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Hip reconstruction in closed triradiate cartilage: long-term outcomes in patients with cerebral palsy

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Hip reconstruction is an established procedure in pediatric patients with neurogenic hip dislocation. An open triradiate cartilage provides the advantage of a high plasticity of the bone which prevents an intraarticular fracture and postoperative adaptation of shape. Some patients with dislocated hips, however, arrive late. A hip reconstruction is still feasible as shown earlier but the long-term risk for osteoarthritis, and recurrence of dislocation, and functional outcome is unknown. It is the aim of our investigation to evaluate long-term clinical and radiological outcomes of hip reconstruction by Dega type pelvic osteotomy performed after fusion of the triradiate epiphyseal cartilage in patients suffering from cerebral palsy.

Material and methods

We retrospectively analyzed 43 hips in 37 patients with a hip reconstruction for correction of hip dislocation or subluxation. In all patients, the triradiate cartilage was fused before surgery. Age at surgery was 15 years and 2 months on average and follow-up time was mean 13 years 5 months.

Results

Mean Kellgren Lawrence score at final follow-up was significantly higher than at preoperative investigation (P < 0.00001). At long-term follow-up 3 of 43 hips had developed pain, and 1 of them required arthroplasty. Reimers´ migration index was stable over the years and was not higher at last follow-up compared to the index observed shortly after surgery (P = 0.857), so was the Sharp angle (P = 0.962). We found no significant reduction in the range of motion of the hip in the sagittal plane.

Conclusion

We noted mild radiological signs of osteoarthritis which possibly occur due to an intraarticular acetabulum fracture during bending down the acetabulum. Nevertheless, hip reconstruction in patients with cerebral palsy and closed triradiate cartilage remains a valuable option as it results in a stable, painless hip for more than a decade.

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Abbreviations

CP:

Cerebral palsy

GMFCS:

Gross Motor Function Classification System

OA:

Osteoarthritis

MP:

Reimers migration percentage

ROM:

Range of motion

References

  1. Kolman SE, Ruzbarsky JJ, Spiegel DA, Baldwin KD (2016) Salvage options in the cerebral palsy hip: a systematic review. J Pediatr Orthop 36(6):645–650. https://doi.org/10.1097/BPO.0000000000000501 (PMID: 25887836)

    Article  PubMed  Google Scholar 

  2. Hwang JH, Varte L, Kim HW, Lee DH, Park H (2016) Salvage procedures for the painful chronically dislocated hip in cerebral palsy. Bone Joint J 98-B(1):137–143. https://doi.org/10.1302/0301-620X.98B1.35202 (PMID: 26733527)

    Article  CAS  PubMed  Google Scholar 

  3. Houdek MT, Watts CD, Wyles CC, Trousdale RT, Milbrandt TA, Taunton MJ (2017) Total hip arthroplasty in patients with cerebral palsy: a cohort study matched to patients with osteoarthritis. J Bone Joint Surg Am 99(6):488–493. https://doi.org/10.2106/JBJS.16.00528 (PMID: 28291181)

    Article  PubMed  Google Scholar 

  4. Strauss D, Brooks J, Rosenbloom L, Shavelle R (2008) Life expectancy in cerebral palsy: an update. Dev Med Child Neurol 50(7):487–493. https://doi.org/10.1111/j.1469-8749.2008.03000.x (PMID: 18611196)

    Article  PubMed  Google Scholar 

  5. Brooks JC, Strauss DJ, Shavelle RM, Tran LM, Rosenbloom L, Wu YW (2014) Recent trends in cerebral palsy survival. Part I: period and cohort effects. Dev Med Child Neurol 56(11):1059–1064. https://doi.org/10.1111/dmcn.12520 (Epub 2014 Jun 26. PMID: 24966011)

    Article  PubMed  Google Scholar 

  6. Brooks JC, Strauss DJ, Shavelle RM, Tran LM, Rosenbloom L, Wu YW (2014) Recent trends in cerebral palsy survival. Part II: individual survival prognosis. Dev Med Child Neurol 56(11):1065–1071. https://doi.org/10.1111/dmcn.12519 (Epub 2014 Jul 12. PMID: 25041081)

    Article  PubMed  Google Scholar 

  7. Dega W (1974) Osteotomia trans-iliakalna w leczeniu wrodzonej dysplazji biodra [transiliac osteotomy in the treatment of congenital hip dysplasia]. Chir Narzadow Ruchu Ortop Pol 39(5):601–613 (Polish. PMID: 4422569)

    CAS  PubMed  Google Scholar 

  8. Pemberton PA (1965) Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip. J Bone Joint Surg Am 47:65–86 (PMID: 14256975)

    Article  CAS  Google Scholar 

  9. Mubarak SJ, Valencia FG, Wenger DR (1992) One-stage correction of the spastic dislocated hip. Use of pericapsular acetabuloplasty to improve coverage. J Bone Joint Surg Am 74(9):1347–1357 (PMID: 1429790)

    Article  CAS  Google Scholar 

  10. Rutz E, Vavken P, Camathias C, Haase C, Jünemann S, Brunner R (2015) Long-term results and outcome predictors in one-stage hip reconstruction in children with cerebral palsy. J Bone Joint Surg Am 97(6):500–506. https://doi.org/10.2106/JBJS.N.00676 (PMID: 25788307)

    Article  PubMed  Google Scholar 

  11. McNerney NP, Mubarak SJ, Wenger DR (2000) One-stage correction of the dysplastic hip in cerebral palsy with the San Diego acetabuloplasty: results and complications in 104 hips. J Pediatr Orthop 20(1):93–103 (PMID: 10641697)

    Article  CAS  Google Scholar 

  12. Reichel H, Hein W (1996) Dega acetabuloplasty combined with intertrochanteric osteotomies. Clin Orthop Relat Res 323:234–242. https://doi.org/10.1097/00003086-199602000-00032 (PMID: 8625586)

    Article  Google Scholar 

  13. Grudziak JS, Ward WT (2001) Dega osteotomy for the treatment of congenital dysplasia of the hip. J Bone Joint Surg Am 83(6):845–854. https://doi.org/10.2106/00004623-200106000-00005 (PMID: 11407792)

    Article  CAS  PubMed  Google Scholar 

  14. Robb JE, Brunner R (2006) A Dega-type osteotomy after closure of the triradiate cartilage in non-walking patients with severe cerebral palsy. J Bone Joint Surg Br 88(7):933–937. https://doi.org/10.1302/0301-620X.88B7.17506 (PMID: 16798999)

    Article  CAS  PubMed  Google Scholar 

  15. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502. https://doi.org/10.1136/ard.16.4.494.PMID:13498604 (PMCID:PMC1006995)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Reimers J (1979) Stabiliteten af børns hofteled bedømt ved ét røntgenfoto [stability of the hip-joint in children assessed by X-ray photograph]. Ugeskr Laeger 141(4):231–233 (Danish. PMID: 760297)

    CAS  PubMed  Google Scholar 

  17. Sharp IK (1961) Acetabular dysplasia. J Bone Joint Surg Br 43-B(2):268–272

    Article  Google Scholar 

  18. Agus H, Biçimoglu A, Omeroglu H, Tümer Y (2002) How should the acetabular angle of sharp be measured on a pelvic radiograph? J Pediatr Orthop 22(2):228–231 (PMID: 11856937)

    Article  Google Scholar 

  19. Clarkson M (2000) The hip. Chapter 6 in musculoskeletal assessment: joint range of motion and manual muscle strength, 3rd edn. Williams and Wilkins, Philadelphia, Lippincott

    Google Scholar 

  20. Farrell G, McGrath F, Hogan B, Logan M, Denvir K, O’Connell B, Irwin E, Gissane C, Wilson F (2016) 95% prevalence of abnormality on hip MRI in elite academy level rugby union: a clinical and imaging study of hip disorders. J Sci Med Sport 19(11):893–897. https://doi.org/10.1016/j.jsams.2016.01.005 (Epub 2016 Feb 8 PMID: 26897392)

    Article  PubMed  Google Scholar 

  21. Smith-Petersen MN (1949) Approach to and exposure of the hip joint for mold arthroplasty. J Bone Joint Surg Am 31A(1):40–46 (PMID: 18122877)

    Article  CAS  Google Scholar 

  22. Brunner R, Baumann JU (2000) Open reduction of hip dislocation in children with cerebral palsy. Orthop Traumatol 8(1):22–36

    Article  Google Scholar 

  23. Inan M, Gabos PG, Domzalski M, Miller F, Dabney KW (2007) Incomplete transiliac osteotomy in skeletally mature adolescents with cerebral palsy. Clin Orthop Relat Res 462:169–174. https://doi.org/10.1097/BLO.0b013e318124fdca (PMID: 17563700)

    Article  PubMed  Google Scholar 

  24. Miller F, Girardi H, Lipton G, Ponzio R, Klaumann M, Dabney KW (1997) Reconstruction of the dysplastic spastic hip with peri-ilial pelvic and femoral osteotomy followed by immediate mobilization. J Pediatr Orthop 17(5):592–602. https://doi.org/10.1097/00004694-199709000-00005 (PMID: 9591996)

    Article  CAS  PubMed  Google Scholar 

  25. Mustard WT (1952) Iliopsoas transfer for weakness of the hip abductors; a preliminary report. J Bone Joint Surg Am 24 A(3):647–650 (PMID: 14946216)

    Article  CAS  Google Scholar 

  26. Visscher R, Hasler N, Freslier M, Singh NB, Taylor WR, Brunner R, Rutz E (2021) Long-term follow-up after multilevel surgery in cerebral palsy. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-021-03797-0 (Online ahead of print)

    Article  PubMed  Google Scholar 

  27. Tomaszewski R, Rutz E, Mayr J, Dajka J (2020) Surgical treatment of benign lesions and pathologic fractures of the proximal femur in children. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03687-x (Online ahead of print)

    Article  PubMed  Google Scholar 

  28. Vogel-Tgetgel ND, Kläusler M, Brunner R, Camathias C, Rutz E (2020) Short-term outcome of double-shelled braces in neuromuscular scoliosis. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03600-6 (Online ahead of print)

    Article  PubMed  Google Scholar 

  29. Hägglund G, Lauge-Pedersen H, Wagner P (2007) Characteristics of children with hip displacement in cerebral palsy. BMC Musculoskelet Disord 26(8):101. https://doi.org/10.1186/1471-2474-8-101.PMID:17963501;PMCID:PMC2194677

    Article  Google Scholar 

  30. Terjesen T (2012) The natural history of hip development in cerebral palsy. Dev Med Child Neurol 54(10):951–957. https://doi.org/10.1111/j.1469-8749.2012.04385.x (Epub 2012 Aug 13 PMID: 22881288)

    Article  PubMed  Google Scholar 

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Acknowledgements

Dr. Erich Rutz, MD, was supported by the Bob Dickens Fellowship in Pediatric Orthopedics, University of Melbourne, Australia

Author information

Author notes

  1. Thomas Schlemmer and Reinald Brunner shared first authorship.

Authors and Affiliations

  1. University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland

    Thomas Schlemmer, Reinald Brunner, Bernhard Speth, Johannes Mayr & Erich Rutz

  2. Praxis Zeppelin, St. Gallen, Switzerland

    Carlo Camathias

  3. University of Basel, Basel, Switzerland

    Reinald Brunner, Carlo Camathias, Johannes Mayr & Erich Rutz

  4. Department of Orthopaedics, The Royal Children’s Hospital, The University of Melbourne, MCRI, 50 Flemington Road Parkville Victoria 3052, Melbourne, Australia

    Erich Rutz

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  1. Thomas Schlemmer
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Correspondence to Erich Rutz.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the Ethical approval was given by the “Ethikkommission Nordwest- und Zentralschweiz” (EKNZ) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Schlemmer, T., Brunner, R., Speth, B. et al. Hip reconstruction in closed triradiate cartilage: long-term outcomes in patients with cerebral palsy. Arch Orthop Trauma Surg 142, 3667–3674 (2022). https://doi.org/10.1007/s00402-021-03970-5

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  • DOI: https://doi.org/10.1007/s00402-021-03970-5

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