Total hip arthroplasty in paediatric patients with cerebral palsy: mid- to long-term outcomes of a retrospective cohort

Introduction: Total hip arthroplasty (THA) is commonly performed in adults with excellent outcomes. Its use in the paediatric population remains rare due to concerns regarding potential damage to the growth plate, pelvic biomechanical changes during growth, leg-length discrepancies, and implant longevity. Although modern prostheses have an estimated lifespan of approximately 30 years, durability remains a major concern in young patients. However, in selected cases, particularly in spastic patients suffering from chronic painful hip dislocation, medical options may be exhausted, and conservative surgical procedures may no longer be effective. The aim of this study was to evaluate the mid- to long-term outcomes of paediatric patients with cerebral palsy who underwent THA. Methods: This retrospective single-centre study included 22 paediatric patients with cerebral palsy who underwent THA. Clinical outcomes were analysed according to patient characteristics and prosthetic factors. The primary outcome was chronic pain relief, defined as absence of pain at the last follow-up. Secondary outcomes included postoperative complications and rehospitalisation within 90 days of surgery. Results: The mean age at surgery was 15.6 years. The mean follow-up duration was 11.1 ± 3.7 years. Preoperative chronic pain was present in all patients except 1, who was non-communicative; in this case, the surgical indication was based on radiographic evidence of hip dislocation. The overall complication rate was 22% ( n = 5), including 2 dislocations, 1 trochanteric nonunion, 1 intraoperative distal femoral fracture requiring plate fixation, and 1 femoral component loosening at 10-year follow-up. No postoperative infections were observed. Rehospitalisation within 3 months occurred in 13.6% of patients ( n = 3). Discussion: THA in paediatric patients with cerebral palsy appears to provide substantial pain relief with acceptable complication rates. Mid- to long-term outcomes are encouraging in this challenging population.