Abstract
Background:Progressive hip displacement is one of the most common and debilitating deformities seen in children with cerebral palsy (CP). The aim of this study was to evaluate the results of temporary medial hemiepiphysiodesis of the proximal femur (TMH-PF) using a transphyseal screw to control hip migration during growth in children with CP.Methods:This was a retrospective study of children with CP and hip dysplasia, age 4 to 11 years and GMFCS levels III-V. There were 28 patients with 56 hips that underwent TMH-PF surgery between 2007 and 2010. Clinical and radiologic evaluation was performed preoperatively, at 6, 12, and 60 months following the index surgery. Acetabular index (AI), neck-shaft angle (NSA) and migration percentage (MP) were measured. All complications were recorded.Results:All radiographic measurements were significantly improved at the final follow-up. Positive correlations were found between NSA, MP, and AI. Multiple regression analysis revealed that MP, time from surgery, and age were influenced by the decrease of the NSA. The femoral physis grew off the screw in 9 hips within 36 months. The screw head broke during attempted screw exchange in 1 hip. The remain cases (4 hips) were treated by placing a second screw parallel to the existing one. Finally, progressive subluxation occurred in 3 hips when the physis grew off the screw and were treated by skeletal reconstruction.Conclusions:TMH-PF was effective in controlling progressive subluxation of the hip in the majority of cases, obviating the need for major reconstructive surgery in these children with CP.Level of Evidence:Level IV.
| Original language | English (US) |
|---|---|
| Pages (from-to) | e622-e628 |
| Journal | Journal of Pediatric Orthopaedics |
| Volume | 39 |
| Issue number | 8 |
| DOIs | |
| State | Published - Sep 1 2019 |
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Keywords
- cerebral palsy
- hip dysplasia
- proximal femoral growth modulation
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Orthopedics and Sports Medicine
Cite this
Guided Growth of the Proximal Femur for the Management of Hip Dysplasia in Children with Cerebral Palsy. / Portinaro, Nicola; Turati, Marco; Cometto, Matteo; Bigoni, Marco; Davids, Jon; Panou, Artemisia.
In: Journal of Pediatric Orthopaedics, Vol. 39, No. 8, 01.09.2019, p. e622-e628.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Guided Growth of the Proximal Femur for the Management of Hip Dysplasia in Children with Cerebral Palsy
AU - Portinaro, Nicola
AU - Turati, Marco
AU - Cometto, Matteo
AU - Bigoni, Marco
AU - Davids, Jon
AU - Panou, Artemisia
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Background:Progressive hip displacement is one of the most common and debilitating deformities seen in children with cerebral palsy (CP). The aim of this study was to evaluate the results of temporary medial hemiepiphysiodesis of the proximal femur (TMH-PF) using a transphyseal screw to control hip migration during growth in children with CP.Methods:This was a retrospective study of children with CP and hip dysplasia, age 4 to 11 years and GMFCS levels III-V. There were 28 patients with 56 hips that underwent TMH-PF surgery between 2007 and 2010. Clinical and radiologic evaluation was performed preoperatively, at 6, 12, and 60 months following the index surgery. Acetabular index (AI), neck-shaft angle (NSA) and migration percentage (MP) were measured. All complications were recorded.Results:All radiographic measurements were significantly improved at the final follow-up. Positive correlations were found between NSA, MP, and AI. Multiple regression analysis revealed that MP, time from surgery, and age were influenced by the decrease of the NSA. The femoral physis grew off the screw in 9 hips within 36 months. The screw head broke during attempted screw exchange in 1 hip. The remain cases (4 hips) were treated by placing a second screw parallel to the existing one. Finally, progressive subluxation occurred in 3 hips when the physis grew off the screw and were treated by skeletal reconstruction.Conclusions:TMH-PF was effective in controlling progressive subluxation of the hip in the majority of cases, obviating the need for major reconstructive surgery in these children with CP.Level of Evidence:Level IV.
AB - Background:Progressive hip displacement is one of the most common and debilitating deformities seen in children with cerebral palsy (CP). The aim of this study was to evaluate the results of temporary medial hemiepiphysiodesis of the proximal femur (TMH-PF) using a transphyseal screw to control hip migration during growth in children with CP.Methods:This was a retrospective study of children with CP and hip dysplasia, age 4 to 11 years and GMFCS levels III-V. There were 28 patients with 56 hips that underwent TMH-PF surgery between 2007 and 2010. Clinical and radiologic evaluation was performed preoperatively, at 6, 12, and 60 months following the index surgery. Acetabular index (AI), neck-shaft angle (NSA) and migration percentage (MP) were measured. All complications were recorded.Results:All radiographic measurements were significantly improved at the final follow-up. Positive correlations were found between NSA, MP, and AI. Multiple regression analysis revealed that MP, time from surgery, and age were influenced by the decrease of the NSA. The femoral physis grew off the screw in 9 hips within 36 months. The screw head broke during attempted screw exchange in 1 hip. The remain cases (4 hips) were treated by placing a second screw parallel to the existing one. Finally, progressive subluxation occurred in 3 hips when the physis grew off the screw and were treated by skeletal reconstruction.Conclusions:TMH-PF was effective in controlling progressive subluxation of the hip in the majority of cases, obviating the need for major reconstructive surgery in these children with CP.Level of Evidence:Level IV.
KW - cerebral palsy
KW - hip dysplasia
KW - proximal femoral growth modulation
UR - http://www.scopus.com/inward/record.url?scp=85071243298&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071243298&partnerID=8YFLogxK
U2 - 10.1097/BPO.0000000000001069
DO - 10.1097/BPO.0000000000001069
M3 - Article
C2 - 31393306
AN - SCOPUS:85071243298
VL - 39
SP - e622-e628
JO - Journal of Pediatric Orthopaedics
JF - Journal of Pediatric Orthopaedics
SN - 0271-6798
IS - 8
ER -