Variability in Postoperative Immobilization and Rehabilitation Following Reconstructive Hip Surgery in Nonambulatory Children With Cerebral Palsy

Stacey D Miller; Maria Juricic; Nandy Fajardo; Judy So; Benjamin J Shore; Unni G Narayanan; Kishore Mulpuri

doi:10.1097/BPO.0000000000001850

Variability in Postoperative Immobilization and Rehabilitation Following Reconstructive Hip Surgery in Nonambulatory Children With Cerebral Palsy

J Pediatr Orthop. 2021 Aug 1;41(7):e563-e569. doi: 10.1097/BPO.0000000000001850.

Authors

Stacey D Miller^{1

2}, Maria Juricic^{1

2}, Nandy Fajardo¹, Judy So³, Benjamin J Shore⁴, Unni G Narayanan^{5

6}, Kishore Mulpuri^{3

7}

Affiliations

¹ BC Children's Hospital.
² Departments of Physical Therapy.
³ Department of Orthopaedic Surgery, BC Children's Hospital.
⁴ Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
⁵ Division of Orthopaedic Surgery & Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto.
⁶ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.
⁷ Orthopaedics, University of British Columbia, Vancouver, BC.

Abstract

Background: Despite being a common procedure, there are no standard protocols for postoperative immobilization and rehabilitation following reconstructive hip surgery in children with cerebral palsy (CP). The purpose of this study was to investigate variability in postoperative management and physical therapy (PT) recommendations among orthopaedic surgeons treating hip displacement in children with CP.

Methods: An invitation to participate in an anonymous, online survey was sent to 44 pediatric orthopaedic surgeons. The case of a child undergoing bilateral femoral varus derotation osteotomies and adductor tenotomies was presented. Surgeons were asked to consider their typical practice and the case scenario when answering questions related to immobilization, weight-bearing, and rehabilitation. Recommendations with increasingly complex surgical interventions and different age or level of motor function were also assessed.

Results: Twenty-eight orthopaedic surgeons from 9 countries with a mean 21.3 years (range: 5 to 40 y) of experience completed the survey. Postoperative immobilization was recommended by 86% (24/28) of respondents with 7 different methods of immobilization identified. All but 1 (23/24) reported immobilizing full time. Most (20/23) reported using immobilization for 4 to 6 weeks. Return to weight-bearing varied from 0 to 6 weeks for partial weight-bearing and 0 to 12 weeks for full weight-bearing. PT in the first 1 to 2 weeks postoperatively was reported as unnecessary by 29% (8/28) of surgeons. PT for range of motion, strengthening, and return to function was recommended by 96% (27/28) of surgeons, starting at a mean of 2.6 weeks postoperatively (range: 0 to 16 wk). Only 48% (13/27) reported all of their patients would receive PT for these goals in their practice setting. Inpatient rehabilitation was available for 75% (21/28) but most surgeons (17/21) reported this was accessed by 20% or fewer of their patients.

Conclusions: Postoperative immobilization and PT recommendations were highly variable among surgeons. This variability may influence surgical outcomes and complication rates and should be considered when evaluating procedures. Further study into the impact of postoperative immobilization and rehabilitation is warranted.

Trial registration: ClinicalTrials.gov NCT01987882.

Associated data

ClinicalTrials.gov/NCT01987882