Minimally Invasive Pelvic Periacetabular Osteotomy in Ambulatory Children with Cerebral Palsy: A Long Tern Retrospective Study

Abstract Hip displacement is a common and debilitating complication in children with cerebral palsy (CP), particularly those classified as GMFCS levels II and III. Traditional reconstructive surgeries, while effective, are associated with higher morbidity. Minimally invasive surgical (MIS) techniques offer a promising alternative for managing hip subluxation and dislocation in this population. Methods: This retrospective study evaluated 20 children (mean age: 9.4 years) with CP (GMFCS levels II and III) who underwent minimally invasive pelvic and femoral osteotomies between 2010 and 2020. Radiographic parameters, including migration percentage (MP), acetabular index (AI), and neck-shaft angle (NSA), were assessed preoperatively and postoperatively. Functional outcomes were measured using the CPCHILD questionnaire. The mean follow-up duration was 6.5 years. Results: Surgical intervention significantly improved radiographic outcomes: mean MP decreased from 59% to 14%, AI from 38.5° to 19°, and NSA from 153° to 128% (all p < 0.001). All patients retained preoperative ambulatory status and reported significant improvements in CPCHILD scores (p < 0.001). Complications were minimal, with no infections or non-unions. Only one patient required reoperation due to a postoperative fracture. Conclusions: Minimally invasive pelvic and femoral osteotomies effectively restore hip stability, improve quality of life, and minimize surgical morbidity in ambulatory children with CP. This approach offers a viable alternative to traditional methods, with favorable clinical and radiographic outcomes. Keywords: Cerebral palsy; Hip dislocation; Minimally invasive surgery