RMI >28% were associated with failure. In pelvic and combined osteotomies, postoperative RMI >32% and AI >30 degrees were associated with failure. Other factors analyzed were not associated with reoperation. CONCLUSIONS Patient selection and quality of surgery in terms of residual postoperative hip subluxation and acetabular dysplasia are associated with need for remedial surgery. Soft-tissue-only procedures should aim to correct RMI to <32%. Bony surgery should be considered when preoperative RMI >44%, and pelvic osteotomies if RMI >48%. Pelvic osteotomies should target postoperative RMI <32% and AI <30 degrees. LEVEL OF EVIDENCE Level II-prognostic study.
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Affiliation(s)
- Janus S H Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pok Fu Lam
| | - Evelyn E Kuong
- Department of Orthopaedics and Traumatology, Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong SAR
| | - Noah L W So
- Department of Orthopaedics and Traumatology, Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong SAR
| | - Abbas Ali
- Khyber Teaching Hospital Peshawar, Peshawar, Pakistan
| | - Michael K T To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pok Fu Lam
| | - Wang Chow
- Department of Orthopaedics and Traumatology, Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong SAR
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25
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DiFazio RL, Vessey JA, Miller PE, Snyder BD, Shore BJ. Health-related quality of life and caregiver burden after hip reconstruction and spinal fusion in children with spastic cerebral palsy. Dev Med Child Neurol 2022; 64:80-87. [PMID: 34296760 DOI: 10.1111/dmcn.14994] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the effect of hip reconstruction or spinal fusion on health-related quality of life (HRQoL) in non-ambulatory children with spastic cerebral palsy (CP) and caregiver burden. METHOD This was a prospective, longitudinal study of changes in HRQoL and caregiver burden over the 5 years after surgical correction of hip instability or scoliosis in children with bilateral spastic CP classified in Gross Motor Function Classification levels IV or V. Serial parent proxy measures of HRQoL and caregiver burden were obtained before and 6 weeks, and 3, 6, 9, 12, 24, and 60 months after surgery using the Caregiver Priorities and Child Health Index of Life with Disabilities and the Assessment of Caregiver Experience with Neuromuscular Disease. Scores 5 years or more after surgery were compared to pre-surgery scores using paired Student's t-tests. Serial outcome trajectories were estimated by linear mixed modeling. RESULTS Of 69 participants (40 males, 29 females; mean age 11y 6mo, SD 4y 1mo, range 3y 10mo-20y 7mo), 43 had hip reconstruction and 26 had spinal fusion. Clinically significant improvements in HRQoL were detected (average increase 7.6 points) 5 years or more postoperatively, with hip reconstruction providing greater benefit. Domains improved by surgery included positioning, transferring/mobility, comfort/emotions, and health. Caregiver burden did not change as these children remain maximally dependent. INTERPRETATION Surgical treatment of hip and spine deformity improves HRQoL, especially for painful hip instability, but does not change caregiver burden.
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Affiliation(s)
- Rachel L DiFazio
- Orthopedic Center, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Judith A Vessey
- William F. Connell School of Nursing, Boston College, Boston, MA, USA.,Medicine Patient Services, Boston Children's Hospital, Boston, MA, USA
| | | | - Brian D Snyder
- Orthopedic Center, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Benjamin J Shore
- Orthopedic Center, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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26
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Nowak P, Narayanan U, Szmurło M, Krzyżańska A, Głowacki M, Misterska E, Jóźwiak M. Psychometric Evaluation of the Polish Version of the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). Neuropsychiatr Dis Treat 2022; 18:773-785. [PMID: 35418755 PMCID: PMC8999719 DOI: 10.2147/ndt.s329070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The assessment of the quality of life is an important element of the clinical examination of the patient. The aim of this study was translation and cross-cultural adaptation of the "Caregiver Priorities and Child Health Index of Life with Disabilities" (CPCHILD) questionnaire into Polish language, and testing of reliability and validity of the CPCHILD-PL for children with cerebral palsy (CP). MATERIAL AND METHODS A Polish version of CPCHILD was created according to internationally accepted guidelines. Parents (n=77) of 51 boys/26 girls between 3 and 17 years with CP with Gross Motor Function Classification System I-V (GMFCS I-V) participated. To assess the reliability each domain and the total measure was tested for internal consistency and test-retest reliability. Convergent validity was evaluated by correlating the CPCHILD-PL with the CHAQ (Childhood Health Assessment Questionnaire) questionnaire. RESULTS Test-retest reliability assessed by Spearman correlation coefficient for the final result of CPCHILD-PL and for most of domains were above 0.90. The values of Cronbach's-α coefficient (measuring internal consistency) were high for all domains (except for domain 5: Health) and the entire CPCHILD-PL, with the range 0.88-0.96. The comparison between CPCHILD-PL and the Disability Index (DI) of the CHAQ showed a negative correlation. The higher the DI, the lower the CPCHILD result. The Spearman's rank coefficient was -0.75. CONCLUSION The Polish version for the CPCHILD for children with CP seems to be reliable and valid tool for assessing health-related quality of life from the caregiver perspective. It can be used in research and clinical practice for evaluation and comparison of health-related quality of life in children with CP in different countries.
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Affiliation(s)
- Paulina Nowak
- Pediatric Orthopedics and Traumatology Department, K. Marcinkowski Medical University W. Dega Orthopedics and Rehabilitation Hospital, Poznan, Poland
| | - Unni Narayanan
- Division of Orthopaedic Surgery Department, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Anna Krzyżańska
- Pediatric Orthopedics and Traumatology Department, K. Marcinkowski Medical University W. Dega Orthopedics and Rehabilitation Hospital, Poznan, Poland
| | - Maciej Głowacki
- Pediatric Orthopedics and Traumatology Department, K. Marcinkowski Medical University W. Dega Orthopedics and Rehabilitation Hospital, Poznan, Poland
| | - Ewa Misterska
- Department of Pedagogy and Psychology, University of Security, Poznan, Poland
| | - Marek Jóźwiak
- Pediatric Orthopedics and Traumatology Department, K. Marcinkowski Medical University W. Dega Orthopedics and Rehabilitation Hospital, Poznan, Poland
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27
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Gibson N, Wynter M, Thomason P, Baker F, Burnett H, Graham HK, Kentish M, Love SC, Maloney E, Stannage K, Willoughby K. Australian hip surveillance guidelines at 10 years: New evidence and implementation. J Pediatr Rehabil Med 2022; 15:31-37. [PMID: 35311729 DOI: 10.3233/prm-220017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Optimum management of hip displacement in children with cerebral palsy (CP) is facilitated by an approach that focuses on anticipatory and preventive measures. Hip surveillance programs for children with CP were developed at the beginning of the new millennium, with the purpose of identifying hip displacement sufficiently early to permit a choice of effective management options. In the early years, hip surveillance was guided by epidemiological analysis of population-based studies of prevalence. In Australia, a National Hip Surveillance in CP Working Group was first convened in 2005. This resulted in a 2008 Consensus Statement of recommendations published and endorsed by Australasian Academy of Cerebral Palsy and Developmental Medicine (AusACPDM). The group undertook that the recommendations should be reviewed every 5 years to ensure currency and congruency with the emerging evidence base. As new evidence became available, hip surveillance guidelines developed, with the most recent 2020 Australian Hip Surveillance Guidelines endorsed by the AusACPDM. Implementing comprehensive hip surveillance programs has now been shown to improve the natural history of hip dislocations and improve quality of life. Standardised hip surveillance programs can also facilitate planning for multicentre research through harmonisation of data collection. This, in turn, can help with the identification of robust new evidence that is based on large cohort or population studies. Here a review of evidence informing the updated 2020 Hip Surveillance Guidelines is presented.
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Affiliation(s)
- Noula Gibson
- Department of Physiotherapy, Perth Children's Hospital, Nedlands, WA, Australia.,Curtin University, School of Physiotherapy and Exercise Science, Perth, WA, Australia
| | - Meredith Wynter
- Department of Paediatric Rehabilitation, Queensland Children's Hospital, South Brisbane, QLD, Australia.,University of Queensland, Child Health Research Centre, Brisbane, QLD, Australia
| | - Pam Thomason
- The Royal Children's Hospital, Hugh Williamson Gait Laboratory, Parkville, VIC, Australia
| | - Felicity Baker
- Women's and Children's Hospital, Paediatric Rehabilitation Department, North Adelaide, SA, Australia
| | - Heather Burnett
- Hunter New England Local Health District, HNEkids Rehab, New Lambton, NSW, Australia
| | - H Kerr Graham
- The Royal Children's Hospital, Hugh Williamson Gait Laboratory, Parkville, VIC, Australia.,Department of Orthopaedics, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Megan Kentish
- Department of Paediatric Rehabilitation, Queensland Children's Hospital, South Brisbane, QLD, Australia.,University of Queensland, Child Health Research Centre, Brisbane, QLD, Australia
| | - Sarah C Love
- University of Notre Dame, School of Physiotherapy, Fremantle, WA, Australia.,SensesWA, WA, Australia
| | - Eliza Maloney
- The Royal Hobart Hospital, State-Wide Paediatric Rehabilitation, Hobart, TAS, Australia
| | - Katherine Stannage
- Department of Orthopaedics, Perth Children's Hospital, Australia, Nedlands, WA, Australia
| | - Kate Willoughby
- Department of Orthopaedics, The Royal Children's Hospital, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Gait Lab and Orthopaedics Research Group, Parkville, VIC, Australia
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28
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Buckland AJ, Woo D, Kerr Graham H, Vasquez-Montes D, Cahill P, Errico TJ, Sponseller PD. Residual lumbar hyperlordosis is associated with worsened hip status 5 years after scoliosis correction in non-ambulant patients with cerebral palsy. Spine Deform 2021; 9:1125-1136. [PMID: 33523455 DOI: 10.1007/s43390-020-00281-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is a static encephalopathy with progressive musculoskeletal pathology. Non-ambulant children (GMFCS IV and V) with CP have high rates of spastic hip disease and neuromuscular scoliosis. The effect of spinal fusion and spinal deformity on hip dislocation following total hip arthroplasty has been well studied, however in CP this remains largely unknown. This study aimed to identify factors associated with worsening postoperative hip status (WHS) following corrective spinal fusion in children with GMFCS IV and V CP. METHODS Retrospective review of GMFSC IV and V CP patients in a prospective multicenter database undergoing spinal fusion, with 5 years follow-up. WHS was determined by permutations of baseline (BL), 1 year, 2 years, and 5 years hip status and defined by a change from an enlocated hip at BL that became subluxated, dislocated or resected post-op, or a subluxated hip that became dislocated or resected. Hip status was analyzed against patient demographics, hip position, surgical variables, and coronal and sagittal spinal alignment parameters. Cutoff values for parameters at which the relationship with hip status was significant was determined using receiver operating characteristic curves. Logistic regression determined odds ratios for predictors of WHS. RESULTS Eighty four patients were included. 37 (44%) had WHS postoperatively. ROC analysis and logistic regression demonstrated that the only spinopelvic alignment parameter that significantly correlated with WHS was lumbar hyperlordosis (T12-L5) > 60° (p = 0.028), OR = 2.77 (CI 1.10-6.94). All patients showed an increase in pre-to-postop LL. Change in LL pre-to-postop was no different between groups (p = 0.318), however the WHS group was more lordotic at BL and postop (pre44°/post58° vs pre32°/post51° in the no change group). Age, sex, Risser, hip position, levels fused, coronal parameters, global sagittal alignment (SVA), thoracic kyphosis, and reoperation were not associated with WHS. CONCLUSION Postoperative hyperlordosis(> 60°) is a risk factor for WHS at 5 years after spinal fusion in non-ambulant CP patients. WHS likely relates to anterior pelvic tilt and functional acetabular retroversion due to hyperlordosis, as well as loss of protective lumbopelvic motion causing anterior femoracetabular impingement. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Aaron J Buckland
- Department of Orthopaedic Surgery, Spine Research Center, NYU Langone Health, NYU Langone Orthopedic Hospital, 306 East 15th Street, New York, NY, 10003, USA. .,The Royal Children's Hospital, University of Melbourne, Melbourne, Australia. .,Melbourne Orthopaedic Group, Melbourne, Australia.
| | - Dainn Woo
- Department of Orthopaedic Surgery, Spine Research Center, NYU Langone Health, NYU Langone Orthopedic Hospital, 306 East 15th Street, New York, NY, 10003, USA
| | - H Kerr Graham
- The Royal Children's Hospital, University of Melbourne, Melbourne, Australia
| | - Dennis Vasquez-Montes
- Department of Orthopaedic Surgery, Spine Research Center, NYU Langone Health, NYU Langone Orthopedic Hospital, 306 East 15th Street, New York, NY, 10003, USA
| | - Patrick Cahill
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas J Errico
- Department of Orthopaedic Surgery, Spine Research Center, NYU Langone Health, NYU Langone Orthopedic Hospital, 306 East 15th Street, New York, NY, 10003, USA
| | - Paul D Sponseller
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Hornáček K, Kujawa J, Varela Donoso E, Dincer F, Ilieva E, Takáč P, Petronic Markovic I, Votava J, Vetra A, Nikolic D, Christodoulou N, Zampolini M, Kiekens C. Evidence Based Position Paper on Physical and Rehabilitation Medicine professional practice for persons with cerebral palsy. Eur J Phys Rehabil Med 2021; 57:1020-1035. [PMID: 33861040 DOI: 10.23736/s1973-9087.21.06983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. AIM The aim of this study was to improve Physical and Rehabilitation Medicine physician´s professional practice for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. MATERIAL AND METHODS A systematic review of the literature including an eighteen-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. RESULTS As the result of a Consensus Delphi procedure process 74 recommendations are presented together with the systematic literature review. CONCLUSIONS The PRM physician´s role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM programme developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients´ health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions.
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Affiliation(s)
- Karol Hornáček
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Jolanta Kujawa
- Department of Physical and Rehabilitation Medicine, Medical University of Lodz, Lodz, Poland
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University of School of Medicine, Madrid, Spain
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elena Ilieva
- Department of Physical and Rehabilitation Medicine, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Peter Takáč
- Department of Physical and Rehabilitation Medicine, L. Pasteur University Hospital, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic -
| | - Ivana Petronic Markovic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jiří Votava
- Faculty of Health Studies, University of J. E. Purkyně, Ústí nad Labem, Czech Republic
| | - Anita Vetra
- Rehabilitation Department, Riga Stradins University, Riga, Latvia
| | - Dejan Nikolic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Mauro Zampolini
- Department of Rehabilitation, Foligno Hospital, USL Umbria 2, Perugia, Italy
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola Bologna, Italy
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30
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Abstract
BACKGROUND Hip dysplasia in the nonambulatory child with spastic cerebral palsy (CP) is a common condition not always effectively treated with conservative measures even when recognized early. Optimal surgical intervention strategies and timing are not clear from previous studies. Contralateral hips with less severe subluxation in these patients also often undergo surgery and little is known of outcomes of these less severe hips. This study aims to clarify treatment factors related to long term success following hip surgery for subluxation in nonambulatory children with CP. METHODS A total of 183 nonambulatory subjects with CP and a minimum of 2-year follow-up were included. All subjects underwent varus rotational osteotomy of the femur; other surgical factors considered were addition of pelvic osteotomy (PO), capsulorrhaphy, and soft tissue releases. Additional factors studied were age at index surgery, sex, and unilateral versus bilateral surgery. Severely subluxated (SS) hips, defined as having >50% migration, were studied separately from contralateral nonsevere hips. Surgeries were deemed successful if final follow-up indicated a migration of <25%; patients with any revision surgeries or >25% migration were categorized as failures. RESULTS A 60% success rate was found in SS hips and a 68% success rate in nonsevere hips. Age at index surgery did not influence success rates in SS hips. In the nonsevere hips, success was associated with index surgery at older age. The addition of a PO was the only concomitant procedure demonstrated to improve outcomes. In SS hips, those with a successful outcome were 2.5 times more likely to have had a PO. The addition of capsulorrhaphy had a negative effect on the entire group, reducing odds of success to 0.8. No other factors were significant. CONCLUSIONS The findings from this multicenter retrospective study suggest that PO be added to varus rotational osteotomies in patients with severe hip subluxation. Surgery should be undertaken for severe dysplasia without concern for age. The addition of capsulorrhaphy does not improve rate of success. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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31
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Comparison of Staged Versus Same-day Bilateral Hip Surgery in Nonambulatory Children With Cerebral Palsy. J Pediatr Orthop 2021; 40:608-614. [PMID: 32453016 DOI: 10.1097/bpo.0000000000001595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bilateral hip reconstructions with osteotomies are commonly required in patients with severe cerebral palsy (CP) and dysplasia. These procedures can be performed by staging each hip surgery, separated by weeks to months, or by addressing both hips in a single-event surgery. The optimal timing of such surgery is yet to be determined. The purpose of this study was to retrospectively compare major complications between the staged and single-event approaches. METHODS Medical records of patients who underwent bilateral hip osteotomies, with at least one side including a pelvic osteotomy, were retrospectively reviewed. Subjects were identified who had a diagnosis of nonambulatory CP (defined by Gross Motor and Functional Classification System level IV or V), and at least 1 year of clinical follow-up. All hips were treated by 1 of 7 surgeons: 2 surgeons who always performing single-event surgery and 5 who always perform staged surgeries. Complications were stratified by the Modified Clavien-Dindo Classification (grades 1 to 5). The primary outcome was major complications (grade ≥3), while minor complications, readmissions, reoperations, and resource utilization outcomes were investigated secondarily. RESULTS Sixty-five patients met our inclusion criteria: 35 received single-event surgery and 30 received staged surgery. The staged group had a higher rate of major complications per patient (0.30 vs. 0; P=0.013). Unplanned readmissions and reoperations were likewise increased in the staged group. Minor complication rates were high in both groups, with no differences observed between staged and single-event approaches (3.27 per patient vs. 2.91; P=0.952). There were no complications causing permanent disability or death. The total length of stay (6.2 vs. 4.0 d; P<0.001) and mean nonsurgical operating room time (65.7 vs. 45.6 min; P<0.001) were increased in the staged group versus the single-event group. CONCLUSIONS The staged approach to bilateral hip reconstructions in the nonambulatory CP population was associated with a higher rate of major complications compared with a single-event approach. Minor complications were similar for both approaches. Both approaches can have an acceptable safety profile with no observed grade 4 or 5 complications. LEVEL OF EVIDENCE Level III.
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Eklund SE, Samineni AV, Koka A, Riley BL, Brusseau RR, Shore BJ, Miller PE, Stone SS, Berde CB, Alrayashi W. Epidural catheter placement in children with baclofen pumps. Paediatr Anaesth 2021; 31:178-185. [PMID: 33135307 DOI: 10.1111/pan.14061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children with cerebral palsy often suffer from increased tone, which can be treated with intrathecal baclofen via implanted pump. Additionally, they often require major orthopedic surgery for hip reconstruction; however, the presence of an intrathecal baclofen pump is a relative contraindication to regional anesthesia due to concerns about damaging the intrathecal baclofen pump system. AIMS (a) To evaluate adverse events related to placing epidural catheters in children with intrathecal baclofen pumps and (b) describe our multidisciplinary approach to the care of these complex patients. METHODS Children with cerebral palsy and intrathecal baclofen pump in situ who underwent hip reconstruction between 2010 and 2019 and had a perioperative epidural placed were reviewed retrospectively. Charts were assessed for adverse events or intrathecal baclofen complications. Fluoroscopic images were reviewed to evaluate the proximity between epidural and intrathecal baclofen catheters. The process of coordinating multiple services was examined. RESULTS Sixteen children met the inclusion criteria. There were no major complications following epidural placement. Postoperative pump interrogation was normal for all patients. Fluoroscopy was utilized for 9/16 (56%) epidural procedures. Epidurogram was used to confirm 11/16 catheters (68%). Children with an intrathecal baclofen pump were identified by orthopedic surgeons at the time of surgical booking and referred to the regional anesthesia team for review. The neurosurgical, pain, and regional anesthesia teams determined the appropriateness and safety of approaching the neuraxis. Pain and/or regional anesthesiologists with competency in spine fluoroscopy were scheduled on the day of surgery for fluoroscopically guided epidural placement. Postoperatively, catheters were managed by the acute pain team. Intrathecal baclofen pumps were interrogated by the baclofen pump team prior to patient discharge. DISCUSSION In this case series, not only was epidural placement feasible but also there were no observed complications. This work highlights the importance of a multidisciplinary approach to complex regional anesthetic techniques, as well as the importance of basic competency in spine fluoroscopy for regional anesthesiologists.
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Affiliation(s)
- Susan E Eklund
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Aneesh V Samineni
- Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Anjali Koka
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Bobbie L Riley
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Roland R Brusseau
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Benjamin J Shore
- Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Patricia E Miller
- Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Scellig S Stone
- Department of Neurosurgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Charles B Berde
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Walid Alrayashi
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Min JJ, Kwon SS, Sung KH, Lee KM, Chung CY, Park MS. Remodelling of femoral head deformity after hip reconstructive surgery in patients with cerebral palsy. Bone Joint J 2021; 103-B:198-203. [PMID: 33380203 PMCID: PMC7954150 DOI: 10.1302/0301-620x.103b1.bjj-2020-1339.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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.
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Affiliation(s)
- Jae Jung Min
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Soon-Sun Kwon
- Department of Mathematics, College of Natural Sciences, Ajou University, Gyeonggi, South Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
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Developing a province-wide hip surveillance program for children with cerebral palsy: from evidence to consensus to program implementation: a mini-review. J Pediatr Orthop B 2020; 29:517-522. [PMID: 31821270 PMCID: PMC7526575 DOI: 10.1097/bpb.0000000000000707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hip displacement is a common orthopedic problem in children with cerebral palsy (CP) that can result in significant morbidity. Hip surveillance has been shown to reduce the incidence of hip dislocations in children with CP and to reduce the need for salvage hip surgeries. Guidelines for hip surveillance have been developed and can be adapted to meet local needs. Implementation of surveillance guidelines for a population of children is complex and highly dependent upon the region, province/state, or country's system of care for children with CP. Recognizing that implementation of the evidence on hip surveillance was necessary in British Columbia, a Canadian province spanning 1 million square kilometers, a comprehensive, coordinated approach to hip surveillance was developed collaboratively by provincial stakeholders. Surveillance guidelines and a desired implementation plan were established based on the best available research evidence, current international practice, and service delivery in British Columbia. Staged implementation preceded full provincial roll out. Implementation was supported by detailed communication, knowledge translation, and evaluation plans. This province-wide hip surveillance program is the first of its kind in North America.
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Sung KH, Kwon SS, Cho GH, Chung CY, Encisa C, Menal H, Narayanan UG, Park MS. Differences in responses to English and Korean versions of the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD). Health Qual Life Outcomes 2020; 18:282. [PMID: 32807199 PMCID: PMC7433359 DOI: 10.1186/s12955-020-01528-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/03/2020] [Indexed: 11/26/2022] Open
Abstract
Background The purpose of this study was to identify differences in caregiver responses to Korean-language and English-language versions of the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD) questionnaire. Methods Patient data were acquired from the Cerebral Palsy Hip Outcomes Project database, which was established to run a large international multicenter prospective cohort study of the outcomes of hip interventions in cerebral palsy. Thirty-three children whose caregivers had completed the Korean version of CPCHILD were matched by propensity scoring with 33 children whose parents completed the English version. Matching was performed on the basis of 12 covariates: age, gender, gross motor function classification system level, migration percentage of right and hip, seizure status, feeding method, tracheostomy status, pelvic obliquity, spinal deformity, parental report of hip pain and contracture interfering with care. Results There were no significant differences in CPCHILD scores for section 4 (Communication and Social Interaction), and section 5 (Health) between two groups. Korean-language CPCHILD scores were significantly lower than English-language CPCHILD scores for section 1 (Personal Care/Activities of Daily Living), section 2 (Positioning, Transferring and Mobility), section 3 (Comfort and Emotions) and section 6 (Overall Quality of Life) as well as in terms of total score. Conclusions Cultural influences, and the community or social environment may impact the caregivers’ perception of the health-related quality of life of their children. Therefore, physicians should consider these differences when interpreting the study outcomes across different countries.
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Affiliation(s)
- Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Sungnam, Gyeonggi, 13620, South Korea
| | - Soon-Sun Kwon
- Department of Mathematics, College of Natural Sciences, Ajou University, Gyeonggi, South Korea
| | - Gyeong Hee Cho
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Sungnam, Gyeonggi, 13620, South Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Sungnam, Gyeonggi, 13620, South Korea
| | - Clarissa Encisa
- Division of Orthopaedics & Child Health Evaluative Sciences Program, The Hospital for Sick Children, University of Toronto, 555 University Avenue, S-107, Toronto, Ontario, M5G 1X8, Canada
| | - Huroy Menal
- Division of Orthopaedics & Child Health Evaluative Sciences Program, The Hospital for Sick Children, University of Toronto, 555 University Avenue, S-107, Toronto, Ontario, M5G 1X8, Canada
| | - Unni G Narayanan
- Division of Orthopaedics & Child Health Evaluative Sciences Program, The Hospital for Sick Children, University of Toronto, 555 University Avenue, S-107, Toronto, Ontario, M5G 1X8, Canada.
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Sungnam, Gyeonggi, 13620, South Korea.
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DiFazio RL, Glader LJ, Tombeno R, Lawler K, Friel K, Brustowicz RM, Shore BJ. Team Approach: The Perioperative Management of Reconstructive Hip Surgery for the Non-Ambulatory Child with Cerebral Palsy and Spastic Hip Disease. JBJS Rev 2020; 8:e1900185. [PMID: 32678539 DOI: 10.2106/jbjs.rvw.19.00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Cerebral palsy (CP) is the leading cause of physical disability in children. Although physical disability is the hallmark of CP, children with CP also often have complex medical comorbidities. Spastic hip subluxation is the second most common orthopaedic deformity in children with CP, and the incidence increases with the severity of CP. Hip surveillance should be implemented in children with CP to monitor hip stability over time. A reconstructive surgical procedure is recommended when the migration percentage is >40%. Perioperative care of children undergoing a hip reconstructive surgical procedure is a multidisciplinary endeavor requiring the expertise of professionals with different backgrounds. The core team should comprise orthopaedic surgeons, nurses, nurse practitioners, pediatricians, nurse case managers, anesthesiologists, and physical therapists. Additional team members include nutritionists, clinical pharmacists, social workers, child life therapists, and consulting specialty services. This review describes the team approach to the perioperative care of non-ambulatory children with spastic hip subluxation undergoing a reconstructive hip surgical procedure, utilizing a case scenario of a 7-year old girl with CP and complex associated medical comorbidities.
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Affiliation(s)
- Rachel L DiFazio
- 1Boston Children's Hospital, Boston, Massachusetts 2Harvard Medical School, Boston, Massachusetts
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Cost-effectiveness analysis of a surveillance program to prevent hip dislocation in children with cerebral palsy. GACETA SANITARIA 2020; 34:377-384. [DOI: 10.1016/j.gaceta.2019.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 01/08/2023]
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Hosseinzadeh P, Baldwin K, Minaie A, Miller F. Management of Hip Disorders in Patients with Cerebral Palsy. JBJS Rev 2020; 8:e0148. [PMID: 32224639 DOI: 10.2106/jbjs.rvw.19.00148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Hip disorders are the second most common musculoskeletal abnormality seen in children with cerebral palsy, affecting nearly 1 in 3.
The goal of surgical intervention is to provide a mobile, located, and painless hip. Reconstructive procedures are indicated for children with migration percentages of >40%. Reconstructive procedures typically result in a long-term satisfactory outcome, although recurrence is seen particularly in nonambulatory children and when the reconstruction is performed earlier than 6 years of age. Salvage procedures are performed when reconstructive procedures are no longer an option and degenerative changes have occurred. They include proximal femoral valgus osteotomy, proximal femoral resection, and hip arthroplasty.
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Affiliation(s)
- Pooya Hosseinzadeh
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Keith Baldwin
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Arya Minaie
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Freeman Miller
- Motion Analysis Laboratory, Alfred I. DuPont Institute, Wilmington, Delaware
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Abstract
PURPOSE Hip dislocation and scoliosis are common in children with cerebral palsy (CP). Hip dislocation develops in 15% and 20% of children with CP, mainly between three and six years of age and especially in the spastic and dyskinetic subtypes. The risk of scoliosis increases with age and increasing disability as expressed by the Gross Motor Function Score. METHODS A hip surveillance programme and early surgical treatment have been shown to reduce the hip dislocation, but it remains unclear if a similar programme could reduce the need for neuromuscular scoliosis. When hip dislocation and neuromuscular scoliosis are co-existent, there appears to be no clear guidelines as to which of these deformities should be addressed first: hip or spine. RESULTS Hip dislocation or windswept deformity may cause pelvic obliquity and initiate scoliosis, while neuromuscular scoliosis itself leads to pelvic obliquity and may increase the risk of hip dislocation especially on the high side. It remains unclear if treating imminent hip dislocation can prevent development of scoliosis and vice versa, but they may present at the same time for surgery. Current expert opinion suggests that when hip dislocation and scoliosis present at the same time, scoliosis associated pelvic obliquity should be corrected before hip reconstruction. If the patient is not presenting with pelvic obliquity the more symptomatic condition should be addressed first. CONCLUSION Early identification of hip displacement and neuromuscular scoliosis appears to be important for better surgical outcomes.
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Affiliation(s)
- Ilkka J. Helenius
- Department of Pediatric Orthopedic Surgery, University of Turku and Turku University Hospital, Turku, Finland,Correspondence should be sent to Ilkka J. Helenius, Department of Pediatric Orthopedic Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland. E-mail:
| | - Elke Viehweger
- Department of Pediatric Orthopedic Surgery, Aix-Marseille University and Timone Children’s Hospital, Marseille, France
| | - Rene M. Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, The Netherlands
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Park H, Abdel-Baki SW, Park KB, Park BK, Rhee I, Hong SP, Kim HW. Outcome of Femoral Varus Derotational Osteotomy for the Spastic Hip Displacement: Implication for the Indication of Concomitant Pelvic Osteotomy. J Clin Med 2020; 9:jcm9010256. [PMID: 31963548 PMCID: PMC7020049 DOI: 10.3390/jcm9010256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/05/2020] [Accepted: 01/15/2020] [Indexed: 11/16/2022] Open
Abstract
No previous studies have suggested a reliable criterion for determining the addition of a concomitant pelvic osteotomy by using a large patient cohort with quadriplegic cerebral palsy and a homogenous treatment entity of femoral varus derotational osteotomies (VDRO). In this retrospective study, we examined our results of hip reconstructions conducted without a concomitant pericapsular acetabuloplasty in patients with varying degrees of hip displacement. We wished to investigate potential predictors for re-subluxation or re-dislocation after the index operation, and to suggest the indications for a simultaneous pelvic osteotomy. We reviewed the results of 144 VDROs, with or without open reduction, in 72 patients, at a mean follow-up of 7.0 (2.0 to 16.0) years. Various radiographic parameters were measured, and surgical outcomes were assessed based on the final migration percentage (MP) and the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS) grades. The effects of potential predictive factors on the surgical outcome was assessed by multivariate regression analysis. A receiver operating characteristic (ROC) curve analysis was also performed to determine whether a threshold of each risk factor existed above which the rate of unsatisfactory outcomes was significantly increased. In total, 113 hips (78.5%) showed satisfactory results, classified as MCPHCS grades I, II, and III. Thirty-one hips (21.5%) showed unsatisfactory results, including six hip dislocations. Age at surgery and preoperative acetabular index had no effects on the results. Lower pre- and postoperative MP were found to be the influential predictors of successful outcomes. The inflection point of the ROC curve for unsatisfactory outcomes corresponded to the preoperative MP of 61.8% and the postoperative MP of 5.1%, respectively; these thresholds of the pre- and postoperative MP may serve as a guideline in the indication for a concomitant pelvic osteotomy. Our results also indicate that the severely subluxated or dislocated hip, as well as the hip in which the femoral head is successfully reduced by VDRO but is still contained within the dysplastic acetabulum, may benefit from concomitant pelvic osteotomy.
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Affiliation(s)
- Hoon Park
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea; (H.P.); (S.-P.H.)
| | - Sharkawy Wagih Abdel-Baki
- Department of Orthopaedic Surgery, Aswan University Hospital, Aswan University Faculty of Medicine, Aswan 81528, Egypt;
| | - Kun-Bo Park
- Division of Pediatric Orthopaedic Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
| | - Byoung Kyu Park
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan 48108, Korea;
| | - Isaac Rhee
- Medical Course, University of Melbourne, Melbourne Medical School, Melbourne 3010, Australia;
| | - Seung-Pyo Hong
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea; (H.P.); (S.-P.H.)
| | - Hyun Woo Kim
- Division of Pediatric Orthopaedic Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
- Correspondence: ; Tel.: +82-2-2228-2180
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Thompson RM, Fowler E, Culo B, Shellock FG. MRI safety and imaging artifacts evaluated for a cannulated screw used for guided growth surgery. Magn Reson Imaging 2019; 66:219-225. [PMID: 31704394 DOI: 10.1016/j.mri.2019.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/20/2019] [Accepted: 11/03/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Percutaneously-placed cannulated screws are the implant of choice for treatment of skeletal deformity associated with growing children that have spastic cerebral palsy (CP). These patients often require MRI examinations throughout their childhood to evaluate associated comorbidities and frequently for research protocols. There are concerns related to the use of MRI when metallic implants are present. Therefore, this study characterized MRI safety and imaging artifacts for a cannulated screw commonly used for guided growth. METHODS Standardized and well-accepted in vitro techniques were used to evaluate a cannulated screw (4.5 mm diameter x 50 mm length, 316 L stainless steel) for MRI issues. Static magnetic field interactions (i.e., translational attraction and torque) and artifacts were tested at 3-Tesla. Radiofrequency-related heating was assessed at 1.5-Tesla/64-MHz and 3-Tesla/128-MHz using relatively high levels of RF energy (whole-body averaged specific absorption rates of 2.7 W/kg and 2.9-W/kg, respectively). Artifacts were determined using T1-weighted, spin echo and gradient echo pulse sequences. RESULTS The cannulated screw exhibited minor magnetic field interactions (14° deflection angle, no torque). The highest temperature changes at 1.5-Tesla/64-MHz and 3-Tesla/128-MHz MRI were 2.1 °C and 2.4 °C, respectively. The maximum artifact size on a gradient echo sequence extended 20 mm relative to the dimensions of the implant. CONCLUSIONS The in vitro tests performed on the cannulated screw indicated that there were no substantial concerns with respect to the use of 1.5- and 3-Tesla MRI. Therefore, a patient with this cannulated screw can safely undergo MRI by following specific conditions to ensure safety.
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Affiliation(s)
- Rachel Mednick Thompson
- Orthopaedic Institute for Children, David Geffen School of Medicine at UCLA, 403 West Adams Blvd, Los Angeles, CA 90007, United States of America.
| | - Eileen Fowler
- UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy, David Geffen School of Medicine, 1000 Veteran Ave., 22-70 Rehab Building, Los Angeles, CA 90095, United States of America.
| | - Bozena Culo
- Loyola Marymount University, 1 LMU Drive, Los Angeles, CA 90045, United States of America.
| | - Frank G Shellock
- Department of Radiology and Medicine, Keck School of Medicine, University of Southern California, 7751 Veragua Dr., Playa Del Rey, CA 90293, United States of America.
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Shore BJ, Graham HK. Management of Moderate to Severe Hip Displacement in Nonambulatory Children with Cerebral Palsy. JBJS Rev 2019; 5:e4. [PMID: 29256976 DOI: 10.2106/jbjs.rvw.17.00027] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - H Kerr Graham
- Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
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The spastic hip in children and adolescents. Orthop Traumatol Surg Res 2019; 105:S133-S141. [PMID: 30056240 DOI: 10.1016/j.otsr.2018.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/15/2018] [Accepted: 03/20/2018] [Indexed: 02/02/2023]
Abstract
The hip is the joint most exposed to orthopaedic complications in cerebral palsy (CP), which is the main cause of spasticity in paediatric patients. The initial immaturity of the hip allows the forces applied by the spastic and retracted muscles to displace the femoral head, eventually causing it to dislocate. The risk of hip dislocation increases with the severity and extent of CP, exceeding 70% in the most severe cases. Hip dislocation causes pain in up to 30% of cases, carries a risk of orthopaedic and cutaneous complications and hinders patient installation and nursing care. These adverse outcomes warrant routine screening, which has been proven effective in lessening the frequency and severity of hip displacement. Preventive techniques including physical therapy, orthoses and treatments to alleviate spasticity are strongly recommended in every case. The beneficial effects of treating spasticity, if needed via neurosurgical procedures, have been convincingly established. Orthopaedic surgery is required when prevention fails. Soft-tissue release is designed to correct the asymmetry in the forces applied by the muscles. Femoral osteotomy creates the possibility for spontaneous correction of secondary acetabular dysplasia. Progress has been made in standardising the use of multilevel surgery involving the soft tissues, femur and pelvis, which is often effective in correcting the morphological abnormalities and stabilising the joint. When hip pain or alterations are severe, hip resection or total hip arthroplasty are highly effective in alleviating the pain and improving patient comfort. The spastic hip is a complex condition in which currently available screening protocols and treatment strategies have been proven effective in benefitting patient outcomes.
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Willoughby KL, Toovey R, Hodgson JM, Graham HK, Reddihough DS. Health professionals' experiences and barriers encountered when implementing hip surveillance for children with cerebral palsy. J Paediatr Child Health 2019; 55:32-41. [PMID: 29975007 DOI: 10.1111/jpc.14108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/17/2018] [Accepted: 05/28/2018] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to explore health professionals' experiences of implementing hip surveillance for young people with cerebral palsy (CP) and to identify any barriers they encounter. METHODS A cross-sectional web-based survey of health professionals supporting children with CP was conducted. Responses were analysed through mixed methods. Responses to items presented as ordinal scales were analysed using descriptive statistics, and open-ended responses through a qualitative approach to identify themes. RESULTS A total of 32 paediatricians, 2 rehabilitation specialists and 50 physiotherapists completed the survey, with respondents working within both hospital- and community-based settings. Barriers most frequently reported were inconsistency in radiology practice and reporting (35%), parent engagement (32%), limited communication between clinicians (31%), lack of clarity in lines of responsibility (27%) and forgetting to undertake surveillance (26%). Four major themes were identified through qualitative analysis: (i) recognition of the importance of clinical guidelines to hip surveillance; (ii) the value of each role in the team around a child; (iii) the challenge of sharing responsibility; and (iv) the importance of communication in facilitating collaboration. CONCLUSIONS Barriers can be encountered at each phase of the hip surveillance process, but there are also factors that act as facilitators. Locally, the results will inform the development of an enhanced state-wide approach to hip surveillance for all children with CP. The identified barriers do not appear unique to the local context, and the findings may be transferable to other settings. Awareness of the potential barriers and facilitators would be valuable to those implementing hip surveillance in other areas.
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Affiliation(s)
- Kate L Willoughby
- Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Orthopaedic Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rachel Toovey
- Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jan M Hodgson
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - H Kerr Graham
- Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Orthopaedic Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
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Cottrill EJ, Johnson DC, Silberstein CE. A single-center retrospective review of factors influencing surgical success in patients with cerebral palsy undergoing corrective hip surgery. J Pediatr Rehabil Med 2019; 12:263-269. [PMID: 31476176 DOI: 10.3233/prm-180553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To identify factors associated with success of corrective bony hip surgery among patients with cerebral palsy (CP). METHODS A retrospective review was conducted of medical records of patients diagnosed with CP and hip displacement who underwent surgery from 2004 to 2016 at the authors' institution and who had a one-year minimum follow-up. Patient age, sex, Gross Motor Function Classification System (GMFCS) level, surgical procedure(s), type and extent of CP, presence of preoperative and postoperative hip pain, and hip migration percentages (MPs) were recorded. Surgical success was defined as a postoperative MP ⩽ 30% and no hip pain at final follow-up. RESULTS Thirty-eight patients (55 hips) met the inclusion criteria. Mean age at surgery was 10.2 years (range, 2-24 years). Mean MP (standard deviation) improved from 64 ± 29% preoperatively to 22 ± 30% at a mean 1.7-year follow-up (p< 0.001). The absence of preoperative hip pain (p= 0.014), surgery after age 5 (p= 0.041), and a milder preoperative MP (p< 0.001) were significantly associated with surgical success. CONCLUSION In patients with CP and hip displacement, early preventative correction of hip displacement after age 5 may improve clinical outcomes, though future studies are needed to provide more definitive clinical direction.
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Affiliation(s)
- Ethan J Cottrill
- Division of Pediatric Orthopaedics, The Johns Hopkins Children's Center, Baltimore, MD, USA
| | - Deanna C Johnson
- Department of Physical Therapy, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Charles E Silberstein
- Division of Pediatric Orthopaedics, The Johns Hopkins Children's Center, Baltimore, MD, USA
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Vallim FCDM, Cruz HAD, Rodrigues RC, Abreu CSGD, Godoy EDP, Cunha MG. O uso de placas bloqueadas pediátricas no quadril paralítico: resultados preliminares de 61 casos. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Vallim FCDM, Cruz HAD, Rodrigues RC, Abreu CSGD, Godoy EDP, Cunha MG. The use of pediatric locked plates in the paralytic hip: preliminary results of 61 cases. Rev Bras Ortop 2018; 53:674-680. [PMID: 30377599 PMCID: PMC6204542 DOI: 10.1016/j.rboe.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/11/2017] [Indexed: 11/03/2022] Open
Abstract
Objective To evaluate the clinical and radiologic results of proximal femoral varus derotational and shortening osteotomy (OVRF) (Port., doesn't match name) with the use of a locked plate in patients with cerebral palsy, classified by the gross motor functional classification system as class IV or V. Methods A retrospective study of 42 patients (61 hips) with cerebral palsy, gross motor functional classification system class IV or V, submitted to OVRF. The minimal follow up was 24 months. This study evaluated clinical (age at surgery, gender, Gross Motor Functional Classification System class, anatomical cerebral palsy classification, and motor pattern), pre- and post-operative radiological (neck shaft angle, acetabular index, Reimers migration index and time until bone healing) characteristics, as well as post-operative complications. Results Mean pre-operative cervicodiaphyseal angle, acetabular index, and Reimers migration index were respectively 121.6°, 22.7°, and 65.4% in uncomplicated cases, and 154.7°, 20.4°, and 81.1% in complicated ones. All parameters were statistically significant difference between pre- and postoperative values (p < 0.05). The patients with postoperative complications had a greater cervicodiaphyseal angle and Reimers migration index (p < 0.0001). There were no differences in clinical characteristics, time of immobilization, or bone healing. Fourteen patients had postoperative complications (33.3%), but only six required surgical treatment. Conclusion The locked plate is a safe resource, with low complication rates and reproducible technique for OVRF in the cerebral palsy population classified as gross motor functional classification system IV and V. Greater cervicodiaphyseal angles and Reimers migration index are associated with greater chances of postoperative complications, as well as gross motor functional classification system V classification.
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Affiliation(s)
- Frederico Coutinho de Moura Vallim
- Serviço de Ortopedia Pediátrica, Hospital Estadual da Criança, Secretaria de Estado de Saúde (SES), Rio de Janeiro, RJ, Brazil.,Instituto Nacional de Traumatologia e Ortopedia (Into), Rio de Janeiro, RJ, Brazil
| | - Henrique Abreu da Cruz
- Serviço de Ortopedia Pediátrica, Hospital Estadual da Criança, Secretaria de Estado de Saúde (SES), Rio de Janeiro, RJ, Brazil
| | - Ricardo Carneiro Rodrigues
- Serviço de Ortopedia Pediátrica, Hospital Estadual da Criança, Secretaria de Estado de Saúde (SES), Rio de Janeiro, RJ, Brazil
| | - Caroline Sandra Gomes de Abreu
- Serviço de Ortopedia Pediátrica, Hospital Estadual da Criança, Secretaria de Estado de Saúde (SES), Rio de Janeiro, RJ, Brazil
| | - Eduardo Duarte Pinto Godoy
- Serviço de Ortopedia Pediátrica, Hospital Estadual da Criança, Secretaria de Estado de Saúde (SES), Rio de Janeiro, RJ, Brazil
| | - Marcio Garcia Cunha
- Serviço de Ortopedia Pediátrica, Hospital Estadual da Criança, Secretaria de Estado de Saúde (SES), Rio de Janeiro, RJ, Brazil
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Caregiver Perceptions and Health-Related Quality-of-Life Changes in Cerebral Palsy Patients After Spinal Arthrodesis. Spine (Phila Pa 1976) 2018; 43:1052-1056. [PMID: 29215495 DOI: 10.1097/brs.0000000000002508] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis of a prospective registry. OBJECTIVE Our objective was to prospectively assess caregivers' perceptions regarding changes in the health-related quality of life (HRQL) of patients with cerebral palsy (CP) after spinal arthrodesis. We assessed caregiver perceptions from three perspectives: 1) qualitative assessment of changes in global quality of life, comfort, and health; 2) relative valuation of spine surgery versus other common interventions in CP patients; and 3) quantitative changes in HRQL scores. SUMMARY OF BACKGROUND DATA Studies of children with CP who undergo surgical treatment of spinal deformity have focused largely on radiographic changes. METHODS We queried a multicenter prospective registry of CP patients with level IV or V motor function according to the Gross Motor Function Classification System who were treated with spinal arthrodesis, and whose caregivers completed preoperative and 2-year postoperative qualitative and quantitative HRQL surveys. A total of 212 caregivers and their patients were included in the study. RESULTS At 2-year follow-up, most caregivers reported that patients' global quality of life, comfort, and health were "a lot better" after spinal arthrodesis. Spinal arthrodesis was ranked as the most beneficial intervention in the patients' lives by 74% of caregivers, ahead of hip, knee, and foot surgeries and baclofen pump insertion. Gastrostomy tube insertion was the only intervention ranked superior to spinal arthrodesis in terms of impact. Quantitative HRQL scores improved significantly during 2-year follow-up across various domains. CONCLUSION In qualitative and quantitative HRQL assessments, caregivers reported overall improvement in patients' lives after spinal arthrodesis. Caregivers ranked spine surgery as the most beneficial intervention in the patients' lives, secondary only to gastrostomy tube insertion. LEVEL OF EVIDENCE 2.
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Management of Neuromuscular Hip Dysplasia in Children With Cerebral Palsy: Lessons and Challenges. J Pediatr Orthop 2018; 38 Suppl 1:S21-S27. [PMID: 29877942 DOI: 10.1097/bpo.0000000000001159] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Optimal clinical decision making and surgical management of hip dysplasia in children with cerebral palsy (CP) requires an understanding of the underlying pathophysiology (pathomechanics and pathoanatomy), incidence, and natural history. The incidence of hip dysplasia in children with CP is directly related to the degree of motor impairment. A subluxated or dislocated hip in a child with CP can compromise the quality of life for both the child and their caregivers. The goal of this article is to highlight the events over the last 25 years that have had the greatest impact on the management of hip dysplasia in children with CP. It is my opinion that the 2 most significant advances during this time have been the development of a classification system based upon motor impairment (the Gross Motor Function Classification System), and the development of surveillance programs for hip dysplasia in children with CP. This article will contrast neuromuscular hip dysplasia with developmental dysplasia of the hip. It will be shown how the development and utilization of the Gross Motor Function Classification System has contributed to our understanding of the epidemiology and natural history of hip dysplasia in children with CP, and to the assessment of outcomes following surgical management. The impact of hip surveillance programs on early soft tissue surgeries, skeletal hip reconstructions, and the incidence of hip dislocations and salvage surgeries will be reviewed. Challenges in the implementation of hip surveillance programs in resource poor and decentralized health care delivery systems will be considered, and innovative approaches identified.
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Alassaf N, Saran N, Benaroch T, Hamdy RC. Combined pelvic and femoral reconstruction in children with cerebral palsy. J Int Med Res 2017; 46:475-484. [PMID: 28823214 PMCID: PMC6011282 DOI: 10.1177/0300060517723797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective The primary aim of this study was to determine the effect of age, femoral head migration, and ambulatory status on radiographic outcomes after combined pelvic and femoral reconstruction in children with cerebral palsy. The secondary aim was to evaluate the fate of the opposite hip after unilateral reconstruction. Methods A retrospective cohort study design of consecutive patients from 1995–2009 was used. The records were screened for patients who underwent varus derotational osteotomy and modified Dega osteotomy. Results Eighty-five hips in 71 patients were included. The mean age was 8.4 ± 3.2 years and the mean follow-up was 6.6 ± 3.1 years. The final measures were a mean migration index of 20% ± 15.58%, centre edge angle of 28.45° ± 15.98°, and Sharp’s angle of 40.75° ± 8.5°. Those values were not correlated with age and the initial migration index. Nonambulatory status did not negatively affect hip stability. Final measurements of the contralateral hips were similar to the reconstructed hips, and the cumulative incidence for later reconstruction was 5.67%. Conclusions Regardless of age, preoperative displacement, and ambulation, the combined procedure provides durable radiographic improvement. In unilateral cases, there is a low risk of later deterioration of the opposite side.
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Affiliation(s)
- Nabil Alassaf
- 1 Department of Surgical Specialties, 37849 King Fahad Medical City , Riyadh, Saudi Arabia
| | - Neil Saran
- 2 McGill University-Orthopaedic Surgery; 70357 Shriners Hospital for Children ; and Montreal's Children Hospital, Montreal-QC, Canada
| | - Theirry Benaroch
- 2 McGill University-Orthopaedic Surgery; 70357 Shriners Hospital for Children ; and Montreal's Children Hospital, Montreal-QC, Canada
| | - Reggie Cherine Hamdy
- 2 McGill University-Orthopaedic Surgery; 70357 Shriners Hospital for Children ; and Montreal's Children Hospital, Montreal-QC, Canada
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