Bernese Periacetabular Osteotomy in Patients with Hip Dysplasia Secondary to Cerebral Palsy and Developmental Dysplasia of the Hips

Author(s): Si Heng Sharon Tan*, James Hoipo Hui and Andrew Kean Seng Lim

Purpose: The current study aims to evaluate the outcomes of the Bernese periacetabular osteotomy when performed for children and adolescents with hip dysplasia secondary to cerebral palsy. The secondary aim of the study was to compare the outcomes of the Bernese periacetabular osteotomy when performed for hip dysplasia secondary to cerebral palsy as opposed to developmental dysplasia of the hips.

Methods: In the prospective case-control study, all patients under the age of 21 years who underwent the Bernese periacetabular osteotomy for hip dysplasia secondary to cerebral palsy or developmental dysplasia of the hips were included.

Results: Statistically significant improvements were noted for the acetabular index (p = 0.040), lateral central edge angle (p = 0.001), migration index (p < 0.001), extrusion index (p = 0.001) and Shenton line (p = 0.002) post-operatively as compared to pre-operatively. These improvements were similarly noted when subgroup analyses were performed for the patients with hip dysplasia secondary to cerebral palsy versus secondary to developmental dysplasia of the hips. Amongst the patients with hip dysplasia secondary to cerebral palsy, there was also improvement, if not maintenance, of the GMFCS levels in all patients postoperatively. All patients who were GMFCS level V also identified that there was less difficulty with perineal care post-operatively. All patients also reported pain relief post-operatively. When comparing between patients with hip dysplasia secondary to cerebral palsy versus patients with hip dysplasia secondary to developmental dysplasia of the hips, there were no statistically significant differences in the post-operative outcomes or change in pre-operative versus post-operative outcomes.

Conclusions: The Bernese periacetabular osteotomy is a viable surgical option for children and adolescents with closed triradiate cartilage and hip dysplasia. This applies to both patients with hip dysplasia secondary to cerebral palsy and hip dysplasia secondary to developmental dysplasia of the hips.