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Heterotopic Ossification Following Hip Osteotomies in Cerebral Palsy: Incidence and Risk Factors

Inan, Muharrem*,†; Chan, Gilbert*; Dabney, Kirk; Miller, Freeman

Journal of Pediatric Orthopaedics: July-August 2006 - Volume 26 - Issue 4 - p 551-556
doi: 10.1097/
Cerebral Palsy: Original Article

Abstract: The aims of this study are, first, to determine the incidence of heterotopic ossification (HO) in patients with cerebral palsy (CP) who have undergone pelvic and/or proximal femoral osteotomies and, second, to identify any risk factors that may contribute to its development in this patient population. The radiographs of 219 consecutive patients with CP who underwent proximal femoral osteotomies with or without pelvic osteotomies were reviewed. Risk factors including gender, age, and degree of involvement, ambulatory status, previous hip operations, bilateral hip surgery, capsular release, concomitant pelvic osteotomy, infection, and history of exuberant callus were evaluated. Thirty-five (16%) patients were diagnosed with HO and the 5 factors that cause HO were identified, which are degree of involvement (quadriplegic), ambulatory status, capsular release, infection, and previous hip operations. Based on logistic regression analysis, if a patient had quadriplegic type of CP, then they have 17.5 times more risk for HO than a patient with hemiplegic type, and capsular release increases the risk 237 times. Although HO occurred in 16% of patients treated with bony procedures in the hip, in a small group (2%) of children it had a clinically significant limitation requiring surgical resection. In this study, clear risk factors were presented for the development of HO; however, none of these risk factors can be altered in ways that will reduce the risk for HO. These risk factors might be used to define a high-risk group in whom attempts at prophylactic treatment for prevention of HO could be initiated.

From the *Department of Orthopaedics, Alfred I. duPont Hospital for Children, Wilmington, DE; the †Orthopaedics and Traumatology Center, Malatya, Turkey; and the ‡Department of Orthopaedics, Alfred I. duPont Hospital for Children, Wilmington, DE.

Investigation performed at the Department of Orthopedics, Alfred I. duPont Hospital for Children Wilmington, DE.

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Reprints: Freeman Miller, MD, Alfred I. duPont Hospital for Children, 1600 Rockland Road, P.O. Box 269, Wilmington, DE 19899 (E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.