Adductor Tenotomy to Treat Progressive Hip Migration in Children With Cerebral Palsy: Identifying Predictors of Success to Guide Clinical Practice.

Abstract

BACKGROUND: Cerebral palsy (CP) often causes progressive hip migration in severely affected children, leading to pain and reduced quality of life. Adductor tenotomies are commonly performed to prevent progressive hip migration. This study evaluated success rates, complications, and predictors of failure after adductor tenotomies in 5 national CP centers in the Netherlands. METHODS: We conducted a retrospective multicenter cohort study of children with CP aged 1 to 12 years who underwent adductor tenotomies, with or without psoas releases, between 2010 and 2020. Patients with prior hip surgery, non-CP diagnoses, or insufficient follow-up (<4 y) were excluded. The primary outcome was treatment success at 4 years of follow-up, defined as the absence of secondary surgery for hip migration or a migration percentage below 50%. Secondary outcomes included predictors of failure, complications, and timing of secondary surgery. Kaplan-Meier survival curves and generalized estimating equation logistic regression were used to evaluate outcomes. RESULTS: A total of 109 hips (55 children) were included. Overall, the success rate was 51.4%. The median time to failure was 2.0 years (IQR: 1.3 to 3.3). Preoperative migration percentage (MP) [odds ratio (OR)=1.1, 95% CI: 1.1-1.2] and not performing a psoas release (OR=7.3, 95% CI: 1.8-30.0) were the strongest independent predictors for failure. No failures occurred when the preoperative MP was <30%, although most of these cases were bilateral procedures with a more severely affected contralateral hip. In contrast, hips with a preoperative MP >50% had a 75.9% failure rate, with a median time to failure of 1.4 years (IQR: 0.9 to 2.6). Without a psoas release, the odds of failure increase significantly. The complication rate was 3.7% in this cohort. CONCLUSIONS: The success rate of adductor tenotomies in the treatment of hip migration was 51.4%. Higher preoperative MP strongly predicted a poorer outcome, and this procedure, as the solitary surgical procedure to manage hip migration, should be avoided when the preoperative MP exceeds 50%. Performing routine psoas release with the adductor tenotomies appears to improve surgical outcomes. LEVEL OF EVIDENCE: Level IV.