Hip function in adults with severe cerebral palsy.

Area of Science:

• Orthopedics
• Neurology
• Rehabilitation Medicine

Background:

• Prevalence of hip pain in severe cerebral palsy (CP) varies.
• Uncertainty exists regarding surgical intervention for progressive hip subluxation in immature CP patients.
• This study investigates the association between hip displacement, osteoarthritis, pain, and function in adults with severe CP.

Purpose of the Study:

• To determine if spastic hip displacement (subluxation or dislocation) or osteoarthritis correlates with hip pain or diminished function in severely affected adults with CP.
• To inform clinical decision-making regarding hip treatment in this population.

Main Methods:

• Retrospective analysis of 77 adults with severe CP.
• Data collection included medical history, function, pain, analgesic use, range of motion, spasticity, and pressure ulcers.
• Radiographic evaluation for osteoarthritis and hip displacement, with statistical analysis to identify associations.

Main Results:

• 15% of hips were dislocated, 12% subluxated, and 23% showed osteoarthritis.
• Hip pain was present in 18% of hips; 45% were not painful.
• Increased spasticity correlated with higher rates of osteoarthritis, dislocation, pain, and pressure ulcers. Hip displacement was linked to osteoarthritis but not pain.

Conclusions:

• Neither hip displacement nor osteoarthritis was associated with hip pain or diminished function in this cohort.
• Low prevalence of hip pain and its lack of association with radiographic findings suggest treatment should focus on symptoms.
• Surgical hip treatment in severe CP should be guided by pain and contractures, not solely by radiographic signs of displacement or osteoarthritis.