Total Hip Arthroplasty in Patients with Cerebral Palsy A Cohort Study Matched to Patients with Osteoarthritis Matthew T. Houdek, MD, Chad D. Watts, MD, Cody C.Wyles, MD, Robert T. Trousdale, MD, Todd A. Milbrandt, MD, and Michael J. Taunton, MD Investigation performed at the Department of Orthopedic Surgery, Mayo Medical School, Mayo Clinic, Rochester, Minnesota Background: The spasticity and increased muscle tone observed in patients with cerebral palsy can lead to hip de- generation, subluxation, and pain. Currently, there is hesitation to perform total hip arthroplasty in patients with cerebral palsy because of fears of early wear and dislocation. The purpose of this study was to review the outcomes of total hip arthroplasty in patients with cerebral palsy and to compare outcomes with those of matched patients with a diagnosis of osteoarthritis. Methods: Over a 24-year period, 39 patients undergoing a total hip arthroplasty with a diagnosis of cerebral palsy were identified. The cohort included 26 male patients (67%), and the mean patient age was 49 years. The mean follow-up was 7 years. Patients with cerebral palsy were matched 1:2 with a group of patients undergoing total hip arthroplasty for osteoarthritis. Results: There was no difference in the rate of reoperation, implant survival, or complications, specifically dislocation. Prior to the surgical procedure, all patients had severe or moderate pain, and postoperatively no patient had moderate or severe pain. Twenty-three patients had an improvement in their ability to independently walk, and all preoperative hip flexion contractures were corrected (n = 9). There was also a significant improvement (p < 0.0001) in functional Harris hip scores. Conclusions: This study refutes previous evidence showing increased risk of complications following total hip arthro- plasty in patients with cerebral palsy. Total hip arthroplasty is a durable treatment option and provides clinically important pain relief and functional improvement in patients with cerebral palsy. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. P atients with cerebral palsy often develop hip subluxation due to flexion and adduction contractures of the hip, coxa valga, and increased femoral anteversion 1-3 . Such deformity leads to symptomatic arthrosis, further limiting their ability to walk, stand, and sit 2,4 . Hip preservation procedures may have a role early on in the disease process, but once joint arthrosis occurs, additional treatment is required to optimize pain relief and function 5-12 . Total hip arthroplasty is considered one of the most successful procedures for the treatment of hip arthrosis. However, the reported use of total hip arthroplasty in patients with cerebral palsy is controversial because of concerns for dislocation, aseptic loosening, infection, and other complica- tions 6,9,11,13 . Recently, studies have shown good outcomes at long-term follow-up, with limited complications among pa- tients with cerebral palsy 8,12 . Although these series have shown a satisfactory outcome in the setting of cerebral palsy 8,12 , to our knowledge, there has been a paucity of data comparing the outcome of total hip arthroplasty in patients with cerebral palsy with that in patients with uncomplicated osteoarthritis. The purpose of this study was to compare revision, reoperation, and complication rates following primary total hip arthroplasty in patients with cerebral palsy with those in a matched cohort with uncomplicated osteoarthritis. Disclosure: No external sources of funding were used for this study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work ( http://links.lww.com/JBJS/A151). Peer Review: This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors. 488 COPYRIGHT Ó 2017 BY THE J OURNAL OF BONE AND J OINT SURGERY,I NCORPORATED J Bone Joint Surg Am. 2017;99:488-93 d http://dx.doi.org/10.2106/JBJS.16.00528