Total Hip Arthroplasty in Patients with Cerebral Palsy: A Cohort Study Matched to Patients with Osteoarthritis

• Published in: Journal of bone and joint surgery. American volume 2017-03, Vol.99 (6), p.488-493
• Main Authors: Houdek, Matthew T., Watts, Chad D., Wyles, Cody C., Trousdale, Robert T., Milbrandt, Todd A., Taunton, Michael J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arthroplasty, Replacement, Hip - adverse effects; Cerebral Palsy - surgery; Cohort Studies; Female; Follow-Up Studies; Hip Dislocation - surgery; Humans; Male; Middle Aged; Osteoarthritis, Hip - surgery; Treatment Outcome; Young Adult
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.16.00528

The spasticity and increased muscle tone observed in patients with cerebral palsy can lead to hip degeneration, subluxation, and pain. Currently, there is hesitation to perform total hip arthroplasty in patients with cerebral palsy because of fears of early wear and dislocation. The purpose of this study was to review the outcomes of total hip arthroplasty in patients with cerebral palsy and to compare outcomes with those of matched patients with a diagnosis of osteoarthritis. Over a 24-year period, 39 patients undergoing a total hip arthroplasty with a diagnosis of cerebral palsy were identified. The cohort included 26 male patients (67%), and the mean patient age was 49 years. The mean follow-up was 7 years. Patients with cerebral palsy were matched 1:2 with a group of patients undergoing total hip arthroplasty for osteoarthritis. There was no difference in the rate of reoperation, implant survival, or complications, specifically dislocation. Prior to the surgical procedure, all patients had severe or moderate pain, and postoperatively no patient had moderate or severe pain. Twenty-three patients had an improvement in their ability to independently walk, and all preoperative hip flexion contractures were corrected (n = 9). There was also a significant improvement (p < 0.0001) in functional Harris hip scores. This study refutes previous evidence showing increased risk of complications following total hip arthroplasty in patients with cerebral palsy. Total hip arthroplasty is a durable treatment option and provides clinically important pain relief and functional improvement in patients with cerebral palsy. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.