Spastic Hips in Cerebral Palsy - Retrospective Study of Salvage with the McHale Procedure

Abstract

Objective To perform a retrospective and cross-sectional assessment to determine the pain and positional improvement of all patients with spastic cerebral palsy (CP) and severe hip deformity who underwent a McHale procedure in our center. A second objective was to analyze the potential complications from the procedure. Methods All consecutive patients treated between 1995 and 2017 were analyzed. Clinically, the patients should present pain on hip mobilization, difficulty in positioning for sitting and hygiene care, and medical records with complete data; functionally was assessed through the Gross Motor Function Classification System (GMFCS). In the preoperative radiographs, we analyzed the migration percentage (MP), the type of deformity according to the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS), and the type of deformity of the femoral head. After the surgery, we assessed the proximal migration of the proximal femoral fragment, implant changes and/or failure, and potential heterotopic ossification. The outcomes were reported as successful (D1) in patients presenting remission of pain, painless mobility, and improved positioning, or unsuccessful (D2) in those presenting procedural failure that required a new surgery. Results In total, 47 patients (53 hips) were treated. Functionally, 43 patients were classified as GMFCS V (91%), 3 as GMFCS IV patients (6%), and 1 as GMFCS III (2%). The mean age was 13 years and 2 months. The follow-up ranged from 1 year to 15 years and 4 months, with an average of 4 years and 8 months. A total of 36 patients (41 hips) presented successful (D1) outcomes after the McHale procedure, corresponding to 77% of our cases, whereas 11 (23%) cases had unsuccessful (D2) outcomes. Conclusion The McHale procedure is a treatment option for GMFCS IV and V, but we must be aware of the potential complications.

Keywords: cerebral palsy; hip/deformities; hip/surgery.

Fig. 1

Tetraparetic female patient, GMFCS grade V. ( A ) Pelvic radiograph at the initial follow-up, at 12 years and 2 months old. ( B ) Postoperative pelvic radiograph, 4 years and 2 months after the bilateral McHale surgery at 16 years old.

Fig. 2

Tetraparetic female patient, GMFCS grade V. ( A ) Pelvic radiograph at the initial follow-up, at 10 years and 2 months old. ( B ) Clinical image at the initial follow-up, at 10 years and 2 months old. ( C ) Pelvic radiograph soon after a McHale procedure on the right hip. ( D ) Pelvic radiograph soon after a bilateral Castle procedure at 14 years old. ( E ) Clinical image 7 years after a bilateral Castle at 21 years old. ( F ) Postoperative pelvic radiograph 14 years after a bilateral Castle technique, at 29 years old.

Fig. 1

Paciente do sexo feminino, tetraparética, GMFCS V. ( A ) Radiografia da bacia no início do acompanhamento com 12 anos e 2 meses de idade. ( B ) Radiografia da bacia após 4 anos e 2 meses da cirurgia de McHale bilateral aos 16 anos de idade da paciente.

Fig. 2

Paciente do sexo feminino, tetraparética, GMFCS V. ( A ) Radiografia da bacia no início do acompanhamento com 10 anos e 2 meses de idade. ( B ) Imagem clínica no início do acompanhamento. ( C ) Radiografia da bacia no pós-operatório imediato da cirurgia de McHale do lado direito. ( D ) Radiografia da bacia no pós-operatório imediato da cirurgia de Castle bilateral, aos 14 anos de idade da paciente. ( E ) Imagem clínica após 7 anos da cirurgia de Castle bilateral, aos 21 anos de idade da paciente. ( F ) radiografia da bacia após 14 anos da cirurgia de Castle bilateral, aos 29 anos de idade da paciente.