Surgical treatment of hip dysplasia in cerebral palsy: A retrospective comparison between open and closed reduction

Hip dysplasia in cerebral palsy (CP) is a common and severe problem, especially among nonambulatory patients. A likely cause is muscular imbalance and developmental bone changes leading to a progressive extrusion of the femoral head from the acetabulum. The ideal surgical treatment aims to reduce the dislocated hip to improve pain, positioning, and function. The purpose of this study is to clinically and radiographically compare the results of hip reconstructive surgery with or without open reduction in patients with CP and hip dysplasia. A retrospective study was conducted through access to medical records, radiographs, and clinical evaluation of patients with CP who underwent surgical correction of hip dysplasia through hip reconstructive surgery with a minimum of 2 years follow-up. Two surgical techniques were compared: open versus closed reduction. Clinical parameters such as pain, hip abduction, age, follow-up time, and the Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire were used. Radiographic evaluation included dislocation degree (hip status), Reimers migration percentage, and the presence or absence of osteonecrosis. One hundred thirty hips were included in the study, and 23.08% of patients underwent bilateral procedures. Thirty-three percent of patients were classified as gross motor function classification system IV and 67% were gross motor function classification system V. The mean preoperative reimers migration percentage decreased from 77.4% to 7.6% in the open reduction group and from 76.0% to 6.2% in the closed group ( P = .656). Postoperative hip abduction increased from 10° to 25° in the open group and from 13.2° to 24.2° in the closed group ( P = .096). Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire scores showed no significant differences in Sections II, III, and VII. Osteonecrosis occured in 50% of the open group and 45.3% of the closed group ( P = .659). Both techniques were effective and had similar clinical and radiographic outcomes in treating hip dysplasia in patients with CP. Further prospective studies are necessary to clarify the best indications for each technique.