Clinical and functional outcomes of the McHale procedure in palliative treatment of hip dislocation in patients with cerebral palsy

Introduction Chronic painful hip dislocation in patients with cerebral palsy (CP) is a severe orthopedic complication of the condition that occurs in 70–90 % of patients classified at GMFCS levels IV–V. Pain management, normalization of postural alignment, and the facilitation of hygiene care determine the daily burden faced by the families of non-ambulatory children.The objective was to evaluate changes in the quality of life of CP patients following the McHale procedure with angular stable plate fixation, to identify clinical factors influencing treatment outcomes, and characterize postoperative complications using the CPCHILD scale. Materials and Methods A retrospective cohort study (STROBE) was produced for 24 patients (35 joints) who underwent the McHale procedure and LCP fixation between 2019 and 2025. The mean age at surgery was 15.4 ± 3.4 years, and the mean follow-up period was 40.6 ± 15.7 months. The primary outcome was the total CPCHILD score at 24 months. Results The CPCHILD score increased from (40.8 ± 9.8) to (57.8 ± 13.1) points (Δ = 17.0; 95 % CI 13.4–20.6; p < 0.001), exceeding the minimal clinically important difference by a factor of 1.4–1.7. Pain relief was achieved in 85.7 % of joints at 12 months. More significant advancements were observed in the hygiene (+26.5 points) and comfort (+22.6 points) domains. Older age and GMFCS level V were associated with less favorable outcomes. Serious complications were observed in 14.3 % of cases. Discussion Grading outcomes based on GMFCS levels establishes realistic expectations for the family: GMFCS level IV patients can develop the ability to stand with assistance with 35–40° of painless hip abduction achieved (passive verticalization), and GMFCS level V patients’ benefit can be limited to improvements in caregiving; parents must be informed of this distinction during preoperative counseling. Conclusion The McHale procedure provides sustained improvement in quality of life of severe CP cases through palliative treatment of hip dislocation. Early referral for the intervention—prior to the progression of scoliosis and decompensation of neurogenic osteoporosis—can optimize the outcome.

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