Short-term outcomes of guided growth of the proximal femur combined with soft-tissue release in children with cerebral palsy

Spastic hip displacement is common in nonambulatory children with cerebral palsy (CP). We evaluated whether adding guided growth (temporary medial proximal femoral hemiepiphysiodesis) to soft-tissue release improves radiographic and clinical outcomes in children with spastic hip displacement. We reviewed 29 children (18 boys and 11 girls; 58 hips) with CP (Gross Motor Function Classification System levels IV–V) who underwent releases combined with placement of a transphyseal screw across the femoral head physis. Migration percentage, neck-shaft angle, acetabular index, and Hilgenreiner-epiphyseal angle were measured preoperatively and at final follow-up. Hip pain was assessed qualitatively. At a mean follow-up of 18 months, all radiographic indices showed significant improvement. All patients experienced a reduction or resolution of hip pain. No major complications occurred. Twenty-one hips (36%) required screw revision because of growth. Combining guided growth with soft-tissue release produced significant short-term improvement in hip stability and alignment in children with CP, with minimal complications. This combined approach may help preserve hip integrity and delay or avoid more extensive bony reconstructive surgery. Level of evidence: Level IV