Palliative hip surgery in nonambulatory children with cerebral palsy: outcomes of two surgical techniques

This study evaluates the clinical, radiographic, and caregiver-reported outcomes of two palliative hip surgery (PHS) techniques - Egermann resection and Girdlestone resection - in nonambulatory children with cerebral palsy. A retrospective cohort of 30 Gross Motor Function Classification System (GMFCS) V children (41 hips) who underwent PHS between 2014 and 2025 at two tertiary referral centers was reviewed. Proximal femoral migration (PFM) was assessed on anteroposterior pelvic radiographs obtained immediately after surgery, at 6-12 months, and at final follow-up. Clinical outcomes were evaluated using the caregiver-reported Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL-Child), and pain using a visual analog scale. Postoperative complications were recorded and classified according to the Clavien-Dindo-Sink (CDS) system. Both surgical techniques were associated with satisfactory pain relief and caregiver-reported quality of life. At final follow-up, PFM did not reach a statistically significant difference between the two groups (3 ± 20 mm vs 14 ± 18 mm; P > 0.05). Technique 2 was associated with fewer painful heterotopic ossifications requiring surgical revision. The overall complication rate was 32% of hips (13/41), with CDS III complications requiring reintervention in 12% of hips (5/41). Caregiver-reported CP QOL-Child scores were comparable between groups. PHS provides effective pain relief and satisfactory caregiver-reported quality of life in GMFCS V children. Both techniques represent viable palliative options, with distinct profiles of PFM and soft tissue-related complications. Surgical decision-making should be individualized according to patient anatomy and anticipated functional needs.