Guided Growth of the Proximal Femur for the Management of the ‘Hip at Risk’ in Children with Cerebral Palsy: A Systematic Review

Moritz Lebe, Renée Anne van Stralen, Pranai Buddhdev

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Abstract

BACKGROUND: Guided growth is frequently used to modify lower-limb alignment in children, and recently temporary medial hemiepiphysiodesis of the proximal femur (TMH-PF) has been used for the management of hips at risk of subluxation in cerebral palsy (CP) patients. The aim of our study was to evaluate the efficacy of TMH-PF in the management of neuromuscular hip dysplasia in children with cerebral palsy.

METHODS: A systematic search of the literature was performed by using PubMed, EMBASE, CINAHL, MEDLINE, Scopus and Cochrane databases. Pre- and postoperative radiographic changes of the migration percentage (MP), head-shaft angle (HSA) and acetabular index (AI) were included in a meta-analysis. Secondary outcomes were treatment complication rates, technical considerations and the limitations of this novel technique.

RESULTS: Four studies (93 patients; 178 hips) met the eligibility criteria for inclusion in the meta-analysis. All three radiographic measurements showed significant changes at a minimum of 2 years of follow-up. Mean changes for MP were 8.48% (95% CI 3.81-13.14), HSA 12.28° (95% CI 11.17-13.39) and AI 3.41° (95% CI 0.72-6.10), with I 2 of 75.74%, 0% and 87.68%, respectively. The serious complication rate was overall low; however, physeal 'growing off' of the screw was reported in up to 43% of hips treated.

CONCLUSION: TMH-PF is an effective and predictable method to treat CP patients with 'hips at risk', and the overall complication rate is low; however, further work is required to identify the best candidates and surgical timing, as well as choice of technique and implant.

Original languageEnglish
Article number609
JournalChildren
Volume9
Issue number5
DOIs
Publication statusPublished - 25 Apr 2022

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© 2022 by the authors. Licensee MDPI, Basel, Switzerland.

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