Early Bony Hip Reconstructive Surgery for Hip Subluxation in Children With Severe Cerebral Palsy.

Hip subluxation occurs frequently in children with severe cerebral palsy. This retrospective study examined the effects of age and type of bony surgery on radiographic outcomes of children with severe cerebral palsy who were treated for hip subluxation. The study included nonambulatory children with cerebral palsy undergoing bony hip reconstructive surgery consisting of proximal femoral varus derotational osteotomy (VDRO) alone or combined with pelvic osteotomy. The migration index was recorded for preoperative, postoperative, and final follow-up (minimum 2 years) radiographs. Failure was defined as subsequent bony hip reconstructive surgery or final follow-up migration index greater than 50%. Seventy-seven hips in 40 patients younger than 6 years (55 VDRO alone, 22 combined) and 73 hips in 43 patients older than 6 years (27 VDRO alone, 46 combined) met inclusion criteria. For VDRO alone, the failure rate for patients younger than 6 years (33%) was significantly higher than for patients older than 6 years (7%). For combined procedures, failure rates between younger (0%) and older groups (9%) were not significantly different. Patients younger than 6 years undergoing combined procedures started with a significantly worse migration index than patients undergoing VDRO alone, 72% vs 46%, yet had significantly better final migration indices of 13% vs 31%, respectively. For surgeons performing bony reconstructive surgery to treat hip subluxation in younger children with severe cerebral palsy who are nonambulatory, the findings of this study support the use of combined VDRO and pelvic osteotomy. [Orthopedics. 2021;44(2):e294-e300.].

Secondary Surgery Rates After Primary Fusion for Adolescent Idiopathic Scoliosis.

Instrumented spinal fusion is the gold standard treatment for surgical magnitude adolescent idiopathic scoliosis (AIS), with the goal being stable fusion without the need for additional procedures. The purpose of this study was to define the surgical return rates of AIS at a single center with respect to various instrumentation constructs used during initial spinal fusion. A retrospective chart review was performed of all patients with AIS who underwent instrumented fusion with a minimum of 2-year follow-up. Demographic information, implant type, and surgical approach for the primary surgery and all subsequent secondary operations were recorded. Four hundred eleven patients who underwent instrumented fusion for AIS during the study period met inclusion criteria. Sixty-six secondary operations were performed in 50 patients (12.2%). Symptomatic hardware, pseudarthrosis, and infection were the most common indications for secondary surgery. Posterior pedicle screw constructs had a lower secondary surgery rate (5.8%) compared with hybrid and combined fusions (P<.05). The all hook, hybrid, anterior only, and combined fusions had secondary surgery rates of 13.0%, 18.5%, 10.0%, and 20.8%, respectively, which were not statistically different. When specifically comparing pedicle screw with hook constructs, there was a statistically lower pseudarthrosis rate (P=.03) favoring pedicle screw instrumentation. Patients undergoing instrumented fusion for AIS are at some risk for subsequent surgery. To lessen that risk, pedicle screw constructs should be considered, as they have shown an overall lower secondary surgery rate and in particular a lower rate of pseudarthrosis. [Orthopedics. 2019; 42(4):235-239.].