CHIP-IN

Rationale:

In children with cerebral palsy (CP), secondary changes occur in bones and joints. This can have serious consequences, such as pain, problems with care and reduced quality of life. The disturbed muscle balance often causes a gradual migration of the femoral head out of the socket, which can lead to a painfully dislocated hip without intervention; a difficult problem to treat in this very vulnerable patient group. It is known that intervention at an early stage is useful in order to keep the hip well in the socket. In early hip migration, an isolated soft tissue procedure (adductors/psoas tenotomy)
is often the first procedure that can be performed at a young age. Unfortunately, this is unsuccessful for some of the children. Major operations are then required (femoral and pelvic osteotomies), which have a high treatment burden and have a high risk of sometimes lifethreatening
complications. The literature regarding the results of isolated soft tissue procedures for the prevention of hip migration in cerebral palsy patients is very heterogeneous. Reported success rates range between 23 and 85%. This wide spread is partly determined by differences in population,
definitions of outcome measures and organization of care for CP patients. The results of these studies can therefore not be translated 1-on-1 to the Dutch situation. In addition, a large proportion of the papers report on patients treated at the end of the 20th century or just after the turn of the century. Since this period, non-operative care for children, especially regarding tone regulation, has improved considerably. The potential positive
influence of improved tone regulation on the outcome of soft tissue surgery to prevent hip migration is unknown.
To better determine the position of this treatment in the current Dutch situation, it is essential to know what the results are within the Dutch context of CP care. At the moment there is insufficient knowledge available for optimal indication, patient/parent information and planning of future scientific research. The aim of this study is therefore to gain more insight into the results regarding progression of hip migration and need for secondary surgery after isolated soft tissue procedures in children with CP in the Netherlands.
 

Objective:
 

The aim of this study is to gain more insight into the results regarding progression of hip migration and need for secondary surgery after an isolated soft tissue procedure (adductor and/or psoas tenotomy) in children with cerebral palsy in the Netherlands. Secondary study goal is to analyse factors that influence the success rate of the surgical intervention, and based on this analysis develop a prediction model to help guide future decision-making
regarding surgery to prevent hip migration in the treatment of cerebral palsy patients. 

Study design: 

Retrospective cohort study.