Outcomes of greater trochanter-sparing proximal femoral resection as a hip salvage procedure in cerebral palsy patients.

Abstract

Greater trochanter-sparing proximal femoral resection (PFR) is a surgical option for managing painful hips in children with cerebral palsy (CP) however, data on postoperative outcomes remain limited. This study aims to evaluate the radiographic and functional outcomes of greater trochanter-sparing PFR in this population. This retrospective study included all nonambulatory CP patients [Gross Motor Function Classification System (GMFCS) IV-V] who underwent greater trochanter-sparing PFR as the standard hip salvage procedure at a single tertiary center. Nineteen patients were initially identified; 2 were deceased, and 3 were lost to follow-up, resulting in 14 patients (17 hips) with complete data. Preoperative assessment involved GMFCS level, Reimer's Migration Index, and Care and Comfort Caregiver Questionnaire (CareQ) scores. Postoperative outcomes included radiographic migration, hip range of motion, presence of heterotopic ossification, complications, and CareQ-based functional improvement. Statistical analyses evaluated changes in functional and radiographic outcomes, using nonparametric methods appropriate for the small sample size. Fourteen patients (17 hips) were included, with a mean age of 19.4 ± 9.2 years. Postoperative femoral migration averaged 20.0 ± 12.2 mm, and heterotopic ossification occurred in most hips (type II 58.8%). CareQ scores improved significantly after surgery (34.5 ± 9.65 vs. 20.0 ± 9.17; P < 0.001). No significant correlations were observed between CareQ improvement and postoperative migration, heterotopic ossification, or range of motion. Greater trochanter-sparing PFR provides significant functional improvement and high caregiver satisfaction in patients with severe CP-related hip pathology. Although patients experienced proximal hip migration and heterotopic ossification, these radiological changes were not correlated with caregiver-reported outcomes.