Analysis of orthopedic surgical procedures in children with cerebral palsy

Table 1 Demographic features, cerebral palsy classification, and Gross Motor Function Classification System

Variable	Value
Mean age at first surgery, yr (range)	8.1 (2-19)
Mean age at end of study period, yr (range)	12.5 (4-27)
Female, n (%)	105 (46)
Cerebral Palsy subtype, n (%)
Bilateral spactic	180 (80)
Unilateral spactic	38 (17)
Dyskinetic	5 (2)
Ataxic	1 (0)
Non classifiable	3 (1)
GMFCS level, n (%)
I	33 (14)
II	51 (22)
III	40 (18)
IV	52 (23)
V	51 (23)

GMFCS: Gross Motor Function Classification System.

Table 2 Surgical Features of 227 children with cerebral palsy

Variable	Value
Total number of surgeries	711
Mean number of surgeries per patient (range) by GMFCS
I	1.8 (1-9)
II	3.2 (1-12)
III	3.2 (1-8)
IV	3.3 (1-13)
V	3.6 (1-11)
Total number of visits to the surgical theater	413
Mean number of visits to the surgical theater per patient (range)1	1.8 (1-10)
Mean number of visits to the surgical theater per patient (range) by GMFCS
I	1.4 (1-5)
II	1.9 (1-6)
III	1.7 (1-4)
IV	1.8 (1-7)
V	2.1 (1-10)
Number of single event multilevel surgeries2 (% of all visits to the surgical theater)	140 (34%)
Number of hip salvage procedures (% of patients)	4 (1.7%)
Number of deep infections (% of all surgeries not including revisions for infections)	2 (0.3%)

¹A patient may have more than one surgery during one visit to the surgical theater;

²Defined as two or more soft tissue or bony surgical procedures at two or more anatomical levels during one operative procedure. Pelvic osteotomies with proximal femur osteotomy and hip tenotomy were not classified as a single event multi-level surgery. GMFCS: Gross Motor Function Classification System.

Table 3 Number of orthopedic surgeries between 1998 and 2016 and average age and range at surgery in 227 children with cerebral palsy, stratified by Gross Motor Function Classification System

Type of surgery	Gross Motor Function Classification System										Total
	I		II		III		IV		V
	n (%)	Years (range)	n (%)	Years (range)	n (%)	Years (range)	n (%)	Years (range)	n (%)	Years (range)	n (%)	Years (range)
Spine	0	NA	1 (1)	10 (10-10)	1 (1)	14 (14-14)	3 (2)	11 (11-11)	5 (3)	13 (11-15)	9 (1)	13 (10-15)
Upper extremi-ty	1 (2)	10 (10-10)	0	NA	1 (1)	10 (10-10)	1 (1)	12 (12-12)	0	NA	3 (0)	11 (10-12)
Pelvic osteo-tomy1	2 (3)	13 (12-12)	1 (1)	13 (13-13)	2 (2)	7 (6-8)	7 (4)	8 (5-13)	21 (12)	7 (3-16)	33 (5)	8 (3-16)
Proxi-mal femur osteo-tomy	4 (7)	12 (7-15)	15 (9)	10 (5-15)	14 (11)	11 (5-16)	22 (13)	11 (3-20)	42 (23)	8 (1-23)	98 (14)	10 (1-23)
Hip teno-tomy	4 (7)	7 (4-8)	22 (13)	7 (0-14)	31 (24)	8 (4-15)	32 (19)	8 (3-15)	46 (24)	7 (1-16)	135 (19)	8 (0-16)
Distal femur osteo-tomy	0	NA	6 (4)	15 (14-18)	7 (5)	13 (12-15)	18 (11)	14 (10-20)	5 (3)	15 (12-18)	36 (5)	15 (10-20)
Surgery for Patella alta	0	NA	5 (3)	16 (13-18)	2 (1)	13 (13-13)	2 (1)	12 (10-15)	0	NA	9 (1)	15 (10-18)
Hamstr-ing tenoto-my	2 (3)	11 (7-15)	22 (13)	8 (0-15)	24 (19)	7 (5-15)	33 (19)	8 (4-15)	21 (12)	8 (2-16)	102 (14)	8 (0-16)
Osteo-tomy lower leg	0	NA	2 (1)	10 (10-11)	1 (1)	19 (19-19)	1 (1)	10 (10-10)	0	NA	4 (1)	13 (10-19)
Soft tissue lower leg	41 (67)	8 (4-15)	65 (39)	8 (0-16)	38 (30)	8 (0-17)	32 (19)	9 (4-16)	14 (8)	7 (3-12)	189 (27)	8 (0 -17)
Foot	5 (8)	10 (7-13)	13 (8)	13 (9-17)	3 (2)	13 (12-14)	11 (7)	13 (9-16)	8 (4)	11 (2-18)	40 (6)	12 (2-18)
Other2	2 (3)	6 (0-13)	13 (8)	14 (7-19)	6 (5)	13 (5-21)	10 (6)	13 (8-18)	22 (12)	10 (2-18)	53 (8)	12 (0-21)
Total	61	9 (0-15)	165	10 (0-19)	130	9 (3-21)	172	10 (3-20)	183	8 (1-23)	711	9 (0-23)

¹Associated proximal femur osteotomies are counted separately;

²Implant removal, reoperations due of wound infections, correction of casts. NA: Not applicable.