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Feasibility of total hip arthroplasty in cerebral palsy patients: a systematic review on clinical outcomes and complications

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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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Authors and Affiliations

  1. Institute of Orthopaedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Buenos Aires, Argentina

    Catalina Larrague & Diego Campelo

  2. University Institute School of Medicine, Italian Hospital of Buenos Aires, 4265 Potosí St., C1199ACL, Buenos Aires, Argentina

    Cecilia Fieiras

  3. Hip Surgery Unit, Institute of Orthopaedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, 4190 Peron St., C1199ABH, Buenos Aires, Argentina

    Fernando M. Comba, Gerardo Zanotti, Pablo A. Slullitel & Martin A. Buttaro

Authors
  1. Catalina Larrague
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  2. Cecilia Fieiras
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  3. Diego Campelo
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  4. Fernando M. Comba
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  5. Gerardo Zanotti
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  6. Pablo A. Slullitel
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  7. Martin A. Buttaro
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Contributions

CL: study selection, data abstraction, methodological quality assessment, wrote first draft of the manuscript. CF: data abstraction, wrote the final manuscript. DC: study selection, data abstraction, methodological quality assessment, wrote first draft of the manuscript. FC: methodological quality assessment, edited the manuscript. GZ: methodological quality assessment, edited the manuscript. PAS: co-designed the study, conducted data analysis, wrote the manuscript, edited the manuscript. MAB: co-designed the study, edited the manuscript.

Corresponding authors

Correspondence to Cecilia Fieiras or Pablo A. Slullitel.

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The authors declare no competing interests.

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This work was performed at the Italian Hospital of Buenos Aires, Argentina. All authors have participated in research. The article is not submitted elsewhere. It is a new manuscript submission.

Catalina Larrague and Cecilia Fieiras are both primary authors.

Pablo A. Slullitel and Martin A. Buttaro are both Senior authors.

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Larrague, C., Fieiras, C., Campelo, D. et al. Feasibility of total hip arthroplasty in cerebral palsy patients: a systematic review on clinical outcomes and complications. International Orthopaedics (SICOT) 46, 2493–2507 (2022). https://doi.org/10.1007/s00264-022-05528-5

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  • DOI: https://doi.org/10.1007/s00264-022-05528-5

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