Journal of the Pediatric Orthopaedic Society of North America · 2026
Proximal Femur Guided Growth for Hip Displacement in Hypotonic Cerebral Palsy: A Preliminary Report.
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Chang Yutse, Wang Szu Y, Kao Hsuan K, Chang Chia H
Аннотация
BACKGROUND: Proximal femur guided growth (PFGG) is a minimally invasive treatment option for coxa valga and hip displacement in cerebral palsy (CP). Its role in hypotonic CP remains unclear. This study evaluated PFGG as a potential intermediate surgical option between observation and reconstructive osteotomy for hypotonic hip coverage deficiency.
METHODS: This retrospective study reviewed children with hypotonic CP who received PFGG for hip acetabular coverage deficiency from 2012 to 2021. Surgical indications included a head-shaft angle (HSA) greater than 155° and a Reimers' migration percentage (MP) greater than 30%. The MP, HSA, and acetabular index were measured on serial radiographs. A decrease or increase in MP by 5 percentage points or more postoperatively was considered clinically significant. Adverse events, revision PFGG, and reconstructive procedures were recorded.
RESULTS: Fourteen patients (25 hips) underwent PFGG without concomitant soft-tissue releases at a mean age of 5.3 years (standard deviation: 2.3). The HSA improved significantly from 175.7° preoperatively to 165.3° at 2 years and 163.0° at the latest follow-up (mean: 50.4 months; P < .001). However, MP showed no significant change (41.2% preoperatively, 40.6% at 2 years, 40.7% at 4.2 years). Among the 12 hips with a preoperative MP of 30%-40%, MP decreased from 34.5% to 31.9%, and all hips were maintained below 40%. In contrast, among the 13 hips with a preoperative MP greater than 40%, subsequent procedures were required, including revision PFGG, femoral varus osteotomy, and pelvic osteotomy.
CONCLUSIONS: PFGG significantly decreased coxa valga but did not reliably affect MP or acetabular coverage. While it may provide a low-morbidity, intermediate surgical treatment option for selected hypotonic CP hips with coxa valga, further research is warranted to assess its clinical effectiveness.
KEY CONCEPTS: (1)Proximal femur guided growth demonstrated a limited effect on reducing hip displacement in hypotonic cerebral palsy despite coxa valga improvement.(2)Guided growth may offer a more active treatment option than observation alone.(3)Early application of proximal femur guided growth is recommended for hips with a migration percentage <40% to prevent progression of hypotonic hip displacement.
LEVEL OF EVIDENCE: Level IV, case series study.
METHODS: This retrospective study reviewed children with hypotonic CP who received PFGG for hip acetabular coverage deficiency from 2012 to 2021. Surgical indications included a head-shaft angle (HSA) greater than 155° and a Reimers' migration percentage (MP) greater than 30%. The MP, HSA, and acetabular index were measured on serial radiographs. A decrease or increase in MP by 5 percentage points or more postoperatively was considered clinically significant. Adverse events, revision PFGG, and reconstructive procedures were recorded.
RESULTS: Fourteen patients (25 hips) underwent PFGG without concomitant soft-tissue releases at a mean age of 5.3 years (standard deviation: 2.3). The HSA improved significantly from 175.7° preoperatively to 165.3° at 2 years and 163.0° at the latest follow-up (mean: 50.4 months; P < .001). However, MP showed no significant change (41.2% preoperatively, 40.6% at 2 years, 40.7% at 4.2 years). Among the 12 hips with a preoperative MP of 30%-40%, MP decreased from 34.5% to 31.9%, and all hips were maintained below 40%. In contrast, among the 13 hips with a preoperative MP greater than 40%, subsequent procedures were required, including revision PFGG, femoral varus osteotomy, and pelvic osteotomy.
CONCLUSIONS: PFGG significantly decreased coxa valga but did not reliably affect MP or acetabular coverage. While it may provide a low-morbidity, intermediate surgical treatment option for selected hypotonic CP hips with coxa valga, further research is warranted to assess its clinical effectiveness.
KEY CONCEPTS: (1)Proximal femur guided growth demonstrated a limited effect on reducing hip displacement in hypotonic cerebral palsy despite coxa valga improvement.(2)Guided growth may offer a more active treatment option than observation alone.(3)Early application of proximal femur guided growth is recommended for hips with a migration percentage <40% to prevent progression of hypotonic hip displacement.
LEVEL OF EVIDENCE: Level IV, case series study.