Comparison of Growth Modulation of Proximal Femur Physis in Cerebral Palsy and Developmental Dysplasia of Hip: A Systematic Review and Meta-analysis.

BACKGROUND: Proximal femoral deformities are a common encounter in pediatric orthopedic practice. Of these, coxa valga in cerebral palsy (CP) and caput valgum in developmental dysplasia of the hip (DDH) are progressive deformities that impair hip function and may lead to early osteoarthritis. Growth modulation offers a minimally invasive alternative to traditional osteotomy. This review compares outcomes of growth modulation in CP and DDH populations for proximal femoral deformities. METHODS: A systematic review and meta-analysis were conducted in accordance with the PRISMA 2020 guidelines. Twelve studies involving 332 hips (269 CP, 63 DDH) met the inclusion criteria. Radiographic outcomes and complications were analyzed, with subgroup comparisons between CP and DDH. RESULTS: Growth modulation significantly improved radiological parameters in both groups, including head-shaft angle (HSA), Hilgenreiner epiphyseal angle (HEA), neck-shaft angle (NSA), and acetabular index (AI). Greater correction was noted in the CP group, particularly for HEA (MD = - 16.66 vs - 9.12 in DDH, P < 0.05). Migration percentage improved significantly in CP, suggesting enhanced hip stability. In DDH, while articulotrochanteric distance (ATD) and Sharp's angle improved significantly (P < 0.05), there was nonsignificant improvement in CE angle. Screw backout and reoperation occurred in approximately one-third of cases, with no significant difference between groups. CONCLUSIONS: Proximal femoral growth modulation is an effective and less invasive alternative to osteotomy for managing coxa valga in CP and caput valgum in DDH, with better radiological correction seen in CP. Despite similar complication rates, outcomes are influenced by age at surgery and underlying pathology.