Health-related quality of life after Dega pelvic osteotomy and varus derotation osteotomy due to spastic hip disease in children with cerebral palsy.

Abstract

Purpose: Our study aimed to present health-related quality of life (HRQL) after combined bone reconstruction in nonambulatory patients with cerebral palsy (CP) after at least a 2-year follow-up and to assess its impact on HRQL using the Caregiver Priorities and Child Health Index of Life with Disabilities questionnaire (CPCHILD) as the primary outcome measure.

Methods: In this prospective study, we analyzed 31 nonambulatory patients with spastic or mixed CP (GMFCS levels IV-V) who underwent hip reconstructive surgery between 2015 and 2021. The surgical procedures included one-sided varus derotation osteotomy of the femur with Dega transiliac osteotomy and, on the opposite side, varus derotation osteotomy (VDRO) of the femur with shortening and, as needed, Dega pelvic osteotomy.

Results: The study demonstrated significant improvement in the hip joint motion range, as assessed by the Thomas test, in hip abduction and rotational movements of the hip, as well as reduction of spasticity. The procedures also resulted in significant radiographic improvement of the femoral head coverage. The assessment of symptoms and problems associated with the hip revealed a positive influence of the surgery on pain, contractures, toileting/perineal hygiene, dressing, seating, transferring, and position changes. The mean improvement at a follow-up visit was significant in all domains of the CPCHILD, except for communication and social interaction.

Conclusion: Hip reconstruction with VDRO and Dega pelvic osteotomy can enhance the HRQL of children with CP. These surgical interventions can help to achieve the correct hip position and to reduce pain, which positively affects the patient QL, although proactive treatment results in less invasive procedures.

Level of evidence: IV case series.