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De Salvo S, Sacco R, Mainard N, Lucenti L, Sapienza M, Dimeglio A, Andreacchio A, Canavese F. Total hip arthroplasty in patients with common pediatric hip orthopedic pathology. J Child Orthop 2024; 18:134-152. [PMID: 38567046 PMCID: PMC10984158 DOI: 10.1177/18632521241229608] [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: 12/15/2023] [Accepted: 01/11/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Literature regarding total hip arthroplasty for pediatric hip diseases is scarce. This review aims to portray the various orthopedic conditions of childhood that can lead to significant impairment of the hip joint and, ultimately, to total hip arthroplasty in adolescence and adulthood. Methods In total, 61 out of 3666 articles were selected according to (1) the diagnosis of one of the 12 pediatric hip pathologies (Legg-Perthes-Calvé disease, developmental dysplasia of the hip, slipped capital femoral epiphysis, neuromuscular hip dysplasia, post-traumatic avascular necrosis of the proximal femur, juvenile rheumatoid arthritis, achondroplasia, spondyloepiphyseal dysplasia, mucopolysaccharidosis, mucolipidosis, hip infections, and tumors) that required total hip arthroplasty; (2) minimum follow-up of 16 months; (3) assessed outcome with a clinical or radiologic score; (4) Methodological Items for Non-Randomized Studies quality score of 9 or higher. The following information for each pathology was retrieved: mean age at total hip arthroplasty, reason for total hip arthroplasty, type of total hip arthroplasty, surgical technique, mean follow-up, and outcomes. Results Overall, the mean age at total hip arthroplasty for pediatric hip disease is in the sixth and seventh decade, except for tumors and skeletal dysplasias. The reason for performing total hip arthroplasty is often osteoarthrosis and abnormal anatomy. Prosthesis types change based on patient's conditions and technological advances; custom-made implants are used for tumors, juvenile rheumatoid arthritis, and skeletal dysplasias; for other diseases, the most frequent are modular cementless implants. Outcomes are generally good, and all studies portray functional and pain improvements. Conclusion Total hip arthroplasty is performed more frequently than in the past in patients with pediatric hip pathologies; it enhances patients' quality of life by reducing pain and improving function. However, revision rate in these patients is not negligible.
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Affiliation(s)
- Sara De Salvo
- Department of Pediatric Orthopedic Surgery, Lille University Hospital and Faculty of Medicine, Lille, France
| | - Ricardo Sacco
- Department of Orthopedic Surgery, CHU de Rouen, Rouen, France
| | - Nicolas Mainard
- Department of Pediatric Orthopedic Surgery, Lille University Hospital and Faculty of Medicine, Lille, France
| | - Ludovico Lucenti
- Section of Orthopaedics and Traumatology, Department of General Surgery and Medical Surgical Specialties, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy
| | - Marco Sapienza
- Section of Orthopaedics and Traumatology, Department of General Surgery and Medical Surgical Specialties, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy
| | - Alain Dimeglio
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Antonio Andreacchio
- Pediatric Orthopedic Surgery Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Hospital and Faculty of Medicine, Lille, France
- Department of Pediatric Orthopedics, Lille University Center, Jeanne de Flandre Hospital, Lille Cedex, France
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Katsma M, Liu H, Pan X, Ryan KJ, Roye DP, Chambers HG. Management and treatment of musculoskeletal problems in adults with cerebral palsy: Experience gained from two lifespan clinics. J Pediatr Rehabil Med 2024; 17:19-33. [PMID: 38552124 PMCID: PMC10977450 DOI: 10.3233/prm-240018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Mark Katsma
- Department of Orthopedic Surgery, Balboa Naval Medical Center, San Diego, CA, USA
| | - Haiqing Liu
- Pediatric Orthopedic Department of Shantou University, Guangzhou Huaxin Orthopedic Hospital, Guangzhou, China
| | - Xiaoyu Pan
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kyle J. Ryan
- University of California San Diego, San Diego, CA, USA
- Department of Orthopedic Surgery and Rehabilitation, Rady Children’s Hospital, San Diego, CA, USA
| | - David P. Roye
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Henry G. Chambers
- University of California San Diego, Rady Children’s Hospital, San Diego, CA, USA
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Costa C, Moniati F, Chatzimatthaiou M, Papaioannou C, Athanasakopoulou S, Chatzimatthaiou M. Systematic Review of Total Hip Arthroplasty Outcomes in Cerebral Palsy Patients and a Comparative Analysis with Rheumatoid Arthritis. Adv Orthop 2023; 2023:8696116. [PMID: 38188921 PMCID: PMC10771333 DOI: 10.1155/2023/8696116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/15/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024] Open
Abstract
Background Total hip arthroplasty (THA) is considered a successful treatment option for patients with degenerative hip arthritis. However, in the setting of neuromuscular diseases, patients with cerebral palsy (CP) are considered high-risk due to instability, contractures, and altered muscle tone. The purpose of this systematic review is to analyse the data in the setting of THA in CP patients including indications, types of implants, revision rates, and patient-reported outcomes and compare these with those of a cohort requiring THA due to degenerative arthritis unrelated to neuromuscular disorders. Methods PubMed, Embase, and Cochrane Library were searched from inception until June 10, 2023, to identify the relevant studies for THA on CP patients. The methodological quality of the studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). Results The initial search generated 190 studies out of which 21 met the inclusion criteria. The most frequently reported indication was painful hip dislocation or subluxation due to failure of prior nonoperative treatment. The most frequently reported complication was dislocation affecting overall 7.5% (0-28%) of all patients, while other complications included periprosthetic fractures and heterotrophic ossification. The survival rates of primary THAs ranged from 85% to 100% at 5 years and from 73% to 86% at 10 years. Patients with CP who undergo total hip arthroplasty experience a greater overall rate of complications compared to patients with rheumatoid arthritis (RA) that undergo the same procedure. Conclusion The current literature suggests that THA is a beneficial procedure for patients with CP through pain reduction and functional improvement. However, the increased rates of potential complications compared to the general population require careful consideration. We suggest that further investigations on the most appropriate time of procedure, implant type, and procedure are needed.
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Affiliation(s)
| | - Foteini Moniati
- Barts and the London School of Medicine and Dentistry—Queen Mary University of London, London, UK
| | | | | | | | - Marios Chatzimatthaiou
- Barts and the London School of Medicine and Dentistry—Queen Mary University of London, London, UK
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O’Driscoll CS, Hughes AJ, Davey MS, Queally JM, O’Daly BJ. Total Hip Arthroplasty in Patients With Neurological Conditions: A Systematic Review. Arthroplast Today 2022; 19:101068. [PMID: 36568851 PMCID: PMC9768244 DOI: 10.1016/j.artd.2022.11.001] [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: 06/20/2022] [Revised: 10/20/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022] Open
Abstract
Background As operative techniques and implant design have evolved over time, total hip arthroplasty (THA) is increasingly being carried out for patients with neurological impairment. This patient group places unique surgical challenges to the arthroplasty surgeon, which may include contractures, instability, and altered muscular tone. The purpose of this systematic review is to report the patient outcomes, complications, and implant survival following THA for patients with neurological conditions affecting the hip. Thus, we aim to support orthopaedic surgeon decision-making when considering and planning THA for these patients. Methods A systematic review was performed as per Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using the PubMed/Medline OVID, Cochrane, and Embase databases. All studies reporting the outcomes of THA in the neurological population which met defined inclusion criteria were included. Results From an initial screen of 1820 studies, 45 studies with a total of 36,251 THAs were included in the final selection. All 45 studies reported complication rates, with controls included in 16 for comparison. High complication rates were observed following THA in the neurologically impaired population, most notably dislocation with observed rates up to 10.6%. An improvement was noted in all 36 studies (1811 THAs) which reported upon patient-reported outcomes. Conclusions THA may be beneficial in the selected patients with neurological conditions, to reduce pain and improve function. There is an increased risk of complications which require careful consideration when planning the operation and open discussion with prospective patients and caregivers before proceeding with surgery.
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Affiliation(s)
- Conor S. O’Driscoll
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, Galway University Hospital, Galway, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,Corresponding author. Tallaght University Hospital, Dublin, Ireland. Tel.: +353857884714.
| | - Andrew J. Hughes
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,Rothman Orthopedic Institute, Thomas Jefferson University Hospital, PA, USA
| | - Martin S. Davey
- Department of Trauma & Orthopaedics, Galway University Hospital, Galway, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Joseph M. Queally
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, St James Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
| | - Brendan J. O’Daly
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
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Larrague C, Fieiras C, Campelo D, Comba FM, Zanotti G, Slullitel PA, Buttaro MA. Feasibility of total hip arthroplasty in cerebral palsy patients: a systematic review on clinical outcomes and complications. INTERNATIONAL ORTHOPAEDICS 2022; 46:2493-2507. [PMID: 35916954 DOI: 10.1007/s00264-022-05528-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/24/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Total hip arthroplasty (THA) is a successful treatment for hip osteoarthritis secondary to hip dysplasia. However, the reported rate of complications following THA in the settings of neuromuscular diseases is high. This systematic review aimed to analyze the indications, functional outcomes and surgical failures of primary THA in cerebral palsy (CP) patients. METHODS MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were searched, and all clinical studies focusing on THA in patients with CP from inception through March 2020 were included. The methodological quality was assessed with Guo et al.'s quality appraisal checklist for case series and case-control studies, while cohort and prospective studies were evaluated with a modified version of the Downs and Black's quality assessment checklist. RESULTS The initial search returned 69 studies out of which 15, including 2732 THAs, met the inclusion criteria. The most frequent indication for THA was dislocated painful hip for which previous non-operative treatment had failed. Complications presented in 10 to 45% of cases. The most frequently reported complication was dislocation (1-20%), followed by component loosening (0.74-20%). Aseptic component loosening was the most frequent cause of revision surgery, followed by dislocation and periprosthetic fracture. Mean implant survival at ten years was 84% (range 81-86%). CONCLUSION The available literature suggests that although THA is a beneficial procedure in CP patients, it has a higher rate of complications and worse implant survival than the general population.
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Affiliation(s)
- Catalina Larrague
- Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Cecilia Fieiras
- University Institute School of Medicine, Italian Hospital of Buenos Aires, 4265 Potosí St., C1199ACL, Buenos Aires, Argentina.
| | - Diego Campelo
- Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Fernando M Comba
- Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Gerardo Zanotti
- Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
| | - Pablo A Slullitel
- Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina.
| | - Martin A Buttaro
- Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina
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Lee NJ, Fields M, Boddapati V, Mathew J, Hong D, Sardar ZM, Selber PR, Roye B, Vitale MG, Lenke LG. Spinal Deformity Surgery in Pediatric Patients With Cerebral Palsy: A National-Level Analysis of Inpatient and Postdischarge Outcomes. Global Spine J 2022; 12:610-619. [PMID: 32964747 PMCID: PMC9109575 DOI: 10.1177/2192568220960075] [Citation(s) in RCA: 2] [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: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To provide a national-level assessment of the short-term outcomes after spinal deformity surgery in pediatric patients with cerebral palsy. METHODS A national, prospectively collected database was queried to identify pediatric (≤18 years) patients with cerebral palsy, who underwent spinal fusion surgery from 2012 to 2017. Separate multivariate analyses were performed for the primary outcomes of interest including extended length of stay (>75th percentile, >8 days), and readmissions within 90 days after the index admission. RESULTS A total of 2856 patients were reviewed. The mean age ± standard deviation was 12.8 ± 2.9 years, and 49.4% of patients were female. The majority of patients underwent a posterior spinal fusion (97.0%) involving ≥8 levels (79.9%) at a teaching hospital (96.6%). Top medical complications (24.5%) included acute respiratory failure requiring mechanical ventilation (11.4%), paralytic ileus (8.2%), and urinary tract infections (4.6%). Top surgical complications (40.7%) included blood transfusion (35.6%), wound complication (4.9%), and mechanical complication (2.7%). The hospital cost for patients with a length of hospital stay >8 days ($113 669) was nearly double than that of those with a shorter length of stay ($68 411). The 90-day readmission rate was 17.6% (mean days to readmission: 30.2). The most common reason for readmission included wound dehiscence (21.1%), surgical site infection (19.1%), other infection (18.9%), dehydration (16.9%), feeding issues (14.5%), and acute respiratory failure (13.1%). Notable independent predictors for 90-day readmissions included preexisting pulmonary disease (odds ratio [OR] 1.5), obesity (OR 3.4), cachexia (OR 27), nonteaching hospital (OR 3.5), inpatient return to operating room (OR 1.9), and length of stay >8 days (OR 1.5). CONCLUSIONS Efforts focused on optimizing the perioperative pulmonary, hematological, and nutritional status as well as reducing wound complications appear to be the most important for improving clinical outcomes.
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Affiliation(s)
- Nathan J. Lee
- Columbia University Medical Center,
The Och Spine Hospital at New York-Presbyterian, New York, NY, USA,Nathan J. Lee, Department of Orthopaedics,
Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY
10032, USA.
| | - Michael Fields
- Columbia University Medical Center,
The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Venkat Boddapati
- Columbia University Medical Center,
The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Justin Mathew
- Columbia University Medical Center,
The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Daniel Hong
- Columbia University Medical Center,
The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Zeeshan M. Sardar
- Columbia University Medical Center,
The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Paulo R. Selber
- Columbia University Medical Center,
The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Benjamin Roye
- Columbia University Medical Center,
The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Michael G. Vitale
- Columbia University Medical Center,
The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Lawrence G. Lenke
- Columbia University Medical Center,
The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
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Moore HG, Gardezi M, Burroughs PJ, Rubin LE, Frumberg DB, Grauer JN. Total Hip Arthroplasty in Patients With Cerebral Palsy: A Matched Comparison of 90-Day Adverse Events and 5-Year Implant Survival. J Arthroplasty 2021; 36:3534-3537. [PMID: 34176692 DOI: 10.1016/j.arth.2021.05.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/19/2021] [Accepted: 05/29/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND People with cerebral palsy (CP) may be considered for total hip arthroplasty (THA). However, short- and long-term outcomes after THA in this population remain poorly characterized. METHODS Data from patients undergoing THA were abstracted from the 2010-2018 PearlDiver Mariner administrative database. Those with CP were matched to those without CP based on demographic and comorbid factors (1:4 matching). Ninety-day incidence of postoperative complications and hospital readmission was identified and compared. Five-year implant survival (based on need for revision) was also assessed and compared. Perioperative adverse events were then compared using multivariate logistic regression to adjust for any potential residual differences in demographic and comorbid factors after matching. Implant survival over time was compared with Kaplan-Meier plots with a log-rank test. Significance was set at P < .05 for all comparisons. RESULTS In total, 864 patients with CP were matched to 3448 patients without CP. After adjusting for differences in demographics and comorbidities, multivariate analyses demonstrated patients with CP had higher odds of urinary tract infection (odds ratio [OR] = 2.42, P = .007), pneumonia (OR = 3.77, P = .001), and periprosthetic fracture (OR = 2.55, P = .001). Rates of the other studied adverse events, including readmissions, were not significantly different between groups. At five years, 94.2% of the CP cohort and 95.2% of the non-CP cohort THAs remained unrevised (no difference by log rank, P = .195). CONCLUSION Compared with patients without CP, patients with CP undergoing THA were found to have higher odds of perioperative urinary tract infection, pneumonia, and periprosthetic fracture but not other perioperative complications or difference in five-year implant survival.
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Affiliation(s)
| | | | | | - Lee E Rubin
- Department of Orthopaedics and Rehabilitation, Yale New Haven Hospital, New Haven, CT
| | - David B Frumberg
- Department of Orthopaedics and Rehabilitation, Yale New Haven Hospital, New Haven, CT
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale New Haven Hospital, New Haven, CT
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A Systematic Review of Total Knee Arthroplasty in Neurologic Conditions: Survivorship, Complications, and Surgical Considerations. J Arthroplasty 2020; 35:3383-3392. [PMID: 32873450 DOI: 10.1016/j.arth.2020.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with neurologic disorders present a unique set of challenges for knee surgeons because of contractures, muscle weakness, spasticity, and ligament instability. The primary purpose of this review was to report the outcomes of total knee arthroplasty (TKA) in these patients, including survivorship, complications, and surgical considerations. METHODS We performed a systematic review of articles using PubMed, Cochrane Central, EMBASE, and Google Scholar. All studies reporting outcomes of TKA in patients with Parkinson disease, multiple sclerosis, poliomyelitis, Charcot joint, spina bifida, stroke, and cerebral palsy were included. RESULTS In total 38 studies were included: 22 studies (461 patients) reported patient-reported outcome measures and 24 studies (510 patients) reported survivorship. All 38 studies reported complication rates. TKA resulted in an improvement in functional outcome in all series. Complication rate was higher in patients with neurologic conditions. Of studies reporting survivorship, mean follow-up ranged from 1 to 12 years with survivorship from 66% to 100%. All levels of implant constraint were reported without consensus. Limited rehabilitative data exist. CONCLUSION TKA in patients with neurologic disorders improves symptoms and function but carries significant risk. This review helps surgeons preoperatively counsel their patients in an informed manner. Careful planning, perioperative care, and appropriate implant selection may mitigate risk of complication.
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