Systematic Review of Total Hip Arthroplasty Outcomes in Cerebral Palsy Patients and a Comparative Analysis with Rheumatoid Arthritis

Christos Costa; Foteini Moniati; Michalis Chatzimatthaiou; Christos Papaioannou; Sapfo Athanasakopoulou; Marios Chatzimatthaiou

doi:10.1155/2023/8696116

Systematic Review of Total Hip Arthroplasty Outcomes in Cerebral Palsy Patients and a Comparative Analysis with Rheumatoid Arthritis

Adv Orthop. 2023 Dec 30:2023:8696116. doi: 10.1155/2023/8696116. eCollection 2023.

Authors

Christos Costa¹, Foteini Moniati², Michalis Chatzimatthaiou³, Christos Papaioannou⁴, Sapfo Athanasakopoulou⁵, Marios Chatzimatthaiou²

Affiliations

¹ Imperial Collage London, London, UK.
² Barts and the London School of Medicine and Dentistry-Queen Mary University of London, London, UK.
³ Barts Health NHS Trust, London, UK.
⁴ Chelsea and Westminster NHS Foundation Trust, London, UK.
⁵ North Middlesex NHS Trust, London, UK.

Abstract

Background: Total hip arthroplasty (THA) is considered a successful treatment option for patients with degenerative hip arthritis. However, in the setting of neuromuscular diseases, patients with cerebral palsy (CP) are considered high-risk due to instability, contractures, and altered muscle tone. The purpose of this systematic review is to analyse the data in the setting of THA in CP patients including indications, types of implants, revision rates, and patient-reported outcomes and compare these with those of a cohort requiring THA due to degenerative arthritis unrelated to neuromuscular disorders.

Methods: PubMed, Embase, and Cochrane Library were searched from inception until June 10, 2023, to identify the relevant studies for THA on CP patients. The methodological quality of the studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS).

Results: The initial search generated 190 studies out of which 21 met the inclusion criteria. The most frequently reported indication was painful hip dislocation or subluxation due to failure of prior nonoperative treatment. The most frequently reported complication was dislocation affecting overall 7.5% (0-28%) of all patients, while other complications included periprosthetic fractures and heterotrophic ossification. The survival rates of primary THAs ranged from 85% to 100% at 5 years and from 73% to 86% at 10 years. Patients with CP who undergo total hip arthroplasty experience a greater overall rate of complications compared to patients with rheumatoid arthritis (RA) that undergo the same procedure.

Conclusion: The current literature suggests that THA is a beneficial procedure for patients with CP through pain reduction and functional improvement. However, the increased rates of potential complications compared to the general population require careful consideration. We suggest that further investigations on the most appropriate time of procedure, implant type, and procedure are needed.

Publication types

Review