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Age cited among predictors of success for varus derotation osteotomy in children with cerebral palsy
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Results from this retrospective, single-center study indicated older patient age, lower Gross Motor Function Classification System levels and increased surgeon volume were predictors of success with proximal femoral varus derotation osteotomy in children with cerebral palsy, and noted 37% failure with the procedure at mid-term follow-up.
Researchers identified 320 children with cerebral palsy who underwent varus derotation osteotomy (VDRO) to manage hip displacement. Patients had a mean age of 8.2 years, and the mean follow-up was 8.3 years. Investigators recorded age at surgery, sex, Gross Motor Function Classification System (GMFCS) levels, pervious soft-tissue releases or botulinum toxin administration, concurrent pelvic osteotomy and unilateral VDRO or bilateral VDRO index procedures.
Using the need for additional surgical procedures on the hip or pelvis, or more than 50% of hip migration at final follow-up to define failure, investigators found 117 patients had a failure. According to multivariate analysis, younger patient age, lower volume of surgeons and increased GMFCS levels correlated with a higher chance of revision hip surgery. At the time of the index surgery, soft-tissue release prevented revision surgery.
At 5 years, the Kaplan-Meier survivorship overall was 80%. At 10 years, survivorship decreased to 60%. Children with GMFCS levels I and II showed 92% surgical survivorship at 5 years and 80% survivorship at 10 years. GMFCS level V children had 76% survivorship at 5 years and 58% at 10 years, according to researchers. ‒ by Monica Jaramillo
Disclosures: Shore reports he is a board or committee member for the American Academy for Cerebral Palsy and Pediatric Orthopaedic Society of North America. Please see the full study for a list of all other authors’ relevant financial disclosures.
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