Journal of Pediatric Orthopaedics - 2026-09-16 - Journal Article
Concomitant Open Reduction Does Not Improve Outcomes in Patients Undergoing Osseous Reconstruction for Severe Hip Dysplasia Secondary to Cerebral Palsy: A Radiographic and Clinical Comparative Analysis.
Dopke K, Campbell R, Talathi N, Bomar JD, Elias A, Thompson RM
Topics
Key Takeaway
Adding open reduction to VDRO plus pelvic osteotomy for CP hip dysplasia (preoperative MP ≥60%) increased 90-day medical complications (47% vs. 22%) and secondary surgery rates (17% vs. 1%) without improving final migration percentage (21% vs. 15%, P=0.187).
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Summary
This two-institution retrospective study compared osseous hip reconstruction (VDRO ± pelvic osteotomy) with versus without open reduction in CP patients with preoperative MP ≥60%. The open reduction group had significantly higher preoperative MP (86% vs. 77%), longer operative time (432 vs. 362 min), greater blood loss (259 vs. 193 mL), higher 90-day medical complication rates (47% vs. 22%), and higher secondary surgery rates (17% vs. 1%). Final MP and proportion of hips with residual MP ≥40% were statistically equivalent between groups.
Key Limitation
The open reduction group had significantly higher baseline MP (86% vs. 77%), meaning the two cohorts are not truly comparable in severity, and the absence of long-term follow-up data prevents assessment of whether radiographic equivalence persists or diverges over time.
Original Abstract
BACKGROUND
Varus derotational osteotomy (VDRO) is frequently combined with pelvic osteotomy and open reduction to treat severe hip subluxation in children with cerebral palsy (CP). The purpose of this study was to compare outcomes of osseous hip reconstruction with and without open reduction in children with CP treated for severe hip subluxation or dislocation.
METHODS
This was a retrospective review of patients with CP and severe subluxation/dislocation [preoperative migration percentage (MP) ≥60%], who underwent VDRO with or without open reduction at 2 academic institutions between 2017 and 2023. Demographics, Gross Motor Function Classification System (GMFCS) level, key comorbidities, radiographic measurements, operative characteristics, and complications were collected. Statistical methods included descriptive analyses, the Mann-Whitney U test, a generalized linear mixed model, the Pearson χ2, and the Fisher exact test, with significance set at P<0.05.
RESULTS
A total of 108 hips (88 patients) were included; 30 underwent open reduction (group A), and 78 did not (group B). Mean age at surgery (8.9 vs. 7.5 y, P=0.17) and GMFCS distribution (P=0.29) were similar. Group A had increased preoperative MP (86% vs. 77%, P=0.004), rate of overall comorbidity burden (100% vs. 79%, P=0.01), operative time (431.9 vs. 362.1 min, P<0.001), estimated blood loss (258.5 vs. 192.6 mL, P=0.03), rate of 90-day medical complications (47% vs. 22%, P=0.01), and rate of secondary surgery (17% vs. 1%, P=0.01) compared with group B. The number of pelvic osteotomies (1.1 vs. 1.3, P=0.23), rate of bilateral procedures (93% vs. 94%, P=1.0), rate of surgical complications (20% vs. 6%, P=0.07), final mean MP (21% vs. 15%, P=0.187), and the proportion of hips with a final MP ≥40% (14% vs. 9%, P=0.48) were comparable between groups.
CONCLUSIONS
In patients with CP and severe hip subluxation, the addition of an open reduction is associated with longer operative time, increased blood loss, and higher complication/revision rates without demonstrable improvement in radiographic outcomes. These findings do not support the routine inclusion of open reduction as part of osseous hip reconstruction for severe CP-associated hip dysplasia.
LEVEL OF EVIDENCE
Level III.