VALIDATION OF THE TROCHANTERIC-SPARING PROXIMAL FEMORAL RESECTION COMPARED TO LEGACY SALVAGE PROCEDURES: A NON-INFERIORITY RETROSPECTIVE COHORT STUDY

Untreated hip dislocation in patients with neuromuscular complex chronic conditions (NMCCs) is associated with pain and dysfunction. Several salvage surgeries have been described, but only a handful of studies directly compare demographic, intra-operative and post-operative parameters between these techniques. The trochanteric sparing proximal femur resection (TSPFR)1 is a novel procedure without previous comparison against standard salvage techniques. This retrospective study aims to compare intra-operative and post-operative parameters for patients receiving a TSPFR versus those receiving a McHale or Girdlestone procedure. Patients diagnosed with NMCCs who underwent salvage surgery for hip dislocation between 2012 and 2023 at our tertiary-level pediatric hospital were eligible for this study. Patients were excluded if follow-up was less than 6 months. Baseline characteristics were summarized for the overall cohort and stratified by procedure group (TSPFR vs. Girdlestone & McHale procedures). Bivariate comparisons were conducted using Student's t-tests and Fisher's exact tests. Non-inferiority testing across the two procedure groups was conducted (Table 1). Fifty-one patients were analyzed who underwent a McHale valgus osteotomy (n=10), Girdlestone hip salvage procedure (n=16), or TSPFR (n=25) at a median of 16 years (7–32 years). The majority of patients (77%) were classified as GMFCS level V. TSPFR procedures rarely underwent additional ipsilateral hip soft-tissue procedures compared to McHale & Girdlestone patients (8% vs. 62%; p For pain improvement from baseline, nearly all patients experienced pain improvement. The TSPFR procedure was found to be non-inferior to the McHale and Girdlestone procedures with respect to pain improvement (p=0.047). Non-inferiority was established for all intra-operative factors, as well as for total number of complications (p < 0 .001), major complication incidence (p=0.04), ability to stand (p=0.02), and for median Brooker heterotopic ossification stage (p=0.03). Although the incidence of minor complications was similar in both groups and patient satisfaction was very high in both groups, non-inferiority could not be concluded (Table 1). This study provides the first comparison between the novel TSPFR compared to more standard salvage approaches. Preliminary data for the outcomes of TSPFR are encouraging; however, future prospective studies with health-related quality of life measures are needed to identify a superior salvage procedure. The results of this non-inferiority study can function as a framework for larger multi-center prospective studies who may choose to adopt this novel trans-trochanteric proximal femoral resection for neuromuscular hip salvage. For any figures or tables, please contact the authors directly.