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

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: Adolescents; Cerebral palsy; Children; GMFCS; Percutaneous pelvic osteotomy; Varus derotation shortening osteotomy.