Outcomes of Reconstructive Hip Surgery in Gross Motor Function Classification System Level IV and V Cerebral Palsy Patients

Abstract

Background: Varying degrees of hip displacement have been observed in up to 75% of paediatric patients with cerebral palsy (CP). Conflicting data exists regarding the incidence of significant hip pain associated with displacement, and whether surgical intervention benefits such patients with known high recurrence and complication rates. There is a paucity of evidence regarding the outcomes of reconstructive hip surgery in an African environment. Study objective: To establish medium-term functional and radiological outcomes of reconstructive hip surgery, in a cohort of non-ambulatory patients with CP, within an African context. Methods: This was a single centre, 5-year, retrospective study, reviewing non-ambulant Gross Motor Function Classification System (GMFCS) Level IV and V patients who underwent reconstructive hip surgery, between 2013 – 2017. Each primary caregiver completed a caretaker questionnaire. Pre- versus post-operative sitting function, hip pain frequency and intensity, activities of daily living (ADL’s), radiological outcomes and complications were explored. Descriptive statistics, Wilcoxon signed rank and Spearman Rho non-parametric tests were used to analyse and present the findings. Results: Forty-one participants were included, who underwent varus derotation osteotomy (VDRO) and adductor tenotomy, performed on 75 hips. Mean age at surgery was 8.7 years (3.3 – 16.3 years), and mean follow up was 6.3 years, (3.2 – 8.4 years). Surgery was bilateral in 34 cases. Ease of changing diapers and maintaining perineal hygiene was the only ADL to have improved (p=0.027). No improvement in sitting ability was noted. Significant hip pain decreased from 88% pre-operatively, to 32% post-operatively. (p<0.001). Using Reimer’s migration percentage (MP), both groups demonstrated significant improvement in hip containment (p=0.029). GMFCS Level V patients experienced more complications (60%), compared to Level IV patients. Conclusion: Natural sequalae of CP renders these patients susceptible to painful hip instability. Although most patients in this study experienced improved hip abduction with increased ease of perineal hygiene, improved pain relief and better post-operative hip enlocation, the high incidence of complications emphasizes the importance of close follow up of patients living with CP.