Hemiepiphysiodesis Of the Proximal Portion of The Femur for The Management of Hip Dysplasia in Children with Cerebral Palsy
Abstract
Abstract: Objectives: To evaluate the efficacy and safety of proximal femoral hemiepiphysiodesis (PFH) in the management of hip dysplasia in children with cerebral palsy (CP), by means of a systematic review with meta-analysis.
Methodology: A systematic review was conducted according to the PRISMA guidelines. Clinical studies investigating PFH in children with CP, with or without a control group, were included. The search was carried out in PubMed, Embase, Scopus, Web of Science and Cochrane Library, with no language or date restrictions. The primary outcomes included the progression of femoral migration (Reimers index), the need for subsequent surgery and complications related to the procedure. The quality of the studies was assessed using instruments appropriate to the methodological design, and the data was synthesized using meta-analysis.
Results: Three studies were included, totaling 84 patients. The meta-analysis showed a significant reduction in the Reimers migration index after HPF (mean difference: -5.91%; 95% CI: -10.55 to -1.27; p < 0.01). The rate of need for subsequent surgery was 24% (95% CI: 14%-38%), while the rate of complications was 18% (95% CI: 11%-29%). The overall quality of the studies ranged from moderate to high.
Conclusion: Proximal femoral hemiepiphysiodesis has been shown to be effective in containing femoral migration in children with cerebral palsy, with acceptable rates of complications and reoperations. These findings support its use as a less invasive alternative in the management of hip dysplasia in this population.
Keywords
Downloads
References
- Aronson E, Stevenson SB. Bone health in children with cerebral palsy and epilepsy. J Pediatr Health Care. 2012 May-Jun;26(3):193-9. doi: 10.1016/j.pedhc.2010.08.008. Epub 2010 Oct 2. PMID: 22525999.
- Kilpinen-Loisa P, Pihko H, Vesander U, Paganus A, Ritanen U, Mäkitie O. Insufficient energy and nutrient intake in children with motor disability. Acta Paediatr. 2009 Aug;98(8):1329-33. doi: 10.1111/j.1651-2227.2009.01340.x. Epub 2009 May 8. PMID: 19432830.
- Levine MA. Assessing bone health in children and adolescents. Indian J Endocrinol Metab. 2012 Dec;16(Suppl 2):S205-12. doi: 10.4103/2230-8210.104040. PMID: 23565379; PMCID: PMC3603027.
- Seeman E. Bone densitometry: relevance to health care. Asia Pac J Clin Nutr. 1995 Mar;4(1):11-3. PMID: 24394240.
- Bianchi ML. Causes of secondary pediatric osteoporosis. Pediatr Endocrinol Rev. 2013 Jun;10 Suppl 2:424-36. PMID: 23858626.
- Scheinberg MA, Golmia RP, Sallum AM, Pippa MG, Cortada AP, Silva TG. Bone health in cerebral palsy and introduction of a novel therapy. Einstein (Sao Paulo). 2015 Oct-Dec;13(4):555-9. doi: 10.1590/S1679-45082015AO3321. PMID: 26761553; PMCID: PMC4878630.
- Marrani E, Giani T, Simonini G, Cimaz R. PediatricOsteoporosis: Diagnosis and Treatment Considerations. Drugs. 2017 Apr;77(6):679-695. doi: 10.1007/s40265-017-0715-3. PMID: 28271302.
- Santos CM da C, Pimenta CA de M, Nobre MRC. The PICO strategy for the research question construction and evidencesearch. Rev Latino-Am Enfermagem. 2007;15(3):508-511. doi:10.1590/S0104-11692007000300023
- Hsieh HC, Wang TM, Kuo KN, Huang SC, Wu KW. Guided Growth Improves Coxa Valga and Hip Subluxation in Children with Cerebral Palsy. Clin Orthop Relat Res. 2019 Nov;477(11):2568-2576. doi: 10.1097/CORR.0000000000000903. PMID: 31425278; PMCID: PMC6903837.
- Hsu PJ, Wu KW, Lee CC, Lin SC, Kuo KN, Wang TM. Does screw position matter for guided growth in cerebral palsy hips? Bone Joint J. 2020 Sep;102-B(9):1242-1247. doi: 10.1302/0301-620X.102B9.BJJ-2020-0340.R1. PMID: 32862682.
- Portinaro N, Turati M, Cometto M, Bigoni M, Davids JR, PanouA. Guided Growth of the Proximal Femur for the Management of Hip Dysplasia in Children With Cerebral Palsy. J Pediatr Orthop. 2019 Sep;39(8):e622-e628. doi: 10.1097/BPO.0000000000001069. PMID: 31393306.
- Lebe M, van Stralen RA, Buddhdev P. Guided Growth of the Proximal Femur for the Management of the 'Hip at Risk' in Children with Cerebral Palsy-A Systematic Review. Children (Basel). 2022;9(5):609. Published 2022 Apr 25. doi:10.3390/children9050609
- Howard JJ, Graham HK, Johari A, et al. Hip displacement in children with cerebral palsy: surveillance to surgery - a current concepts review. SICOT J. 2024;10:30. doi:10.1051/sicotj/2024023
- Terjesen T. The natural history of hip development in cerebral palsy. Dev Med Child Neurol. 2012;54(10):951-957. doi:10.1111/j.1469-8749.2012.04385.x
- McCartney DK, Frankovitch KF. Proximal femoral diaphysectomy in cerebral palsy. Contemp Orthop. 1994;29(1):52-58.