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Review
. 2022 Apr 25;9(5):609.
doi: 10.3390/children9050609.

Guided Growth of the Proximal Femur for the Management of the 'Hip at Risk' in Children with Cerebral Palsy-A Systematic Review

Moritz Lebe  1 , Renée Anne van Stralen  2 , Pranai Buddhdev  1
Affiliations
Review

Guided Growth of the Proximal Femur for the Management of the 'Hip at Risk' in Children with Cerebral Palsy-A Systematic Review

Moritz Lebe et al. Children (Basel). .

Abstract

Background: Guided growth is frequently used to modify lower-limb alignment in children, and recently temporary medial hemiepiphysiodesis of the proximal femur (TMH-PF) has been used for the management of hips at risk of subluxation in cerebral palsy (CP) patients. The aim of our study was to evaluate the efficacy of TMH-PF in the management of neuromuscular hip dysplasia in children with cerebral palsy.

Methods: A systematic search of the literature was performed by using PubMed, EMBASE, CINAHL, MEDLINE, Scopus and Cochrane databases. Pre- and postoperative radiographic changes of the migration percentage (MP), head-shaft angle (HSA) and acetabular index (AI) were included in a meta-analysis. Secondary outcomes were treatment complication rates, technical considerations and the limitations of this novel technique.

Results: Four studies (93 patients; 178 hips) met the eligibility criteria for inclusion in the meta-analysis. All three radiographic measurements showed significant changes at a minimum of 2 years of follow-up. Mean changes for MP were 8.48% (95% CI 3.81-13.14), HSA 12.28° (95% CI 11.17-13.39) and AI 3.41° (95% CI 0.72-6.10), with I2 of 75.74%, 0% and 87.68%, respectively. The serious complication rate was overall low; however, physeal 'growing off' of the screw was reported in up to 43% of hips treated.

Conclusion: TMH-PF is an effective and predictable method to treat CP patients with 'hips at risk', and the overall complication rate is low; however, further work is required to identify the best candidates and surgical timing, as well as choice of technique and implant.

Keywords: DDH; cerebral palsy; guided growth; temporary medial hemiepiphysiodesis for the proximal femur (TMH-PF).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Final AP (a) and lateral (b) fluoroscopy image showing the desired screw placement across the proximal femoral physis (with copyright permission from Jon Davids [35]).
Figure 2
Figure 2
PRISMA flowchart demonstrating the results from the literature search and exclusions of papers.
Figure 3
Figure 3
Forest plot demonstrating changes of primary outcomes measures after 2 and more years of follow-up. (a) Changes of migration percentage (MP). (b) Changes of head-shaft angle (HSA). (c) Change of acetabular index (AI).
Figure 3
Figure 3
Forest plot demonstrating changes of primary outcomes measures after 2 and more years of follow-up. (a) Changes of migration percentage (MP). (b) Changes of head-shaft angle (HSA). (c) Change of acetabular index (AI).
See this image and copyright information in PMC

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