The effect of hip reconstruction on gross motor function levels in children with cerebral palsy

Abstract

Objective: The aim of this study was to determine whether the hip reconstruction has an effect on grossmotor function classiŞcation system (GMFCS) levels in patients with hip instability in cerebral palsy (CP).Methods: A total of 45 hips of 30 patients (mean age: 8.7 (4e17) years) with CP operated due to hipinstability with a minimum of 2 years of follow-up were included into the study. Migration index wasused for classiŞcation of the severity of hip instability. Clinical evaluation included sitting and walkingability, existence of pressure sores, difŞculty in perineal care, and hip pain. The functional gains from thesurgery were evaluated with changes in GMFCS levels. Wilcoxon T test, chi-square test and Spearmancorrelation test were used.Results: Mean follow-up time was 57 (24e132) months. The distribution of preoperative GMFCS waslevel I in 1 patient, level II in 4 patients, level III in 5 patients, level IV in 9 patients and level V in 11patients. The complaints resolved in 25 patients, and persisted in 5 postoperatively. There was no correlation between the changes in GMFCS levels and the postoperative complaints (p¼ 0.504). The GMFCSlevels did not change in 20 patients, improved in 8, and worsened in 2. There were no signiŞcant differences between the preoperative and postoperative GMFCS levels (p¼ 0.052). Positive correlationswere found between the preoperative GMFCS-MI, the type of CP-MI respectively (p¼ 0.001, p ¼ 0.015).Conclusion: There was an improvement in preoperative complaints. GMFCS levels remained stable aftersurgery. Relief in symptoms was not consistent with the changes in GMFCS in children with cerebralpalsy after hip reconstruction.Level of evidence: Level IV, Therapeutic study.© 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).