Combined pelvic and femoral reconstruction in children with cerebral palsy

Objective The primary aim of this study was to determine the effect of age, femoral head migration, and ambulatory status on radiographic outcomes after combined pelvic and femoral reconstruction in children with cerebral palsy. The secondary aim was to evaluate the fate of the opposite hip after unilateral reconstruction. Methods A retrospective cohort study design of consecutive patients from 1995–2009 was used. The records were screened for patients who underwent varus derotational osteotomy and modified Dega osteotomy. Results Eighty-five hips in 71 patients were included. The mean age was 8.4 ± 3.2 years and the mean follow-up was 6.6 ± 3.1 years. The final measures were a mean migration index of 20% ± 15.58%, centre edge angle of 28.45° ± 15.98°, and Sharp’s angle of 40.75° ± 8.5°. Those values were not correlated with age and the initial migration index. Nonambulatory status did not negatively affect hip stability. Final measurements of the contralateral hips were similar to the reconstructed hips, and the cumulative incidence for later reconstruction was 5.67%. Conclusions Regardless of age, preoperative displacement, and ambulation, the combined procedure provides durable radiographic improvement. In unilateral cases, there is a low risk of later deterioration of the opposite side.

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The unstable hip in children with cerebral palsy: does an acetabuloplasty add midterm stability?

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.210154 ◽

2021 ◽

pp. 1-7

Author(s):

Matthias W. Axt ◽

Danielle L. Wadley

Keyword(s):

Cerebral Palsy ◽

Classification System ◽

Group Versus ◽

Level Of Evidence ◽

Hip Stability ◽

Children With Cerebral Palsy ◽

Migration Percentage ◽

Outcome Difference ◽

Retrospective Comparative Study

Purpose This study addresses whether an additional pelvic procedure is superior to a varus derotation osteotomy femur (VDRO) alone in unstable hips in children with cerebral palsy (CP). Methods All patients had unstable hips utilising the Melbourne Cerebral Palsy Hip Classification System (MCPHCS). We compared one group that underwent VDRO alone with one that had a combination of VDRO and Dega osteotomy (VDRO+). Measurements were taken before surgery, postoperatively, two years after surgery and at latest follow-up. Generalised estimating equations were used to account for known and unknown correlations between hips from bilateral cases. Results In total, 74 hips in 57 children fulfilled the inclusion criteria. There was no outcome difference between Gross Motor Function Classification System levels III, IV and V. Age at time of operation ranged from three to 16 years (mean 9.8 years). Mean follow-up was 49.1 months. In the VDRO group (28 hips) migration percentage (MP) changed from 61% preoperative to a final value of 35.7%. In the VDRO+ group (46 hips) the MP changed from 64.4% to 19.3%. At final follow-up 15 hips (54%) were stable in the VDRO group, 37 hips (83%) in the VDRO+ group. The odds ratio (OR) of hip stability at final follow-up was 3.5-times higher in the VDRO+ group versus the VDRO group (OR = 3.9; 95% confidence interval = 1.5 to 9.7; p = 0.004). Conclusion Reconstruction of unstable hips via VDRO + Dega in children with CP provides a higher likelihood of long-term stability than an isolated VDRO. Level of Evidence Level III, retrospective comparative study

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Hip development in children with cerebral palsy and adductor spasticity treated with botulinum toxin type A: A two-year follow-up

Neuropediatrics ◽

10.1055/s-0029-1215844 ◽

2008 ◽

Vol 39 (05) ◽

Author(s):

NH Jung ◽

F Heinen ◽

A Reissig ◽

B Westhoff ◽

S Berweck ◽

...

Keyword(s):

Cerebral Palsy ◽

Botulinum Toxin ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Children With Cerebral Palsy

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No Difference in Outcomes Following Osteochondral Allograft with Fresh Precut Cores Compared to Hemi-Condylar Allografts

Cartilage ◽

10.1177/19476035211021911 ◽

2021 ◽

pp. 194760352110219

Author(s):

Danielle H. Markus ◽

Anna M. Blaeser ◽

Eoghan T. Hurley ◽

Brian J. Mannino ◽

Kirk A. Campbell ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Knee Injury ◽

Lesion Size ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Radiographic Outcomes ◽

Significant Difference ◽

Patient Reported ◽

The Mean

Objective The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. Design A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups. The cartilage at the graft site was assessed with use of a modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system and patient-reported outcomes were collected. Results Overall, 52 total patients who underwent OCA with either fresh precut OCA cores ( n = 26) and hemi-condylar OCA ( n = 26) were pair matched at a mean follow-up of 34.0 months (range 12 months to 99 months). The mean ages were 31.5 ± 10.7 for fresh precut cores and 30.9 ± 9.8 for hemi-condylar ( P = 0.673). Males accounted for 36.4% of the overall cohort, and the mean lesion size for fresh precut OCA core was 19.6 mm2 compared to 21.2 mm2 for whole condyle ( P = 0.178). There was no significant difference in patient-reported outcomes including Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and Tegner ( P > 0.5 for each), or in MOCART score (69.2 vs. 68.3, P = 0.93). Conclusions This study found that there was no difference in patient-reported clinical outcomes or MOCART scores following OCA implantation using fresh precut OCA cores or size matched condylar grafts at early to midterm follow-up.

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Constrained liners revisited: favourable mid-term results in patients with high-risk of dislocation: technical considerations for the optimal outcome

Hip International ◽

10.1177/11207000211010712 ◽

2021 ◽

pp. 112070002110107

Author(s):

Eustathios Kenanidis ◽

Panagiotis Kakoulidis ◽

Panagiotis Anagnostis ◽

Michael Potoupnis ◽

Eleftherios Tsiridis

Keyword(s):

High Risk ◽

Recurrent Dislocation ◽

Deep Infection ◽

Consecutive Series ◽

Revision Thas ◽

Hip Stability ◽

Functional Scores ◽

Revision Tha ◽

The Mean

Background: The outcomes of constrained liners (CLs) in total hip arthroplasty (THA) remain inconclusive. We evaluated the mid-term performance of CLs in a consecutive series of high-risk dislocation patients undergoing primary or revision THA performed by a single surgeon. The survival, dislocation rate, complications, and functional patients’ scores were assessed. Surgical tips to enhance outcomes were reviewed. Methods: 45 patients who received the Trident Tripolar CL between 2010 to 2019 were retrospectively evaluated from Arthroplasty Registry Thessaloniki. There were 17 primary and 28 revision THAs. The primary indications for using CL were severe abductor insufficiency or comorbidities, increasing the dislocation risk in primary, and recurrent dislocation or abductor insufficiency in revision THAs. The mean patient’s age was 68.5 (±14.5) years, and the mean follow-up 3.81 (±1.66) years. Results: There were 2 dislocations and 1 deep infection in the revision group. For any reason, the cumulative 6-year survival rate was 93.3%, 100% for primary, and 89.3% for revision THAs. The mean overall CL survival was 76.3 months for any reason (95% CI, 68.1–84.5) and 80.5 months for dislocation (95% CI, 75.8–85.2). The mean postoperative functional scores were significantly improved ( p < 0.001) at the latest follow-up. Conclusions: CLs can provide hip stability and durable fixation in selected low-demand patients with high-risk for dislocation after primary and revision THA at mid-term follow-up. Careful patient selection and the refined surgical technique aiming at the neutral liner position and considering the high CLs’ offset relative to stem-neck impingement are necessary to maximise outcomes.

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CHILDREN WITH CEREBRAL PALSY

PEDIATRICS ◽

10.1542/peds.20.4.703 ◽

1957 ◽

Vol 20 (4) ◽

pp. 703-715

Author(s):

Helen M. Wallace ◽

Margaret A. Losty ◽

David Sanders ◽

Robert S. Siffert ◽

Jerome S. Tobis ◽

...

Keyword(s):

New York ◽

New York City ◽

Cerebral Palsy ◽

Financial Aid ◽

York City ◽

Follow Up Study ◽

Children With Cerebral Palsy

This report describes the findings and interim results of a follow-up study of 770 children with cerebral palsy who were cared for under the aegis of the New York City Financial Aid Program from 1945 to July 1, 1954. The findings seem to indicate that some redirection of the program to include development, expansion and improvement of some alternate services within the community is advisable. It is likely that this same type of follow-up study would be of equal value for children of other diagnostic groups, and similar studies might be initiated.

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Comparison of hamstring transfer with hamstring lengthening in ambulatory children with cerebral palsy: further follow-up

Journal of Children s Orthopaedics ◽

10.1007/s11832-014-0626-8 ◽

2014 ◽

Vol 8 (6) ◽

pp. 513-520 ◽

Cited By ~ 25

Author(s):

Camila De Mattos ◽

K. Patrick Do ◽

Rosemary Pierce ◽

Jing Feng ◽

Michael Aiona ◽

...

Keyword(s):

Cerebral Palsy ◽

Children With Cerebral Palsy

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Revascularization versus apical barrier technique with mineral trioxide aggregate plug: A systematic review

Giornale Italiano di Endodonzia ◽

10.4081/j.gien.2018.10 ◽

2018 ◽

Vol 32 (1) ◽

pp. 9-16 ◽

Cited By ~ 3

Author(s):

Luiz Alexandre Chisini ◽

Guillermo Grazioli ◽

Alejandro Francia ◽

Alissa Schmidt San Martin ◽

Flavio Fernando Demarco ◽

...

Keyword(s):

Clinical Success ◽

Mineral Trioxide Aggregate ◽

Clinical Success Rate ◽

Permanent Teeth ◽

Radiographic Outcomes ◽

Bias Risk ◽

Radiographic Measurements ◽

High Bias ◽

The Mean

Aim: To compare the clinical and radiographic outcomes observed in Necrotic Immature Permanent Teeth (NIPT) after revascularization or apexification with MTA-apical plug. Methodology: PubMed/MEDLINE, Web of science and Scopus were the databases used, up to July 30th, 2017, for article research. Independent reviewers read the titles and abstracts of all reports that met inclusion/exclusion criteria: prospective or retrospective clinical studies comparing the revascularization of root canal and apexification. Clinical success of therapies, deposition and thickening of lateral dentinal walls (root width) and the continuation of root development (root length) were investigated. Bias risk of included studies was assessed using the Cochrane risk of bias. Results: From 1642 records, five papers fulfilled all inclusion criteria. Overall, 91 teeth were submitted to revascularization and 64 teeth to apexification with MTA. The mean follow-up was 23.2 months in revascularization and 21.8 in apexification. Clinical success rate was of 87.9% in the revascularization group and 90.6% in the apexification group. An increase on lateral dentinal walls thickening was observed in most revascularization cases (13%) while MTA as apical plug suggest a mild resorption of the root (1.3%). High bias risk was observed on included studies. Conclusions: Apexification with MTA-apical plug provides similar clinical success to revascularization. However, radiographic measurements showed an improvement in thickening of lateral dentinal walls in most of the revascularization cases in addition to a higher dental development. However, these results should be interpreted with caution.

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STATURE ESTIMATE OF CHILDREN WITH CEREBRAL PALSY THROUGH SEGMENTAL MEASURES: A SYSTEMATIC REVIEW

Revista Paulista de Pediatria ◽

10.1590/1984-0462/2020/38/2018185 ◽

2020 ◽

Vol 38 ◽

Author(s):

Joel Alves Lamounier ◽

Nathália Macedo Marteletto ◽

Cristina Amaral Calixto ◽

Marcia Reimol de Andrade ◽

Jacqueline Domingues Tibúrcio

Keyword(s):

Cerebral Palsy ◽

Infant Health ◽

Body Height ◽

Japanese Patients ◽

Healthcare Research ◽

Small Samples ◽

Children With Cerebral Palsy ◽

Actual Height ◽

Meta Analyses

ABSTRACT Objective: To review studies that evaluate the correspondence between the estimate height via segmental measures and the actual height of children with cerebral palsy. Data sources: Systematic literature review between 1995–2018, guided by the PRISMA criteria (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), in PubMed, BVS, MEDLINE and Lilacs databases. The descriptors, connected by the AND Boolean Operators, were: anthropometry, cerebral palsy, child and body height. The research comprised papers in Portuguese, English and Spanish, with Qualis-CAPES equal or superior to B3 that addressed the question: “Is there any correlation between estimate height by equations and direct height measures in children with cerebral palsy?” 152 studies were recovered and seven were selected. Their methodological quality was assessed by the scale of the Agency for Healthcare Research and Quality (AHRQ). Data synthesis: Most studies showed no correspondence between estimated and real height. Studies that showed coincidence of the measures contain limitations that could jeopardize the results (sample losses, small samples and exclusion of patients with severe contractures, scoliosis and severe cerebral palsy). Japanese researchers developed an equation which harmoniously aligns the statures; the study comprised only Japanese patients, though. Conclusions: Given the importance of accuracy in height measures to evaluate infant health, it is crucial to carry out more researches in order to safely establish an association between both estimate and real statures. The development of anthropometric protocols, emerged from such researches, would benefit the follow-up of children with severe psychomotor disabilities.

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