Spastic Hips in Cerebral Palsy - Retrospective Study of Salvage with the McHale Procedure

Helder Henzo Yamada; Dante Galvanese Amato Neto; Juliano Mangini Dias Malpaga; Patricia Maria de Moraes Barros Fucs

doi:10.1055/s-0040-1713391

Spastic Hips in Cerebral Palsy - Retrospective Study of Salvage with the McHale Procedure

Rev Bras Ortop (Sao Paulo). 2021 Apr;56(2):244-250. doi: 10.1055/s-0040-1713391. Epub 2020 Sep 22.

Authors

Helder Henzo Yamada¹, Dante Galvanese Amato Neto¹, Juliano Mangini Dias Malpaga¹, Patricia Maria de Moraes Barros Fucs¹

Affiliation

¹ Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil.

Abstract

Objective To perform a retrospective and cross-sectional assessment to determine the pain and positional improvement of all patients with spastic cerebral palsy (CP) and severe hip deformity who underwent a McHale procedure in our center. A second objective was to analyze the potential complications from the procedure. Methods All consecutive patients treated between 1995 and 2017 were analyzed. Clinically, the patients should present pain on hip mobilization, difficulty in positioning for sitting and hygiene care, and medical records with complete data; functionally was assessed through the Gross Motor Function Classification System (GMFCS). In the preoperative radiographs, we analyzed the migration percentage (MP), the type of deformity according to the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS), and the type of deformity of the femoral head. After the surgery, we assessed the proximal migration of the proximal femoral fragment, implant changes and/or failure, and potential heterotopic ossification. The outcomes were reported as successful (D1) in patients presenting remission of pain, painless mobility, and improved positioning, or unsuccessful (D2) in those presenting procedural failure that required a new surgery. Results In total, 47 patients (53 hips) were treated. Functionally, 43 patients were classified as GMFCS V (91%), 3 as GMFCS IV patients (6%), and 1 as GMFCS III (2%). The mean age was 13 years and 2 months. The follow-up ranged from 1 year to 15 years and 4 months, with an average of 4 years and 8 months. A total of 36 patients (41 hips) presented successful (D1) outcomes after the McHale procedure, corresponding to 77% of our cases, whereas 11 (23%) cases had unsuccessful (D2) outcomes. Conclusion The McHale procedure is a treatment option for GMFCS IV and V, but we must be aware of the potential complications.

Keywords: cerebral palsy; hip/deformities; hip/surgery.

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