Effect of Hip Reconstructive Surgery on Health-Related Quality of Life of Non-Ambulatory Children with Cerebral Palsy

Background: The primary aim of this study was to evaluate the relationship of the migration percentage (a radiographic metric quantifying hip displacement) in children with Gross Motor Function Classification System (GMFCS) level-IV or V cerebral palsy and spastic hip dysplasia to the acetabular index and the health-related quality of life (HRQOL) as measured with the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) before and after reconstructive hip surgery. Methods: In a prospective cohort study (n = 38), the migration percentage, acetabular index, and CPCHILD scores were analyzed using the Pearson correlation analysis immediately before reconstructive hip surgery and at 6 weeks and 3, 6, 12, and 24 months after the surgery. Subgroup analysis was used to compare patients who had a preoperative migration percentage of >= 50% with those who had a preoperative migration percentage of <50% and to compare the acetabular index between patients who had a pelvic osteotomy and those who had not. Linear mixed models were used to analyze changes in the migration percentage, acetabular index, and CPCHILD scores over time. Results: The preoperative migration percentage negatively correlated with the preoperative CPCHILD score (r = -0.50; p = 0.002). This relationship continued throughout the follow-up period such that, for each additional 1% correction in migration percentage, the CPCHILD total score increased by 0.2 point (p < 0.001). There was no correlation between the acetabular index and CPCHILD total score before or after surgery (p = 0.09 to 0.71). The preoperative CPCHILD total scores differed between the migration-percentile groups (mean difference = 13 points; 95% confidence interval = 3.3 to 22.8; p = 0.01). However, after hip surgery, the CPCHILD score improved similarly for both groups. Conclusions: These data support the effectiveness of reconstructive hip surgery for the treatment of spastic hip dysplasia to improve the HRQOL of non-ambulatory children with severe cerebral palsy.