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Results and complications of percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy in 54 consecutively operated GMFCS level IV and V cerebral palsy patients

  • Federico CanaveseEmail author
  • Lorenza Marengo
  • Geraldo de Coulon
Original Article • PAEDIATRICS - CEREBRAL PALSY

Abstract

Purpose

This retrospective study evaluated mid-to-long-term outcome of a minimally invasive percutaneous pelvic osteotomy (PPO) approach combined with varus derotational shortening osteotomy (VDRSO) and soft tissue release in children with severe CP.

Methods

A retrospective review was performed of all patients presenting with a diagnosis of CP with hip subluxation or dislocation treated surgically by simultaneous soft tissue release, VDRSO, and PPO between 2002 and 2015. Eligible patients included those with a diagnosis of spastic quadriplegia or CP GMFCS level IV or V with unilateral or bilateral hip subluxation or dislocation and surgical treatment of the deformity by simultaneous soft tissue release, VDRSO and PPO. All anterior–posterior (AP) radiographs of the pelvis were reviewed and Reimers migration percentage (MP) and acetabular angle (AA) were measured.

Results

In total, 54 children and adolescents (34 boys, 20 girls) with CP GMFCS level IV and V were treated during study period: 38 (70.4%) classified GMFCS level IV and 16 (29.6%) classified GMFCS level V. A total of 64 consecutive hips underwent simultaneous PPO associated with VDRSO. Overall, at the time of chart and radiograph review, mean age was 9.1 ± 3.3 years (range 4–16.5) and mean follow-up was 43.9 ± 19.5 months (range 3–72). Mean migration percentage improved from 66.8 ± 19.8% (range 33–100) preoperatively to 8.1 ± 16.5% (range 0–70) at last follow-up. Mean acetabular angle improved from 32.7° ± 7.1° (range 20–50) preoperatively to 14° ± 6.7° (range 0–27) at last follow-up. Only one case of bone graft dislodgment was observed. We did not observe any cases of avascular necrosis of the femoral head. All operated hips were pain free at the time of last follow-up.

Conclusion

PPO through a less invasive surgical approach offers a valuable alternative to standard techniques as it gives similar outcome but with less muscle stripping and less time in surgery.

Level of evidence

III.

Keywords

Cerebral palsy GMFCS Percutaneous pelvic osteotomy Varus derotation shortening osteotomy Children Adolescents 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest in the research. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Ethical approval

All procedures in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

No patients were involved. This is a retrospective study of patient’s data, and an IRB approval was obtained.

References

  1. 1.
    Canavese F, Gomez H, Kaelin A, Ceroni D, De Coulon G (2013) Percutaneous pelvic osteotomy and varus shortening osteotomy in nonambulatory GMFCS level IV and V cerebral palsy patients: preliminary results on 30 operated hips. J Pediatr Orthop B 22:1–7CrossRefPubMedGoogle Scholar
  2. 2.
    Canavese F, Rousset M, Samba A, De Coulon G (2013) Percutaneous pelvic osteotomy in cerebral palsy patients: surgical technique and indications. World J Orthop 4:1–8CrossRefGoogle Scholar
  3. 3.
    Canavese F, De Coulon G (2014) Percutaneous pelvic osteotomy in non-ambulatory cerebral palsy patients. OTSR 100:329–332PubMedGoogle Scholar
  4. 4.
    Zuckerman JD, Staheli LT, McLaughlin JF (1984) Acetabular augmentation for progressive hip subluxation in cerebral palsy. J Pediatr Orthop 4:436–442CrossRefPubMedGoogle Scholar
  5. 5.
    Gordon JE, Capelli AM, Strecker WB, Delgado ED, Schoenecker PL (1986) Pemberton pelvic osteotomy and varus rotational osteotomy in treatment of acetabular dysplasia in patients who have static encephalopathy. J Bone Jt Surg [Am] 78:1863–1870CrossRefGoogle Scholar
  6. 6.
    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 17:592–602CrossRefPubMedGoogle Scholar
  7. 7.
    Shea KG, Coleman SS, Carroll K, Stevens P, Van Boerum DH (1997) Pemberton pericapsular osteotomy to treat a dysplastic hip in cerebral palsy. J Bone Jt Surg [Am] 79:1342–1351CrossRefGoogle Scholar
  8. 8.
    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 20:93–103PubMedGoogle Scholar
  9. 9.
    Sankar WN, Spiegel DA, Gregg JR, Sennett BJ (2006) Long-term follow-up after one-stage reconstruction of dislocated hips in patients with cerebral palsy. J Pediatr Orthop 26:1–7CrossRefPubMedGoogle Scholar
  10. 10.
    Karlen JW, Skaggs DL, Ramachandran M, Kay RM (2009) The Dega osteotomy: a versatile osteotomy in the treatment of developmental and neuromuscular hip pathology. J Pediatr Orthop 29:676–682CrossRefPubMedGoogle Scholar
  11. 11.
    Canavese F, Emara K, Sembrano J, Bialik V, Aiona MD, Sussman MD (2010) Varus derotation osteotomy for the treatment of hip subluxation and dislocation in GMFCS level III to V patients with unilateral hip involvement. Follow-up at skeletal maturity. J Pediatr Orthop 30:357–364CrossRefPubMedGoogle Scholar
  12. 12.
    Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39:214–223CrossRefPubMedGoogle Scholar
  13. 13.
    Reimers J (1980) The stability of the hip in children. A radiological study of the results of muscle surgery in cerebral palsy. Acta Orthop Scand 184(Suppl.):1–100CrossRefGoogle Scholar
  14. 14.
    Sharp IK (1961) Acetabular dysplasia: the acetabular angle. J Bone Jt Surg [Br] 43:268–272Google Scholar
  15. 15.
    Broughton NS, Brougham DI, Cole WG, Menelaus MB (1989) Reliability of radiological measurements in the assessment of the child’s hip. J Bone Jt Surg [Br] 71:6–8Google Scholar
  16. 16.
    Scrutton D, Baird G, Smeeton N (2001) Hip dysplasia in bilateral cerebral palsy: incidence and natural history in children aged 18 months to 5 years. Dev Med Child Neurol 43:586–600CrossRefPubMedGoogle Scholar
  17. 17.
    Graham HK (2002) Painful hip dislocation in cerebral palsy. Lancet 359:907–908CrossRefPubMedGoogle Scholar
  18. 18.
    Soo B, Howard JJ, Boyd RN, Reid SM, Lanigan A, Wolfe R, Raddihough D, Graham HK (2006) Hip displacement in cerebral palsy. J Bone Jt Surg [Am] 88:121–129Google Scholar
  19. 19.
    Albee FH (1915) The bone graft wedge. Its use in the treatment of relapsing, acquired, and congenital dislocation of the hip. New York Med J 102:433–435Google Scholar
  20. 20.
    Dega W (1974) Selection of surgical methods in the treatment of congenital dislocation of the hip in children. Chir Narzadow Ruchu Ortop Pol 39:601–613PubMedGoogle Scholar
  21. 21.
    Pemberton PA (1965) Pericapsular osteotomy of the ilium for the treatment of congenital subluxation and dislocation of the hip. J Bone Jt Surg [Am] 47:65–86CrossRefGoogle Scholar
  22. 22.
    Roposch A, Wedge JH (2005) An incomplete periacetabular osteotomy for treatment of neuromuscular hip dysplasia. Clin Orthop Relat Res 431:166–175CrossRefGoogle Scholar
  23. 23.
    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 Jt Surg [Br] 88:933–977CrossRefGoogle Scholar
  24. 24.
    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 462:169–174CrossRefPubMedGoogle Scholar
  25. 25.
    Song HR, Carroll NC (1998) Femoral varus derotation osteotomy with or without acetabuloplasty for unstable hips in cerebral palsy. J Pediatr Orthop 18:62–68CrossRefPubMedGoogle Scholar
  26. 26.
    Oh CW, Presedo A, Dabney KW, Miller F (2007) Factors affecting femoral varus osteotomy in cerebral palsy: a long-term result over 10 years. J Pediatr Orthop B 16:23–30CrossRefPubMedGoogle Scholar
  27. 27.
    Huh K, Rethlefsen SA, Wiren TAL, Kay RM (2011) Surgical management of hip subluxation and dislocation in children with cerebral palsy: isolated VDRO or combined surgery? J Pediatr Orthop 31:858–863CrossRefPubMedGoogle Scholar
  28. 28.
    Dhawale AA, Karatas AF, Holmes L, Rogers KJ, Dabney KW, Miller F (2013) Long-term outcome of reconstruction of the hip in young children with cerebral palsy. Bone Jt J 95:259–265CrossRefGoogle Scholar
  29. 29.
    Mallet C, Ilharreborde B, Presedo A, Khairouni A, Mazda K, Pennecot GF (2014) One stage hip reconstruction in children with cerebral palsy: long-term results at skeletal maturity. J Child Orthop 8:221–228CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    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 Jt Surg Am 18(97):500–506CrossRefGoogle Scholar
  31. 31.
    Henderson RC (1997) Bone density and other possible predictors of fracture risk in children and adolescents with spastic quadriplegia. Devel Med and Child Neurol 1997(39):224–227Google Scholar
  32. 32.
    Henderson RC, Lin PP, Green W (1995) Bone mineral density in children and adolescents who have spastic cerebral palsy. J Bone Jt Surg Am 77:1671–1681CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2017

Authors and Affiliations

  • Federico Canavese
    • 1
    Email author
  • Lorenza Marengo
    • 1
  • Geraldo de Coulon
    • 2
  1. 1.Department of Pediatric SurgeryUniversity Hospital EstaingClermont-FerrandFrance
  2. 2.Department of Pediatric Orthopedic SurgeryUniversity Hospital of GenevaGenevaSwitzerland

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