A Systematic Review of the Systematic Utilitarian Procedure for Extremity Reconstruction of the Hip (SUPERhip) for Congenital Femoral Deficiency with Reference to Recent Extra-network Cohort Findings.

AIMS AND

BACKGROUND

Congenital femoral deficiency (CFD) is a rare limb anomaly requiring Hip reconstruction before femoral lengthening. The Systematic Utilitarian Procedure for Extremity Reconstruction of the Hip (SUPERhip), introduced by Paley in 1997, is the principal protocol for type Ib and type II CFD. No systematic review has consolidated outcomes in this population. This review synthesised radiographic outcomes, complications and protocol fidelity.

MATERIALS AND

METHODS

PubMed, Google Scholar, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and China National Knowledge Infrastructure (CNKI) were searched in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 [International Prospective Register of Systematic Reviews (PROSPERO) CRD420261386450]. Eligible studies were peer-reviewed cohorts of three or more patients with Paley type Ib or type II CFD (subtypes IIa and SUPERhip-eligible IIb) treated with the full SUPERhip protocol. Single-arm narrative synthesis was performed; meta-analysis was not feasible due to outcome reporting heterogeneity.

RESULTS

Two cohorts met the inclusion criteria: Paley et al. (106 procedures, 1997-2012) and Violante Júnior et al (26 patients, 2005-2020). Outcome reporting was structurally asymmetric: Paley et al. (pooled n = 106) reported reduction with bone morphogenic protein 2 (BMP2) - delayed ossification (41% → 13%) and recurrent varus (37% → 11%) (p < 0.005 for both); Violante Júnior et al. reported radiographic indices [neck-shaft angle (NSA): 72° → 133°; centre-edge angle (CEA): 17° → 34°; and acetabular index (AI): 28° → 16°, all p < 0.001]. Neither cohort reported medial proximal femoral angle (MPFA). Protocol fidelity ranged from canonical practice through within-network variants to extra-network adaptations.

CONCLUSION

The SUPERhip procedure achieves substantial radiographic correction in Paley type Ib CFD; a within-cohort signal from a single primary dataset suggests that fixed-angle fixation with intra-osseous BMP2 may reduce late complications. Outcomes are reported asymmetrically; no peer-reviewed type-II-specific cohort outcomes exist; MPFA is reported in no cohort; and the evidence base remains concentrated within a single methodological lineage.

CLINICAL SIGNIFICANCE: Hip reconstruction before femoral lengthening is supported by comparator literature for both type Ib and type Ia CFD. Within this limited evidence base, canonical SUPERhip with fixed-angle fixation and BMP2 is the best-evidenced approach for type Ib; a within-network supply-constrained variant achieved comparable radiographic correction. Late Hip instability is a post-lengthening risk in type Ia CFD.