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Topic:

​

Issue:

Hip

Category:

Neuromuscular

Title:

Medium-term Results After Femoral Head Resection and Subtrochanteric Valgus Osteotomy in Children and Adolescents With Neuromuscular Disorders

Author:

Marowsky, Madeleine; Jungesblut, Oliver MD; Strahl, André PhD; Stücker, Ralf MD; Rupprecht, Martin MD

Journal:

Journal of Pediatric Orthopaedics

Date:

January 2024

Reference:

44(1): p 49-54, DOI: 10.1097/BPO.0000000000002556

Level Of Evidence:

IV

# of Patients:

52 patients (65 hips)

Study Type:

Retrospective study

Location:

Not specified

Summary:

This study evaluates the medium-term outcomes of the McHale procedure, which involves femoral head resection and subtrochanteric valgus osteotomy, in children and adolescents with neuromuscular disorders, specifically cerebral palsy (CP).

Methods:

Inclusion Criteria: Patients with painful hip dislocation and/or femoral head deformity secondary to cerebral palsy. Data Collection: Surgical reports, x-ray evaluations, migration of the proximal femur, heterotopic ossification (Brooker classification), and a telephone interview with caretakers were used. Variables Collected: Pain (pre- and post-surgery), mobility, sitting tolerance, quality of life, personal hygiene, range of motion, complications, implant removal outcomes.

Exclusions:

Not specified

Results:

Participants: 52 patients (65 hips), mean age 13.5 years (range: 4 to 20 years). Surgical Details: Mean surgery time was 178.4 minutes (range: 45 to 380 min). Mean follow-up period was 45.17 months (range: 12 to 204 months). Pain Reduction: There was a significant reduction in pain postoperatively (P < 0.001). Improvement in Quality of Life: Personal hygiene (P = 0.02) and quality of life (P = 0.013) showed significant improvement. Caretaker Feedback: 85% of caregivers would opt for the surgery again, and 81% would recommend it to others. Implant Removal: Removal of implants led to a significant improvement in pain (P = 0.011). Complications: 22 complications occurred in 65 procedures (33.9%), indicating some risk involved with the procedure.

Conclusions:

The McHale procedure significantly reduces pain and improves quality of life and hygiene for children with CP and chronic hip dislocations. The procedure is generally considered beneficial by caregivers, with a high rate of willingness to recommend it. Removal of implants provides additional pain relief. However, complications occur in about one-third of patients, which should be considered in treatment planning.

Relevance:

Limitations:

Perspective:

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