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. 2024 Aug 1;9(8):773-784.
doi: 10.1530/EOR-23-0043.

Redisplacement rate after bony hip reconstructive surgery in nonambulatory patients with cerebral palsy: a systematic review and meta-analysis

Heide Delbrück  1 , Yannik Gehlen  1 , Frank Hildebrand  1 , Reinald Brunner  2
Affiliations

Redisplacement rate after bony hip reconstructive surgery in nonambulatory patients with cerebral palsy: a systematic review and meta-analysis

Heide Delbrück et al. EFORT Open Rev. .

Abstract

Purpose: Up to 90% of nonambulatory patients with cerebral palsy (CP) experience hip displacement during their lifetime. Reconstructive surgery is recommended. Redisplacement rate is an outcome parameter.

Methods: In a systematic literature review (MEDLINE, Embase and CENTRAL databases) until January 2023 we searched for reports with redisplacement rates after bony hip reconstructive surgery in nonambulatory patients. Quantitative data synthesis, subgroup analysis and meta-regression with moderators were carried out.

Results: The pooled mean redisplacement rate was 16% (95% CI: 12-21%) with a prediction interval of 3-51% (Q: 149; df: 32; P < 0.001; I2: 78%; τ2: 0.67 and τ: 0.82) in 28 studies (1540 hips). Varus derotation osteotomy (VDRO) alone showed a higher redisplacement rate than VDRO + pelvic osteotomy (30% vs 12%, P < .0001). Mean age in the VDRO-alone subgroup was 7.1 years and in the combined group 9.5 years (P = .004). In meta-regression, lower redisplacement rates were observed with higher preoperative migration index (MI) (correlation coefficient: -0.0279; P = .0137), where comprehensive surgery was performed. Variance in true effects are explained by type of bone surgery (57%), preoperative MI (11%), age (5%) and MI for definition of failure (20%). No significant reduction in the redisplacement rate could be observed over the mid-years of studies (1977-2015).

Conclusion: Our pooled data support the more extensive surgical approach in patients with high preoperative MI and emphasize the superiority of combined surgery. Studies should report a coordinated set of parameters and outcome classifications according to internationally accepted gradings to reduce redisplacement in future.

Keywords: cerebral palsy; hip reconstruction; redisplacement.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the study reported.

Figures

Figure 1
Figure 1
PRISMA flow diagram for study election.
Figure 2
Figure 2
Forest plot of the pooled redisplacement rate after bony reconstructive surgery in nonambulatory patients with CP (CMA) (13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 26, 27, 28, 29, 30, 31, 32, 33, 34, 41, 42, 43, 44, 45, 46, 47, 48, 49).
Figure 3
Figure 3
Distribution of true effects: redisplacement rate after bony reconstructive surgery in nonambulatory patients with CP (computed by CMA).
Figure 4
Figure 4
Subgroup analysis of VDRO alone vs VDRO + pelvic osteotomy shows a significantly higher redisplacement rate in the VDRO-alone subgroup computed with CMA.
Figure 5
Figure 5
Relationship between preoperative MI and redisplacement rate (logit), with confidence and prediction intervals computed with CMA.
Figure 6
Figure 6
R2 for meta-regression model with surgery- and patient-related covariates: bony surgery, age and preoperative MI computed with CMA.
See this image and copyright information in PMC

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