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Journal of Children's Orthopaedics

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Open Access 01-12-2016 | Original Clinical Article

Proximal femur prosthetic interposition arthroplasty for painful dislocated hips in children with cerebral palsy

Authors: Anthony L. Silverio, Shawn V. Nguyen, John A. Schlechter, Samuel R. Rosenfeld

Published in: Journal of Children's Orthopaedics | Issue 6/2016

Abstract

Purpose

Children with cerebral palsy often have musculoskeletal disorders involving the hip. There are several procedures that are commonly used to treat these disorders. Proximal femur prosthetic interposition arthroplasty (PFIA) is an option for non-ambulatory children with cerebral palsy who have a painful, spastic dislocated hip. The purpose of our study was to evaluate the results of PFIA by examining treatment outcomes, complications, and overall effects on the child and their caregiver.

Methods

Charts were reviewed over a 5-year period at our institution. The focus of the data collection was pain, range of motion (ROM), and overall clinical outcome. Clinical outcome was graded as excellent, good, fair, and poor. Length of follow-up, presence of heterotopic ossification, femoral prosthesis migration, and information provided by competed caregiver questionnaires were analyzed.

Results

A total of 16 hips in 12 patients met the inclusion criteria. Average age at time of surgery was 12 years 1.2 months. Average follow-up was 40.4 months. Three hips required revision surgery. Average time before revision surgery was 16 months. Overall outcomes were excellent/good for seven hips and fair/poor for nine. Pain outcomes were excellent/good for nine hips and fair/good for seven. ROM outcomes were excellent/good for nine hips and fair/poor for seven. The majority of caregivers surveyed would recommend this procedure.

Conclusion

Clinical evaluation of the effectiveness of PFIA yielded variable results with this cohort of children with regards to pain and range of motion. Despite these varied results, the majority of caregivers were satisfied with the outcome and would recommend PFIA. PFIA is a salvage option for the painful, spastic dislocated hip, but significant evidence to prove its effectiveness over other salvage procedures is lacking. Based on our results, we conclude that PFIA has the ability to benefit children with cerebral palsy with an acceptable risk profile similar to that reported in recent publications.

Level of evidence IV; retrospective case-series.

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Title: Proximal femur prosthetic interposition arthroplasty for painful dislocated hips in children with cerebral palsy
Authors: Anthony L. Silverio
Shawn V. Nguyen
John A. Schlechter
Samuel R. Rosenfeld
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Journal of Children's Orthopaedics / Issue 6/2016
Print ISSN: 1863-2521
Electronic ISSN: 1863-2548
DOI: https://doi.org/10.1007/s11832-016-0775-z

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Proximal femur prosthetic interposition arthroplasty for painful dislocated hips in children with cerebral palsy

Abstract

Purpose

Methods

Results

Conclusion

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Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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