Three-Year Outcomes Following Hip Reconstruction in Cerebral Palsy: A Population-Based Analysis.

BACKGROUND: Pelvic reconstruction is commonly performed to manage hip displacement in patients with cerebral palsy (CP), yet population-based outcome data remain limited. Most existing studies are from single centers and have limited generalizability. Here, we present a national descriptive study outlining outcomes of hip reconstruction in patients with CP. METHODS: A retrospective cohort study was conducted using the TriNetX Research Network, a federated database of 163 million patients across 117 US healthcare organizations. Patients aged 1 to 25 years with CP who underwent hip reconstruction between 2015 and 2022 were included. Outcomes assessed included hardware removal, hip dislocation, infection, and mortality, which were analyzed using the Kaplan-Meier method from 6 months to 3 years postoperatively. RESULTS: Among 1037 patients, 3-year cumulative incidence was 38.6% (95% CI: 35.6-41.7) for hardware removal, 38.5% (95% CI: 35.5-41.6) for hip dislocation, 3.6% (95% CI: 2.5-5.3) for infection, and 2.6% (95% CI: 1.8-3.9) for mortality. Temporal analysis revealed that hip dislocation occurred early, with 61% of events in year 1, whereas hardware removal was late-predominant, with 70% of events in years 2 to 3. Notably, 83% of infections presented after the first postoperative year (0.60% at 1 y vs. 3.6% at 3 y). CONCLUSIONS: This large-scale, population-based analysis of hip reconstruction outcomes in CP demonstrates high rates of hardware removal and hip dislocation, and that 83% of hardware-associated infections present after the first postoperative year. These findings suggest that long-term hip surveillance may be warranted after reconstruction. Prospective studies are needed to validate these findings and inform targeted prevention strategies. LEVEL OF EVIDENCE: Level III.