Reconstructive Surgery for Hip Dislocation in Patients with Cerebral Palsy: A Comparative Analysis With and Without Capsuloplasty

Background. Hip dislocation in spastic cerebral palsy (CP) is conventionally addressed through derotation varus femoral osteotomy combined with pelvic osteotomy, frequently supplemented by capsuloplasty. Whether routine capsuloplasty is warranted in all cases remains a subject of ongoing debate.Objective. To assess the non-inferiority of closed reduction without capsuloplasty compared with capsuloplasty, guided by a standardized intraoperative fluoroscopic reducibility test (center-edge angle threshold ≥20°), in children with spastic CP undergoing reconstructive hip surgery.Patients and Methods. A retrospective comparative cohort study (2019–2025) was conducted in accordance with the STROBE reporting guidelines. A total of 118 hips in 82 patients with spastic CP (diplegia 79%, tetraplegia 21%; mean age 8.4 years; GMFCS levels II–V) were included. When the intraoperative center-edge angle was ≥20°, closed reduction without capsulotomy was performed (Group I, n=76, 64%); when the angle was 20°, capsuloplasty was carried out (Group II, n=42, 36%). To address baseline imbalance, cohorts were matched 1:1 by Reimers migration percentage, CP subtype, and age (n=84 hips). Statistical analysis employed generalized estimating equations (GEE) with patient-level clustering. The primary outcome was radiographic stability (Reimers migration percentage 30%) at a minimum follow-up of two years, with a predefined non-inferiority margin of 15%.Results. Mean follow-up was 3.6 years (95% CI 3.3–3.9). Reimers migration percentage decreased from 70% to 8% (p0.001). Radiographic stability was achieved in 93% of hips in Group I and 88% in Group II; the between-group difference was 5.2% (95% CI −4.1% to +14.5%). As the upper confidence boundary did not exceed the predefined non-inferiority margin, non-inferiority of closed reduction without capsuloplasty was confirmed. Rates of avascular necrosis (8%) and redislocation (5%) did not differ significantly between groups. Operative time in Group I was significantly shorter by 45 minutes (p0.001). A preoperative Reimers migration percentage ≥75% predicted the need for capsuloplasty with an area under the ROC curve of 0.80 (95% CI 0.69–0.91).Conclusion. In a cohort predominantly comprising patients with diplegia (79%), the intraoperative fluoroscopic reducibility test enabled omission of capsuloplasty in 64% of cases, with non-inferior radiographic outcomes and a significantly reduced operative time.

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