Article

This review presents an overview of the effectiveness of preventive and
corrective surgical interventions to treat hip displacement in patients with
severe cerebral palsy (CP).
A systematic literature search was applied to
identify studies concerning surgical procedures in hip(sub)luxations in severe CP
(GMFCS IV and V). A qualitative analysis and a best evidence synthesis were
performed for soft tissue surgery and osteotomies. RESULTS: The literature search
identified 15 studies, all of which were observational. Five studies involved
soft tissue surgery and 10 involved osteotomies. Only one study involving soft
tissue surgery was of sufficient quality. Nine of the 10 studies involving
osteotomies were of sufficient quality, including a total of 189 patients. The
mean MP (migration percentage) at follow-up ranged from 6 to 29%. No relationship
could be established between the effect of the surgical procedure and the
patients' age or the duration of follow-up. The percentage of patients reporting
pain decreased from 81% preoperatively to 5% at follow-up. Twenty-five percent
had complications such as osteoarthritis, ulcers or fractures. CONCLUSIONS: There
is insufficient evidence for the effectiveness of soft tissue surgery to
stabilize the hip, due to insufficient quality of the retrospective observational
studies. This review shows indicative findings (provided by consistent,
statistically significant findings on outcome and/or process measures in at least
two Observational Studies with sufficient quality) for an effect of bony surgery
in stabilizing the hip. Timing of the procedure remains an issue. Multicenter
trials could shed further light on this complicated subject.

Langue : ANGLAIS