Sulis Bayu Sentono, M.D.†, Young Choi, M.D., Chin Youb Chung, M.D.,
Soon-Sun Kwon, Ph.D.*, Kyoung Min Lee, M.D., Moon Seok Park, M.D.
†Department
of Orthopaedic Surgery, Airlangga University Dr Soetomo Hospital, East Java, Indonesia. Department of
Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea. *Biomedical Research Institute,
Seoul National University Bundang Hospital, Kyungki, Korea
Purpose
To assess progression of hip subluxation after femoral
varization derotation osteotomy (FVDO) in patients with
cerebral palsy using a Linear Mixed Model (LMM)
application and determined factors influence it
Background
Hip subluxation and dislocation in children with
spasticity resulting from CP may cause serious problems
for affected patient
Satisfactory short term results after FVDO or combined
with Dega pelvic osteotomy for the treatment of hip
subluxation and dislocation were reported by many
authors
There are only a few long term studies reporting
recurrency after FVDO or combined with Dega pelvic
osteotomy after some periodic follow-up.
Methods
This study was a retrospective design
Patients with CP, who visited our hospital and
underwent FVDO or combined with Dega pelvic
osteotomy between from 2003 Jun. to 2012 Oct.
Investigate using X-ray in AP and Internal rotation view
to assess Neck shaft angle(NSA), Head shaft angle
(HAS), Migration percentage(MP) on pre-operative,
immediate post operative and until last follow up
Methods
For each of GMFCS level, the value of measurements
(NSA, HSA, MP) was adjusted by multiple factors by
using a Linear Mixed Model (LMM) with gender as the
fixed effects and follow-up time (years) effect, laterality
(side of hip) and each subject as the random effect
Operation
Preop : FVDO + Dega
Operation
Preop : FVDO + Dega
Methods
Pre Operative
(Measurement of NSA)
Post Operative
Figure 1.:The angle between a line passing through the midway of the femoral shaft
and another line connecting the femoral head center and midpoint of the femoral
neck. The femoral head center was the center of best fitting outer circle of the
femoral head.
Methods
(Measurement of HSA)
Pre Operative
Post Operative
Figure 1.:The head shaft angle was the angle between line passing through the
femoral shaft midway and another line perpendicular to the proximal femoral physis.
Methods
(Measurement of MP)
Pre Operative
Post Operative
Figure 1.:The migration percentage was calculated by dividing the amount of the
femoral head lateral to the Perkin’s line (A) with the total width of the femoral head
(B)
Results
There were one hundreds and fourty-four hips in 76
bilateral spastic CP patients
All were bilateral CP type with GMFCS II-III / IV / V were
12 / 30 / 34, respectively
All got bilateral FVDO in equal amount and 80 hips
combined with Dega pelvic osteotomy
There were 57 males and 19 females with an average
age at surgery was 8.5 ± 2.3 years (SD range from 4.5
to 16.5 years) and duration of follow up was 4.9±2.4
years
Results
Parameters
No. of patients (M/F)
CP type (Uni/Bi)
Patient’s Information
Type of surgery
Values
76(57/19)
0/76
GMFCS (II-III/IV/V)
12/30/34
Age at surgery (yr)
8.5 ± 2.3
Follow up duration
4.9±2.4
No. of Hips involved
(Right/Left)
144(72/72)
FVDO (Right/Left)
144(72/72)
Dega PO (Right/Left)
80(45/35)
Results
Parameters
Values
NSA (°)
Radiographic characteristics
Preop
151.3±9.9
Immediate postop
129.0±14.6
Last F/U
129.1±15.3
HSA (°)
Preop
161.1±9.0
Immediate postop
141.9±13.9
Last F/U
142.9±14.7
MP (%)
Preop
53.7±30.0
Immediate postop
11.9±13.9
Last F/U
16.3±14.2
Estimate(%) 95% CI
p
GMFCS II-III
(Intercept)
12.4
-0.8 to 25.5
0.062
Gender
Male
11.4
-2.5 to 25.3
0.106
Side of hip
Right
-2.8
-8.3 to 2.7
0.285
Follow up
Year
0.7
-4.1 to 5.5
0.742
(Intercept)
18.7
10.5 to 26.9
<0.001
Gender
Male
-7.1
-15.6 to 1.4
0.100
Side of hip
Right
-0.8
-5.1 to 3.5
0.694
Follow up
Year
1.9
1.0 to 2.8
<0.001
(Intercept)
11.2
0.2 to 22.1
0.046
Gender
Male
-1.7
-13.2 to 9.8
0.774
Side of hip
Right
-0.8
-6.2 to 4.7
0.777
Follow up
Year
3.5
1.3 to 5.8
0.003
GMFCS IV
GMFCS V
Results
Results
Results
Conclusions
There is progression of hip subluxation after FVDO in
patients with CP particularly in patients non-ambulatory
(GMFCS level IV and V)
Time of follow-up duration has main role in the occurency
of this postulated
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