Orthopedic surgical procedures in 3,305 children and young adults with cerebral palsy: a register-based cohort study

BACKGROUND AND PURPOSE: Few reports have described the panorama of orthopedic surgeries that children with cerebral palsy (CP) undergo. We analyzed the risk of a first surgery, and describe the frequency of orthopedic surgeries in terms of age, sex, anatomical location, and Gross Motor Function Classification System (GMFCS) level in children and young adults with CP. PATIENTS AND METHODS: This was a register-based cohort study of 3,305 individuals followed until 2–25 years of age. We used data from 2 national Swedish registers: the CPUP CP surveillance program and the Swedish National Patient Register. Kaplan–Meier survival curves were calculated to describe the risk of undergoing a first orthopedic surgery, related to age. RESULTS: We included data for 3,311 orthopedic operations in 1,717 surgical sessions. The percentage of children operated on before age 15 years increased from 22% (95% CI 19–26) for GMFCS level I to 70% (CI 64–75) for level V. Ankle and foot surgery was predominant as first surgery for GMFCS I–II, and hip and femur surgery for GMFCS IV–V. Spinal surgery occurred almost exclusively for GMFCS IV–V. Descriptive data showed repeated surgical sessions to be frequent for higher GMFCS levels. INTERPRETATION: The risk of having a first orthopedic surgical treatment increased with increasing GMFCS level and was initiated at younger age in children with higher GMFCS level.