One-stage hip reconstruction is the gold standard for treatment of hip displacement in children with cerebral palsy. The aims of this study were (1) to report the subjective clinical, objective clinical, and radiographic outcomes; and (2) to investigate outcome predictors, including the influence of the following risk factors: femoral head shape, migration percentage, direction of migration, and age at surgery. We reviewed 168 hip reconstructions (eighty-two right, eighty-six left) in 121 patients (101 male, twenty female) at a mean follow-up of 7.3 ± 4.6 years (range, four to eighteen years). Surgical outcomes were assessed on the basis of the pain intensity and frequency (measured on 10-point visual analog scales) as well as GMFCS (Gross Motor Function Classification System) and MCPHCS (Melbourne Cerebral Palsy Hip Classification System) scores and postoperative migration percentage. The effects of femoral head shape, preoperative migration percentage, direction of migration, and age at surgery on surgical outcome were assessed by multivariate regression adjusting for potential confounders including sex, triradiate cartilage status, type of cerebral palsy, and surgical technique. Pain intensity and frequency were reduced significantly. Preoperative femoral head shape had no significant effect on the changes in pain, MCPHCS grade, and GMFCS level. The preoperative migration percentage was the most influential risk factor with respect to postoperative outcome. Age at surgery had no effect on the changes in pain score and GMFCS level. The overall surgical complication rate was 10.5%. Our data on 168 hip reconstructions at a mean follow-up of seven years showed significant and clinically meaningful improvements in pain intensity and frequency as well as in clinical scores and hip coverage. Analysis of potential risk factors showed only the preoperative migration percentage to have a relevant influence on outcomes. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background Hip dislocation or subluxation together with poor nutrition, reduced weight bearing, and osteoporosis is a frequent condition in severe cerebral palsy (CP). Severe osteoporosis may cause difficulties in fixing a proximal femoral osteotomy with a conventional blade plate. The Pediatric locking compression plate (LCP) Hip Plate system offers better grip and more stable fixation. Methods Fifty-three proximal femoral osteotomies, alone or as part of a more complex surgical intervention, were performed in 28 patients (17 boys and 11 girls, age at surgery average 10.4 y, 3 to 19 y). All children suffered from CP (24 quadriplegics, 2 diplegics, and 2 hemiplegics) with Gross Motor Function Classification System levels: 3× III, 3× IV, and 22× V. This cohort was compared with a historical (conventional AO blade plate) group (38 patients with 53 operative interventions, 24 girls and 14 boys, age at surgery average 9.8 y, 3 to 18.5 y, Gross Motor Function Classification System levels: 4× III, 5× IV, and 29× V; 34 quadriplegics, 3 diplegics, and 1 hemiplegic). Results The operative interventions of both cohorts that are performed are comparable considering the average amount of varisation and derotation. Operations with the conventional AO blade plate were 17.2 minutes shorter on average and the blood loss was 45.6 mL less on average. Radiologically, 19.6% of the patients had signs of complete consolidation with the LCP Hip Plate 6 weeks after surgery (vs. 91.1% of the patients of the historical cohort, P <0.001) but all osteotomies in both groups were completely consolidated by 12 weeks. In the LCP cohort in 3 patients (10.7%) full weight bearing was allowed immediately after the operation. Conclusions Both implants, the Pediatric LCP Hip Plate and the conventional AO blade plate, produce similar results regarding fixation and correction of the neck-shaft angle. The consolidation rate 6 weeks postoperatively using the LCP plate is lower than with the conventional blade plate, whereas equivalent healing at 3 months was found. Hence, LCP plate removal is recommended not earlier than 6 months after surgery despite good callus formation on x-ray. Level of Evidence Level III.