Article

This study was undertaken to determine the need for concurrent prophylactic
femoral varization osteotomy (FVO) of contralateral stable hips at the time of
hip reconstructive surgery on unstable hips in non-ambulant individuals with
cerebral palsy (Gross Motor Function Classification System levels IV and V).
METHOD: A decision analysis model was constructed that included (1) the
probability of unstable hips during observation of the contralateral stable hips,
(2) unstable hip rate (subluxation or dislocation rate) after prophylactic FVO or
after delayed reconstructive surgery (including FVO) for unstable hips, and (3)
complication rates after concurrent prophylactic FVO or after hip reconstructive
surgery. The final outcome score was based on pain utility measures. The
probabilities of all cases and the utility score were obtained by literature
review. RESULTS: The decision model favoured concurrent prophylactic FVO for the
contralateral stable hips over observation (pain utility measure scores 0.814 vs
0.781). In a one-way sensitivity analysis, the decision model favoured concurrent
prophylactic FVO when the unstable hip rate of contralateral stable hips during
observation was 27% or over. Concurrent prophylactic surgery also demonstrated
higher utility scores than observation when the unstable hip rate after FVO was
between 0% and 29%. INTERPRETATION: The decision analysis model demonstrated that
concurrent prophylactic FVO for a contralateral stable hip in individuals with
cerebral palsy undergoing hip reconstructive surgery was beneficial from a
medical perspective, which was based on current evidence.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2012 Mac Keith
Press.

Langue : ANGLAIS