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Published on: January 11, 2016
Characteristics of children with hip displacement in cerebral palsy
Gunnar Hägglund1, Henrik Lauge-Pedersen, Philippe Wagner
1Department of Orthopaedics, Lund University Hospital, S-221 85 Lund, Sweden. gunnar.hagglund@med.lu.se
Insights
Hip displacement in children with cerebral palsy (CP) is common, with risk varying by CP subtype and motor function. Early radiographic screening using the Gross Motor Function Classification System (GMFCS) is crucial for timely intervention.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Hip dislocation is a frequent and severe complication in children with cerebral palsy (CP).
- Early screening and preventive treatment can mitigate hip displacement in at-risk children.
- Optimizing hip surveillance programs requires understanding the characteristics of children with CP who develop hip displacement.
Purpose of the Study:
- To analyze the characteristics of children with CP who develop hip displacement.
- To identify risk factors associated with hip displacement in pediatric CP.
- To inform the optimization of hip surveillance programs for children with CP.
Main Methods:
- A standardized clinical and radiological follow-up of hips was conducted in a total population of children with CP.
- The study included 212 children with CP, monitored until 9-16 years of age.
- Risk factors analyzed included CP subtype and Gross Motor Function Classification System (GMFCS) level.
Main Results:
- 18% of children developed hip displacement (Migration Percentage >40%), with an additional 9% showing significant displacement (MP 33-39%).
- Mean age of hip displacement diagnosis was 4 years, but some cases presented by age 2.
- Risk of displacement varied significantly by CP subtype (0-79%) and GMFCS level (0-64% for GMFCS V).
Conclusions:
- Hip displacement in CP can occur as early as 2-3 years of age.
- Passive range of hip motion is an unreliable indicator for identifying hips at risk.
- A hip surveillance program incorporating age and GMFCS level for radiographic examinations is recommended for children with CP.
Background:
Hip dislocation in children with cerebral palsy (CP) is a common and severe problem. The dislocation can be avoided, by screening and preventive treatment of children with hips at risk. The aim of this study was to analyse the characteristics of children with CP who develop hip displacement, in order to optimise a hip surveillance programme.
Methods:
In a total population of children with CP a standardised clinical and radiological follow-up of the hips was carried out as a part of a hip prevention programme. The present study is based on 212 children followed until 9-16 years of age.
Results:
Of the 212 children, 38 (18%) developed displacement with Migration Percentage (MP) >40% and further 19 (9%) MP between 33 and 39%. Mean age at first registration of hip displacement was 4 years, but some hips showed MP > 40% already at two years of age. The passive range of hip motion at the time of first registration of hip displacement did not differ significantly from the findings in hips without displacement. The risk of hip displacement varied according to CP-subtype, from 0% in children with pure ataxia to 79% in children with spastic tetraplegia. The risk of displacement (MP > 40%) was directly related to the level of gross motor function, classified according to the gross motor function classification system, GMFCS, from 0% in children in GMFCS level I to 64% in GMFCS level V.
Conclusion:
Hip displacement in CP often occurs already at 2-3 years of age. Range of motion is a poor indicator of hips at risk. Thus early identification and early radiographic examination of children at risk is of great importance. The risk of hip displacement varies according to both CP-subtype and GMFCS. It is sometimes not possible to determine subtype before 4 years of age, and at present several definitions and classification systems are used. GMFCS is valid and reliable from 2 years of age, and it is internationally accepted. We recommend a hip surveillance programme for children with CP with radiographic examinations based on the child's age and GMFCS level.