523 Systematic Review of Total Hip Arthroplasty Outcomes in Cerebral Palsy

Abstract Aim Total Hip Arthroplasty (THA) in patients with cerebral palsy (CP) is considered high-risk due to neuromuscular instability, contractures and altered muscle tone. The purpose of this systematic review is to investigate the surgical indication, surgical approach, and clinical outcomes of THA in CP patients. Method A systematic review was undertaken in accordance with PRISMA guidelines, encompassing original articles that investigated the outcomes of THA in CP patients and compared it with controls. The systematic literature search was conducted using COVIDENCE® software (Melbourne, Australia). The primary endpoints of interest included: surgical indication, clinical outcomes (complications, survivorship) and surgical approach (cementing, additional procedures, bearing surfaces). Results The initial search generated 190 studies out of which 21 met the inclusion criteria. The most frequently reported indication was painful hip dislocation or subluxation followed by treatment failure for prior femoral neck fractures and secondary arthritis. The most frequently reported complication was dislocation affecting overall 7.5% (0-28%) of all patients followed by periprosthetic fractures 5.6% (0-21%) and heterotrophic ossification 4.2% (0-37.8%). The survival rates of primary THAs ranged from 85%-100% at 5 years and from 73%-86% at 10 years. Conclusions The current literature suggests that THA is a beneficial procedure for patients with CP through pain reduction and functional improvement. However, the increased rates of potential complications compared to the general population require careful consideration. We suggest that further investigations on the most appropriate time of procedure, implant type and procedure type are needed.