Effectiveness of preventive and corrective surgical intervention on hip disorders in severe cerebral palsy: a systematic review.

PURPOSE: This review presents an overview of the effectiveness of preventive and corrective surgical interventions to treat hip displacement in patients with severe cerebral palsy (CP).

METHOD: A systematic literature search was applied to identify studies concerning surgical procedures in hip(sub)luxations in severe CP (GMFCS IV and V). A qualitative analysis and a best evidence synthesis were performed for soft tissue surgery and osteotomies.

RESULTS

The literature search identified 15 studies, all of which were observational. Five studies involved soft tissue surgery and 10 involved osteotomies. Only one study involving soft tissue surgery was of sufficient quality. Nine of the 10 studies involving osteotomies were of sufficient quality, including a total of 189 patients. The mean MP (migration percentage) at follow-up ranged from 6 to 29%. No relationship could be established between the effect of the surgical procedure and the patients' age or the duration of follow-up. The percentage of patients reporting pain decreased from 81% preoperatively to 5% at follow-up. Twenty-five percent had complications such as osteoarthritis, ulcers or fractures.

CONCLUSIONS

There is insufficient evidence for the effectiveness of soft tissue surgery to stabilize the hip, due to insufficient quality of the retrospective observational studies. This review shows indicative findings (provided by consistent, statistically significant findings on outcome and/or process measures in at least two Observational Studies with sufficient quality) for an effect of bony surgery in stabilizing the hip. Timing of the procedure remains an issue. Multicenter trials could shed further light on this complicated subject.