Outcomes of hip reconstruction in ambulatory patients with cerebral palsy and spastic hip displacement: a retrospective study of 73 hips in 55 consecutive patients
DOI:
https://doi.org/10.2340/17453674.2026.45513Keywords:
ambulatory patient, cerebral palsy, hip, hip displacement, hip reconstruction, paediatric orthopaedicsAbstract
Background and purpose: Currently, there is no specific surgical treatment strategy established for spastic hip displacement in ambulatory patients with cerebral palsy. We aimed to evaluate the outcomes of our hip reconstructions, specifically designed to address hip displacement within the context of single-event multilevel surgery (SEMLS).
Methods: We conducted a retrospective study on patients with Gross Motor Function Classification System (GMFCS) levels II (n = 27) and III (n = 28). Surgical procedures involved various combinations of open or closed reduction, iliac osteotomy, proximal femoral derotational osteotomy, distal femoral derotational and shortening osteotomy, and proximal femoral varus derotational osteotomy. The overall developmental status of the hip was assessed using the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS) at a mean age of 17.3 years (SD 4.7).
Results: 73 hips in 55 patients were included. They underwent hip reconstruction at a mean age of 9.7 years (SD 2.6). 69 of 73 hips achieved successful outcomes. Before surgery, 51 hips had a migration percentage (MP) of 30–60%, 21 had 60–100%, and 1 hip > 100%. At the final follow-up, 12 hips were classified as MCPHCS grade 1 (MP < 10%), 36 as grade 2 (10–15%), 21 as grade 3 (15–30%), 3 as grade 4 (30–60%), and 1 as grade 5 (60–100%). 52 patients either maintained or improved their preoperative GMFCS levels.
Conclusion: Within the SEMLS framework, our tailored hip reconstruction achieved satisfactory hip outcomes in 69 of 73 hips and resulted in sustained improvement in hip stability at long-term follow-up.
Downloads
References
Hanna S E, Rosenbaum P L, Bartlett D J, Palisano R J, Walter S D, Avery L, et al. Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years. Dev Med Child Neurol 2009; 51(4): 295-302. doi: 10.1111/j.1469-8749.2008.03196.x. DOI: https://doi.org/10.1111/j.1469-8749.2008.03196.x
Soo B, Howard J J, Boyd R N, Reid S M, Lanigan A, Wolfe R, et al. Hip displacement in cerebral palsy. J Bone Joint Surg Am 2006; 88(1): 121-9. doi: 10.2106/jbjs.E.00071. DOI: https://doi.org/10.2106/00004623-200601000-00015
Abousamra O, Er M S, Rogers K J, Nishnianidze T, Dabney K W, Miller F. Hip reconstruction in children with unilateral cerebral palsy and hip dysplasia. J Pediatr Orthop 2016; 36(8): 834-40. doi: 10.1097/bpo.0000000000000563. DOI: https://doi.org/10.1097/BPO.0000000000000563
Rutz E, Passmore E, Baker R, Graham H K. Multilevel surgery improves gait in spastic hemiplegia but does not resolve hip dysplasia. Clin Orthop Relat Res 2012; 470(5): 1294-302. doi: 10.1007/s11999-011-2079-4. DOI: https://doi.org/10.1007/s11999-011-2079-4
Miller S, Leveille L, Juricic M, Mulpuri K. Late hip displacement identified in children at Gross Motor Function Classification System II and III with asymmetric diplegia and fixed pelvic obliquity. J Am Acad Orthop Surg Glob Res Rev 2022; 6(9)e20.00094. doi: 10.5435/JAAOSGlobal-D-20-00094. DOI: https://doi.org/10.5435/JAAOSGlobal-D-20-00094
Chang F M, Ma J, Pan Z, Ingram J D, Novais E N. Acetabular remodeling after a varus derotational osteotomy in children with cerebral palsy. J Pediatr Orthop 2016; 36(2): 198-204. doi: 10.1097/bpo.0000000000000418. DOI: https://doi.org/10.1097/BPO.0000000000000418
Rutz E, Vavken P, Camathias C, Haase C, Jünemann S, Brunner R. Long-term results and outcome predictors in one-stage hip reconstruction in children with cerebral palsy. J Bone Joint Surg Am 2015; 97(6): 500-6. doi: 10.2106/jbjs.N.00676. DOI: https://doi.org/10.2106/JBJS.N.00676
Shore B J, Zurakowski D, Dufreny C, Powell D, Matheney T H, Snyder B D. Proximal femoral varus derotation osteotomy in children with cerebral palsy: the effect of age, gross motor function classification system level, and surgeon volume on surgical success. J Bone Joint Surg Am 2015; 97(24): 2024-31. doi: 10.2106/jbjs.O.00505. DOI: https://doi.org/10.2106/JBJS.O.00505
Badina A, du Cluzel de Remaurin X, Khouri N. Long-term outcomes of hip reconstruction surgery in children with GMFCS III diplegic cerebral palsy. Orthop Traumatol Surg Res 2023; 109(3): 103344. doi: 10.1016/j.otsr.2022.103344. DOI: https://doi.org/10.1016/j.otsr.2022.103344
Metaxiotis D, Accles W, Siebel A, Doederlein L. Hip deformities in walking patients with cerebral palsy. Gait Posture 2000; 11(2): 86-91. doi: 10.1016/s0966-6362(00)00043-6. DOI: https://doi.org/10.1016/S0966-6362(00)00043-6
Chambers H G. Identification and treatment of gait problems in cerebral palsy. 2nd ed. London: Mac Keith Press; 2009.
Thomason P, Graham K, Ye K, O’Donnell A, Kulkarni V, Davids J R, et al. Knee surveillance for ambulant children with cerebral palsy. J Child Orthop 2025; 19(4): 253-66. doi: 10.1177/18632521251330448. DOI: https://doi.org/10.1177/18632521251330448
Rutz E, Novacheck T F, Dreher T, Davids J R, McCarthy J, Kay R M, et al. Distal femoral extension osteotomy and patellar tendon advancement or shortening in ambulatory children with cerebral palsy: a modified Delphi consensus study and literature review. J Child Orthop 2022; 16(6): 442-53. doi: 10.1177/18632521221137391. DOI: https://doi.org/10.1177/18632521221137391
Park H, Park B K, Park K B, Abdel-Baki S W, Rhee I, Kim C W, et al. Distal femoral shortening osteotomy for severe knee flexion contracture and crouch gait in cerebral palsy. J Clin Med 2019; 8(9):1354. doi: 10.3390/jcm8091354. DOI: https://doi.org/10.3390/jcm8091354
Kim H T, Wenger D R. Location of acetabular deficiency and associated hip dislocation in neuromuscular hip dysplasia: three-dimensional computed tomographic analysis. J Pediatr Orthop 1997; 17(2): 143-51. doi: 10.1097/00004694-199703000-00002. DOI: https://doi.org/10.1097/01241398-199703000-00002
Abel M F, Wenger D R, Mubarak S J, Sutherland D H. Quantitative analysis of hip dysplasia in cerebral palsy: a study of radiographs and 3-D reformatted images. J Pediatr Orthop 1994; 14(3): 283-9. doi: 10.1097/01241398-199405000-00002. DOI: https://doi.org/10.1097/01241398-199405000-00002
Buckley S L, Sponseller P D, Magid D. The acetabulum in congenital and neuromuscular hip instability. J Pediatr Orthop 1991; 11(4): 498-501. doi: 10.1097/01241398-199107000-00015. DOI: https://doi.org/10.1097/01241398-199107000-00015
Park B K, Park H, Park K B, Rhee I, Kim S, Kim H W. Fate of hips complicated by avascular necrosis of the femoral head following reconstructive surgery in nonambulatory patients with cerebral palsy. Sci Rep 2022; 12(1): 11767. doi: 10.1038/s41598-022-16023-7. DOI: https://doi.org/10.1038/s41598-022-16023-7
Wawrzuta J, Willoughby K L, Molesworth C, Ang S G, Shore B J, Thomason P, et al. Hip health at skeletal maturity: a population-based study of young adults with cerebral palsy. Dev Med Child Neurol 2016; 58(12): 1273-80. doi: 10.1111/dmcn.13171. DOI: https://doi.org/10.1111/dmcn.13171
Chung C Y, Park M S, Choi I H, Cho T J, Yoo W J, Lee K M. Morphometric analysis of acetabular dysplasia in cerebral palsy. J Bone Joint Surg Br 2006; 88(2): 243-7. doi: 10.1302/0301-620x.88b2.16274. DOI: https://doi.org/10.1302/0301-620X.88B2.16274
Jóźwiak M, Rychlik M, Szymczak W, Grzegorzewski A, Musielak B. Acetabular shape and orientation of the spastic hip in children with cerebral palsy. Dev Med Child Neurol 2021; 63(5): 608-13. doi: 10.1111/dmcn.14793. DOI: https://doi.org/10.1111/dmcn.14793
Park M S, Chung C Y, Lee S H, Cho T J, Yoo W J, Choi I H. Two-dimensional computed tomographic measurement of acetabulum: reliability, validity, and limitation. J Pediatr Orthop 2008; 28(8): 812-18. doi: 10.1097/BPO.0b013e31818af6c9. DOI: https://doi.org/10.1097/BPO.0b013e31818af6c9
Park H, Abdel-Baki S W, Park K B, Park B K, Rhee I, Hong S P, et al. Outcome of femoral varus derotational osteotomy for the spastic hip displacement: implication for the indication of concomitant pelvic osteotomy. J Clin Med 2020; 9(1): 256. doi: 10.3390/jcm9010256. DOI: https://doi.org/10.3390/jcm9010256
Robin J, Graham H K, Selber P, Dobson F, Smith K, Baker R. Proximal femoral geometry in cerebral palsy: a population-based cross-sectional study. J Bone Joint Surg Br 2008; 90(10): 1372-9. doi: 10.1302/0301-620x.90b10.20733. DOI: https://doi.org/10.1302/0301-620X.90B10.20733
Presedo A, Rutz E, Howard J J, Shrader M W, Miller F. The etiology of neuromuscular hip dysplasia and implications for management: a narrative review. Children (Basel) 2024; 11(7): 844. doi: 10.3390/children11070844. DOI: https://doi.org/10.3390/children11070844
Laplaza F J, Root L. Femoral anteversion and neck–shaft angles in hip instability in cerebral palsy. J Pediatr Orthop 1994; 14(6): 719-23. doi: 10.1097/01241398-199414060-00006. DOI: https://doi.org/10.1097/01241398-199414060-00006
Miller F, Girardi H, Lipton G, Ponzio R, Klaumann M, Dabney K W. Reconstruction of the dysplastic spastic hip with peri-ilial pelvic and femoral osteotomy followed by immediate mobilization. J Pediatr Orthop 1997; 17(5): 592-602. doi: 10.1097/00004694-199709000-00005. DOI: https://doi.org/10.1097/00004694-199709000-00005
Spiegel D A, Flynn J M. Evaluation and treatment of hip dysplasia in cerebral palsy. Orthop Clin North Am 2006; 37(2): 185-96, vi. doi: 10.1016/j.ocl.2005.11.001. DOI: https://doi.org/10.1016/j.ocl.2005.11.001
Lindgren A M, Asma A, Rogers K J, Miller F, Shrader M W, Howard J J. Hip displacement after triradiate closure in ambulatory cerebral palsy: who needs continued surveillance? J Pediatr Orthop 2024; 44(10): 601-7. doi: 10.1097/bpo.0000000000002783. DOI: https://doi.org/10.1097/BPO.0000000000002783
Additional Files
Published
How to Cite
License
Copyright (c) 2026 Kyeong Hyeon Park, Byoung Kyu Park, Isaac Rhee, Kun Bo Park, Hoon Park, Yun Ho Roh, Hyun Woo Kim
This work is licensed under a Creative Commons Attribution 4.0 International License.
