Comparison of Staged Versus Same-day Bilateral Hip Surgery in Nonambulatory Children With Cerebral Palsy

Background: Bilateral hip reconstructions with osteotomies are commonly required in patients with severe cerebral palsy (CP) and dysplasia. These procedures can be performed by staging each hip surgery, separated by weeks to months, or by addressing both hips in a single-event surgery. The optimal timing of such surgery is yet to be determined. The purpose of this study was to retrospectively compare major complications between the staged and single-event approaches. Methods: Medical records of patients who underwent bilateral hip osteotomies, with at least one side including a pelvic osteotomy, were retrospectively reviewed. Subjects were identified who had a diagnosis of nonambulatory CP (defined by Gross Motor and Functional Classification System level IV or V), and at least 1 year of clinical follow-up. All hips were treated by 1 of 7 surgeons: 2 surgeons who always performing single-event surgery and 5 who always perform staged surgeries. Complications were stratified by the Modified Clavien-Dindo Classification (grades 1 to 5). The primary outcome was major complications (grade ≥3), while minor complications, readmissions, reoperations, and resource utilization outcomes were investigated secondarily. Results: Sixty-five patients met our inclusion criteria: 35 received single-event surgery and 30 received staged surgery. The staged group had a higher rate of major complications per patient (0.30 vs. 0; P=0.013). Unplanned readmissions and reoperations were lik...
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

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Conclusions: The prevalence of HD in MECP2 disorders is comparable to cerebral palsy, associated with proxy measures of disease severity. These results can be used to develop hip surveillance programs for MECP2 disorders, allowing for timely management. Level of Evidence: Level III.
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Hip Source Type: research
CONCLUSIONS: A systematic AFO-FC tuning protocol using incremented heel height can be effective to improve gait in children with CP walking with EXT. The current results emphasise the importance of including kinematics as well as kinetics of multiple instances throughout the gait cycle for reliable interpretation of the effect of AFO tuning on gait.Implications for rehabilitationA systematic ankle foot orthosis footwear combinations (AFO-FC) tuning protocol using incremented heel height can improve gait in children walking with knee hyperextension.Tuning results in changes throughout the gait cycle.Little evidence is found...
Source: Disability and Rehabilitation - Category: Rehabilitation Authors: Source Type: research
CONCLUSION: The occurrence of complications during the follow-up period was high in patients with CP. However, postoperative complications did not significantly affect clinical outcomes.PMID:34503314 | DOI:10.3340/jkns.2021.0012
Source: Journal of Korean Neurosurgical Society - Category: Neurosurgery Authors: Source Type: research
CONCLUSIONS: Service providers should inculcate knowledge and active-living skills during the transition to adulthood. Professional guidance needed to ensure inclusion in communal PA and offer adapted programs for young people with CP.IMPLICATIONS FOR REHABILITATIONThere is a need for ongoing, accessible, adapted, community-based physical activity programs for young adults with CP guided by skilled professionals that can provide them with opportunities for enjoyable activities involving social interactions.When planning treatment interventions for children and young individuals with CP, healthcare providers should be aware...
Source: Disability and Rehabilitation - Category: Rehabilitation Authors: Source Type: research
CONCLUSIONS: The relatively low prevalence of disability (32%) at 18-24 months suggests that use of TH in a Level 2 nursery is feasible and possibly beneficial. More studies are needed to confirm these findings.ABBREVIATIONS: aEEG: amplitude electroencephalogram; CP: cerebral palsy; GMDS: Griffiths mental developmental scales; GQ: general quotient; HIC: high-income countries; HIE: hypoxic-ischaemic encephalopathy; LMIC: low- and middle-income countries; LTFU: loss to follow-up; NICU: neonatal intensive care unit; TH: therapeutic hypothermia; TOBY: total body hypothermia.PMID:34493152 | DOI:10.1080/20469047.2021.1967625
Source: Paediatrics and international child health - Category: Pediatrics Authors: Source Type: research
CONCLUSION: The likelihood of having scoliosis, windswept hips and flexion contractures in the hips and knees increased if the child had postural asymmetries, and for increased age and higher GMFCS levels. Efforts should focus on preventing postural asymmetries from occurring or progressing, and on increasing the child's ability to change position. Reducing postural asymmetries may also reduce the likelihood of pain.Implications for RehabilitationThe risk of having scoliosis, windswept hip deformity and flexion contractures in the hips and knees increased if the child had postural asymmetries in sitting or lying.Efforts sh...
Source: Disability and Rehabilitation - Category: Rehabilitation Authors: Source Type: research
CONCLUSION: Brain MRICS-based groups were associated with perinatal risk factors and related disabilities of cerebral palsy, but not with common motor disorders. MRI classification score is a reliable diagnostic tool, which strongly correlates with perinatal factors and related disabilities of cerebral palsy.PMID:34472740
Source: Croatian Medical Journal - Category: General Medicine Authors: Source Type: research
CONCLUSIONS: The risk of poor nutritional status is associated with more severe disability in children and adolescents with CP. There is a mismatch between HCP and caregiver perceptions of participants' nutritional status as well as between subjective and objective nutritional status. Our data warrant the use of a simple and objective screening tool in daily practice to determine nutritional status in children and adolescents with CP. Clinical trial registration: ClinicalTrials.gov Identifier: NCT03499288 (https://clinicaltrials.gov/ct2/show/NCT03499288).IMPLICATIONS FOR REHABILITATIONUse of the ESPGHAN recommendations and...
Source: Disability and Rehabilitation - Category: Rehabilitation Authors: Source Type: research
CONCLUSION: Brain MRICS-based groups were associated with perinatal risk factors and related disabilities of cerebral palsy, but not with common motor disorders. MRI classification score is a reliable diagnostic tool, which strongly correlates with perinatal factors and related disabilities of cerebral palsy.PMID:34472740
Source: Croatian Medical Journal - Category: General Medicine Authors: Source Type: research
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