The Efficacy of Proximal Femur Guided Growth in Cerebral Palsy Children With Hip Displacement: Long-Term Follow-Up

Soft tissue release combined with guided growth has been used to correct coxa valga and hip displacement in children with cerebral palsy (CP). The purpose of this study was to report the long term clinical and radiological outcomes. This case series study included consecutive patients who received soft-tissue release and guided growth in the proximal femur from January 2005 to 2014 with a minimum 8-years of follow-up. Surgical indications were children with spastic CP aged 4 to 12 years, gross motor function classification system level IV or V, and hip displacement with migration percentage (MP) ＞ 30%. Parameters including Reimer's MP, head-shaft angle (HSA) were compared between preoperative and postoperative 1-year, 2-year, 5-year, and last follow-up images. Seventeen children with 32 spastic hips received proximal femur guided growth and soft tissue release during the study period. Mean age at the time of operation was 7.3 years with a mean follow-up duration of 9.6 years. Three patients received hip osteotomy surgery after guided growth due to persistent hip displacement. The MP improved from preoperative 44.1% (range: 30.0%~85.9%), improving to 35.2% at post-OP 2 years, and 27.2% at last follow up. The HSA decreased from preoperative 171 °, improving to 164° at post-OP 2 years, and 154° at last follow-up. Almost all screws were backing out from the femoral capital epiphysis between 1 and 2 years postoperatively. No physis bar formation was noted crossing the femoral capital physis after screw backing-out. This long-term follow-up review encouraged the treatment effect of proximal femur guided growth in children with CP. Our study showed the improvement of migration percentage (MP) and head shaft angle (HSA) even after screw backing out. Proximal femur guided growth increased rate of good results after soft tissue release and extended surgical indications to MP > 50%.