Proximal femoral resection arthroplasty for patients with cerebral palsy and dislocated hips

Figures & data

Table 1. Clinical data and patient satisfaction

Case	Age	Sex	A	B	C	D	E	F	G	H	I	J
1	20	F	R L	R L	S, PC	T	6	E, LA	51	51	not satisfied	51 m
2	19	F	R L	R L	Pain, PC	T				48	very satisfied
3	17	F	L	L	S, PC	T	6			55	very satisfied
4	16	F	L	R L	Pain, S, PC	T				52	uncertain
5	10	F	L	R L	Pain, S, PC	T						5 d
6	25	M	R	R L	Pain, S	P				27	satisfied
7	14	F	L	R L	Pain, S, PC	T				40	very satisfied
8	12	M	L	L	Pain, PC	T				54	satisfied
9	18	M	L	L	Pain, PC	T	3	DVT		26	very satisfied
10	13	M	R L	R L	Pain, PC	P				34	satisfied
11	16	M	R	R L	Pain, PC	T	4–5			72	not satisfied	72 m
12	12	F	R	R L	Pain, PC	P	3			28	very satisfied
13	11	M	R L	R L	Pain, PC	T				55	very satisfied
14	27	M	R	R	Pain, PC	N	3			50	satisfied
15	3	M	R L	R L	S	P				12	very satisfied	19 m
16	16	F	L	L	Pain, PC	P				61	satisfied
17	14	M	L	R L	Pain, S	T				73	satisfied
18	15	M	R	R	Pain S	T					not satisfied	3 m
19	12	M	R L	R L	Pain, PC	T				61	very satisfied
20	12	M	R L	R L	Pain, S, PC	T	6			60	uncertain

A Side dislocated.

B Side operated on.

C Indication for surgery: S, sitting difficulties; PC, problems with perineal care.

D Postoperative treatment: T, traction; P, plaster; N, no treatment.

E Duration of pain (in months) for at least 3 months and up to 6 months postoperatively.

F Complications: E, edema; LA, loss of appetite; DVT, deep vein thrombosis.

G Time (in months) from primary operation to reoperation.

H Follow-up (months)

I Satisfaction

J Time from operation to death: days (d) or months (m).

Patient number 7, a 14-year-old girl with quadriplegic cerebral palsy. She had severe pain, was unable to sit in her wheelchair, and had problems with perineal care. A. Radiograph showing left hip dislocation indicating the vertical distance (a) from the femoral resection level to the distal horizontal tangent of the os ischii. B. Radiograph 1 day postoperatively after bilateral PFRIA, showing the vertical distance (b) from the proximal femur to the distal horizontal tangent of the os ischii. C. Radiograph at 16 months, showing the vertical distance (c) from the proximal femur to the distal horizontal tangent of the os ischii and showing bilateral heterotopic ossification.

Table 2. Proximal migration (in cm) of the dislocated femur according to postoperative treatment

	Postoperative treatment				p-value	All patients
	Traction		Plaster ^d			Mean	SD	Range
Migration	Mean	SD	Mean	SD
Postoperative migration ^a	1.0	1.3	4.5	1.5	< 0.001	2.1	2.2	-0.9–6.9
From postop. to follow-up ^b	3.3	2.1	2.3	1.0	0.4	2.9	1.8	-0.9–6.6
Total migration ^c	4.0	1.9	6.3	1.3	0.03	4.8	2.0	1.6–8.0

^a “Postoperative migration” is the migration between the operation and the first postoperative day.

^b “From postop. to follow-up” is the migration from the first postoperative day to the last radiographic follow-up.

^c “Total migration” is the total migration of the femur from preoperatively to the last follow-up.

^d One patient without any postoperative treatment was included in the “Plaster” group.

SD: standard deviation; p-value: the significance level according to Student t-test for independent samples.