Unilateral hip reconstruction combined with contralateral guided growth versus bilateral reconstruction in children with cerebral palsy and unilateral hip displacement

Hip displacement in cerebral palsy (CP) compromises function and quality of life. While bilateral hip reconstruction (HRS) is often used to treat unilateral displacement, hip guided growth (HGG) has emerged as a less invasive alternative for the contralateral hip with growth potential. This study compared outcomes of unilateral HRS combined with contralateral guided growth (HGG group) versus bilateral HRS (Recon group). A retrospective matched cohort study was conducted at a pediatric referral center (2017–2023). Propensity score matching (1 : 1 nearest neighbor) controlled for age, sex, Gross Motor Function Classification System level, and preoperative migration percentage. Patients with greater than or equal to 2 years of follow-up were included. Outcomes assessed included surgical time, transfusion needs, intensive care/reanimation and hospital stay, radiographic parameters, complications, and reinterventions. Twenty-two matched patients were analyzed (HGG: 11; Recon: 11). The HGG group had significantly shorter surgeries, fewer transfusions, and reduced recovery and hospital stays (all P < 0.01). Radiographic correction of the reconstructed hip was comparable. Contralateral hip improvement in migration percentage and HSA was greater in the Recon group; however, HGG hips also showed radiographic improvement, and none in either group required further surgery due to progression of hip displacement. Changes in pelvic obliquity did not differ. The Recon group had a higher complication burden (median 2 vs. 1, P = 0.04) and reintervention rate (81.8 vs. 54.5%; P = 0.024). Combining HGG with unilateral HRS reduced surgical morbidity without compromising medium-term radiological outcomes, supporting its use in selected patients with growth potential and a stable, at-risk contralateral hip. Level of evidence: Level III, retrospective comparative study