Non-reconstructive/salvage hip surgery in cerebral palsy: a systematic review

Purpose: Hip displacement is common in patients with cerebral palsy, carrying high morbidity without surgical intervention (pain, seating tolerance, perineal hygiene, and care). Operative techniques commonly used for non-reconstructive/salvage hip surgery are proximal femoral resection (PFR), valgus osteotomy (VO), and arthrodesis. There is limited literature comparing the outcomes between these operations. The main aim of this study is to provide an up-to-date comparison to guide surgical decision-making. Methods: This study was registered with PROSPERO (registration no.: CRD42022364078). A literature search was conducted using Cochrane Library, PubMed, MEDLINE, and EMBASE. English publications were included with no date restriction, including prospective, retrospective, and comparative studies. Data were extracted, including, but not limited to, pain improvement, increased sitting tolerance, seating time, parent and caregiver satisfaction, range of movement (ROM), heterotopic ossification (HO) rate, and ease of hygiene. Results: Forty-two studies fulfilled our inclusion criteria, totalling 1,261 hips in 1,103 patients. The pain relief was comparable between PFR and VO (95 vs 100%), with PFR having a higher patient/carer satisfaction rate (100 vs 80%) and much higher rates of heterotopic ossification (52 vs 13%). PFR provided a more favourable ROM. Arthrodesis had a higher rate of secondary surgery (24%) than PFR (16%) and VO (10%). Conclusion: This systematic review found that PFR has a higher patient/carer satisfaction rate and ROM with comparable pain relief to VO and a higher rate of HO. More research is needed to understand the clinical impact of HO. Arthrodesis was less commonly performed.