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Radiation Prophylaxis for Hip Salvage Surgery in Cerebral Palsy

Can We Reduce the Incidence of Heterotopic Ossification?

Davis, Eric, MD*; Williams, Kathryn, MS*; Matheney, Travis H., MD*; Snyder, Brian, MD PhD*; Marcus, Karen J., MD; Shore, Benjamin J., MD, MPH, FRCSC

Journal of Pediatric Orthopaedics: May/June 2019 - Volume 39 - Issue 5 - p e386–e391
doi: 10.1097/BPO.0000000000001314
Cerebral Palsy

Background: Heterotopic ossification (HO) is a well-recognized complication of proximal femoral resection (PFR) surgery in children with cerebral palsy (CP). Although single-dose radiation prophylaxis (SDRP) has been shown to be effective at lowering the rates of HO following adult total hip arthroplasty; there has been limited study examining the efficacy of SDRP for HO prevention in children with CP undergoing PFR. The purpose of this study was to assess the efficacy of SDRP in children with CP undergoing PFR.

Methods: This retrospective case control series identified all patients from one tertiary children's hospital undergoing PFHR. Patients were dichotomized into (1) SDRP and (2) non-SDRP groups. In SDRP, radiation was delivered preoperatively at a dose of 7.5 Gy utilizing a 6 MV photon beam. The incidence of HO in the SDRP cohort was compared to historic data using binomial testing. The size of HO lesions was compared using Wilcoxon signed-rank test. McCarthy, Brooker, and Anatomic Classifications of HO were compared using repeated measures logistic regression.

Results: Twenty-three patients (mean age, 15.5) and 35 hips (17 SDRP, 18 Non-SDRP) were included in the analysis. There were 17 females and 6 males in the cohort with the majority classified as GMFCS V, 21/23 (91%). HO was seen in 6 of the SDRP cohort (6/17, 35%) and 15 of the non-SDRP cohort (15/18, 83%) (P=0.015). The average size of HO at maturity was 282.7 mm2 in the SDRP cohort compared with 1221.5 mm2 in the Non-SDRP cohort (P=0.026). Radiation treatment was associated with a 938.9 mm2 decrease in HO size at maturity (P= 0.026). Multivariate repeated measures logistic regression analysis found that non-SDRP hips had 13 times higher odds of developing HO (P=0.015). There were no significant differences in infection rates between the 2 cohorts and there were no radiation-associated complications.

Conclusions: Short-term follow up demonstrates that SDRP is a safe and efficacious intervention in decreasing the incidence and size of HO in children with CP undergoing PFR.

Levels of Evidence: Level III—Case control cohort study.

Departments of *Orthopedic Surgery

Orthopaedic Surgery, Harvard Medical School, Boston Children’s Hospital, Boston, MA

Pediatric Radiation Oncology, Dana Farber/Boston Children’s Cancer and Blood Disorders Center, Brigham and Women’s Hospital, Boston, MA

The authors declare no conflicts of interest.

Reprints: Benjamin J. Shore, MD, MPH, FRCSC, Department of Orthopaedic Surgery, Boston Children’s Hospital/Harvard Medical School, Boston, MA 02115. E-mail:

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