Published online Apr 18, 2020. doi: 10.5312/wjo.v11.i4.222
Peer-review started: December 10, 2019
First decision: February 20, 2020
Revised: February 21, 2020
Accepted: March 12, 2020
Article in press: March 12, 2020
Published online: April 18, 2020
Little is known about the frequency of different types of orthopedic surgery in children with cerebral palsy (CP), particularly in Latin America.
The aim of this retrospective cohort study was to analyze the frequency, anatomic location, and type of orthopedic surgical procedures in relation to age and gross motor function classification (GMFCS) in children with CP in a public university hospital providing care to children of lower socioeconomic status.
We hypothesized that the frequency of surgical procedures per child would increase with higher GMFCS level. Information from this study may help to predict future orthopedic surgical interventions based on the GMFCS level and age and can be useful as a basis for comparison for future studies.
This retrospective study included all children with CP (n = 245) treated with elective orthopedic surgery at a Uruguayan university hospital between October 2010 and May 2016 identified from a surgical database. Demographics, GMFCS, and orthopedic surgeries were obtained from the medical records of 227 children.
This study examined surgical procedures among children with CP, with a total of 711 surgical procedures performed between 1998 and 2016. On average, children had 3.1 surgical procedures and no differences existed regarding age at first surgery. The most common procedures were: lower leg soft tissue surgery, hip tenotomy, and hamstring tenotomy. For children with GMFCS level I the mean number of surgeries per child differed significantly with children with GMFCS levels II, III, IV and V. Within II, III, IV, and V there was not a significantly significant difference of mean number of surgeries per child when comparing across the groups. The proportion of soft tissue surgery vs bone surgery was significantly higher in GMFCS levels I-III, compared to levels IV and V. This study provides a rich description of orthopedic procedures performed in children with CP. However, we do not know the prevalence of surgery in all patients with CP.
This is to our knowledge the first study to describe the frequency of different orthopedic surgical procedures in children with CP in relation to GMFCS level and age group. Our hypothesis that the frequency of surgical procedures per child would increase with higher GMFCS level could not be confirmed with our data, as the frequency of surgical procedures per child did not increase with higher GMFCS level after level I. This result could partly be explained by the indication and goal of the surgery in an ambulatory child which is to improve gait, compared to the goal of surgery in a non-ambulatory child where the goal is often related to pain relief, greater comfort with positioning, improved basic care, correction of severe foot deformities, prevention of hip dislocation, and/or to halt scoliosis progression. Additionally, the benefit of surgery in non-ambulatory children needs to be judged against the increased risk of major complications due to the presence of comorbidities. There is also an increased risk of complications from surgery.
Few studies describe the panorama of different surgical procedures used in an entire population of children with CP or investigate differences in orthopedic surgical treatment between different CP-subtypes.