Preoperative radiologic predictors of successful soft tissue release surgery for hip subluxation among cerebral palsy patients: A STROBE compliant study

Paralytic hip subluxation is a common problem in children with cerebral palsy. Although surgical procedures such as soft tissue release and osteotomy have been advocated for its prevention, the exact indications of such procedures remain unclear. We attempted to evaluate preoperative radiographic parameters and identify prognostic factors in children with cerebral palsy. We retrospectively investigated 43 hips in 27 children with cerebral palsy who had undergone soft tissue release surgery for hip subluxation. We evaluated the age at the time of surgery and the radiographic parameters such as the center-edge angle (CEA), the migration percentage (MP), and the acetabular index (AI) at 3 time points: preoperation, 1 year after surgery, and at final follow-up. The outcome measure was determined by the MP value at final follow-up. Student t test was used to compare the quantitative variables between 2 groups (good vs poor outcome). Then the multiple regression analysis was applied to determine the prognostic factors upon soft tissue release surgery. Children with good outcome exhibited higher CEA (average value of −1.43° vs −13.2° in those with poor outcome), lower MP (53.9% vs 71.3%), and lower AI (28.1° vs 35.3°). Upon multiple regression analysis, we found that the age at the time of surgery, preoperative CEA, and preoperative MP did not appear to be independent prognostic factors. The only independent factor that affected prognosis after soft tissue release surgery was the preoperative AI. The preoperative AI values <34° were associated with the good outcome with specificity of 87% and sensitivity of 60% according to the receiver operating characteristic curve analysis. These findings indicate that the outcome of soft tissue release surgery can be predicted by the preoperative AI value.