Survivorship analysis of adductor surgery to prevent hip displacement in children with cerebral palsy

Survivorship analysis of adductor surgery to prevent hip displacement in children with cerebral palsy
1Murdoch Children’s Research Institute, Melbourne, VIC,
2Hugh Williamson Gait Laboratory, Royal Children’s Hospital, Melbourne, VIC;
3Department of orthopaedic Surgery, Royal children’s Hospital, Melbourne, VIC;
4The University Of Melboune, Melbourne, VIC;
5 Department of Epidemiology and preventative Medicine, Monash University, Alfred Hospital, Melbourne, VIC, Australia

Background/Objectives: previous studies evaluating the outcomes of hip adductor surgery in children with cerebral palsy, with the intention of preventing or treating early hip displacement, are limited to follow-up periods of about 3 years. This reviews the outcomes of hip adductor surgery to prevent or treat early hip[ displacement in children with cerebral palsy with an extended follow –up and evaluation according to the gross motor function classification system (GMFCS).

Design: Study of therapy; retrospective cohort audit.

Participants and Setting: Consecutive series of children with cerebral palsy aged 2-10 years who had primary adductor surgery at a tertiary children’s hospital between January 1994 and December 2004. These children had hip migration percentages (MP)>30%and followed up for a minimum 12 months post- operatively.

Materials/Methods: demographic data reviewed included gender, MP at time of primary surgery, GMFCS level, age at time of surgery and type of adductor release procedure performed. Outcome variables assessed were type of subsequent failure, time of failure after primary procedure, and length of follow-up. A Cox proportional hazards survivorship analysis was constructed to chart the time course of progression to further surgery over time according to GMFCS level.

Results: Three hundred and thirty children underwent hip adductor surgery. The number of children per GMFCS level was 33 Level II, 55 level III, 103 level IV, and 139 level V. The average age at time of primary was 4.19 years, mean MP at time of primary surgery 43.16%, and mean length of post-operative follow-up was 7.10 years. Eighty-two children had adductor longus and gracilis lengthening alone 97 also had an iliopsoas release, 97 had psoas tenotomy and neurectomy of the anterior branch of obturator never (in addition to longus & gracilis lengthening). At time of audit 106 children (32%)did not require further surgery (surgery success).Thirty one were in children of GMFCS level II (94%),27 level III (49%), 28 level IV (27%),and 20 level V (14%).The survivorship analysis (Figure 1) revealed difference in ‘surgery success’ rates according to GMFCS, particularly apparent beyond 3 years post-operatively.

Conclusion/significance: The GMFCS is crucial is predicting the outcomes of adductor surgery in preventing further hip displacement. Current treatment strategies need to be evaluated to ensure they undertake long-term post-operative follow up, particularly for children GMFCS levels VI and V, and provide appropriate prognostic counseling in light of these findings.


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