Total Hip Arthroplasty in Patients with Cerebral Palsy: A Matched Comparison of 90-Day Adverse Events and 5-Year Implant Survival

Background

People with cerebral palsy (CP) may be considered for total hip arthroplasty (THA). However, short- and long-term outcomes after THA in this population remain poorly characterized.

Methods

Data from patients undergoing THA were abstracted from the 2010-2018 PearlDiver Mariner administrative database. Those with CP were matched to those without CP based on demographic and comorbid factors (1:4 matching). Ninety-day incidence of postoperative complications and hospital readmission were identified and compared. Five-year implant survival (based on need for revision) was also assessed and compared.

Perioperative adverse events were the compared using multivariate logistic regression to adjust for any potential residual differences in demographic and comorbid factors after matching. Implant survival over time was compared with Kaplan Meier plots with a log-rank test. Significance was set at p<0.05 for all comparisons.

Results

In total, 864 patients with CP were matched to 3,448 patients without CP. After adjusting for differences in demographics and comorbidities, multivariate analyses demonstrated patients with CP had higher odds of UTI (Odds Ratio [OR]=2.42, p=0.007), pneumonia (OR=3.77, p=0.001) and periprosthetic fracture (OR=2.55, p=0.001). Rates of the other studied adverse events, including readmissions, were not significantly different between groups.

At five years, 94.2% of the CP cohort and 95.2% of the non-CP cohort THAs remained unrevised, respectively (no difference by log rank, p=0.195).

Conclusion

Compared to patients without CP, patients with CP undergoing THA were found to have higher odds of perioperative UTI, pneumonia and periprosthetic fracture but not other perioperative complications or difference in five-year implant survival.

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