Hip reconstruction surgery combined with contralateral guided growth in cerebral palsy patients: preliminary results of a novel approach.

Abstract

Hip dislocation is a common and severe complication in children with cerebral palsy (CP), significantly affecting their quality of life. In cases of unilateral hip dislocation, there is ongoing debate regarding the choice between unilateral versus bilateral reconstructive surgeries. This study explores an alternative approach that combines unilateral hip reconstruction surgery with contralateral Proximal Femoral Guided Growth (PFGG) as a potential solution. A retrospective observational study was conducted at a pediatric neuro-orthopedic referral center from 2019 to 2022, including children who underwent hip reconstruction surgery and contralateral PFGG. The minimum follow-up period was 2 years. Collected data included demographic, clinical, and surgical details, radiological parameters, as well as complications. Eleven patients (six females and five males) with varying levels of functional impairment (2 Gross Motor Function Classification System level III, 4 level IV, and 5 level V) were included. The median age at surgery was 7.7 years (range: 4.9-11 years), with a median follow-up period of 29.6 months (range: 24.1-55.6 months). Significant improvements were observed in all parameters for the reconstructed hip and in several parameters for the PFGG-treated hip, particularly migration percentage, head-shaft angle, and Hilgenreiner epiphyseal angle (P < 0.05). Reconstructed hips had significantly more complications than those treated with PFGG(13 versus 2, P < 0.001). Combining hip reconstruction surgery with contralateral PFGG offers a promising alternative to traditional bilateral reconstructive procedures when managing unilateral hip dislocation in CP patients. This approach not only addresses the immediate hip dislocation but also prevents future contralateral hip displacement within the same surgical session, while minimizing complication rates. Further studies are needed to validate these findings and establish comprehensive guidelines for this surgical strategy. Level of evidence: Level IV, case series.