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Hip subluxation and dislocation in cerebral palsy - a prospective study on the effectiveness of postural management
Teresa E Pountney1, Anne Mandy, Elizabeth Green
1Chailey Heritage Clinical Services, North Chailey, East Sussex BN8 4JN, UK. Pountney@southdowns.nhs.uk
Insights
Early postural management for children with cerebral palsy significantly reduces hip problems and the need for surgical treatment by age five. This intervention offers a less invasive approach to managing hip subluxation and dislocation.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Hip subluxation and dislocation are common in children with bilateral cerebral palsy.
- Current management often involves surgical interventions.
Purpose of the Study:
- To evaluate the effectiveness of early postural management programs.
- To assess the impact on hip subluxation/dislocation at five years.
- To compare treatment needs with a historical control group.
Main Methods:
- Prospective cohort study of 39 children using postural management equipment before 18 months.
- Hip migration percentage measured via X-ray at 30 and 60 months.
- Comparison with a historical control group.
Main Results:
- Children using equipment at recommended/moderate levels had significantly fewer hip subluxations.
- The intervention group showed significantly fewer hip problems compared to controls at five years.
- Fewer children in the intervention group required treatments like surgery or orthotics.
Conclusions:
- Early provision of postural management equipment is effective.
- This approach reduces hip problems and the need for treatment in children with cerebral palsy.
- Postural management offers a viable non-surgical strategy.
Background And Purpose:
Hip subluxation and dislocation are common sequelae in children with bilateral cerebral palsy and are currently managed by surgical interventions. This study aimed to investigate the effectiveness of early postural management programmes on hip subluxation and dislocation at five years, and the need for treatment in children with bilateral cerebral palsy, and to compare these findings with a historical control group.
Methods:
A prospective cohort study followed 39 children who commenced using postural management equipment under 18 months of age. Levels of ability, type and amount of equipment use and treatments were recorded every three months. At 30 and 60 months, the hips were X-rayed and the hip migration percentage was measured. The results were compared with the historical control group.
Results:
Children who used equipment at recommended and moderate levels had significantly less chance of both hips being subluxed than those using equipment at minimal levels (two-tailed Fisher's exact chi(2) p = 0.024). The frequency of children with hip problems was significantly less in the intervention group in comparison to the historical control group at five years (chi(2) = 11.53, df = 2, p = 0.006). The frequency of children receiving bilateral or unilateral treatments, i.e. surgery, use of a hip and spinal orthosis and/or botulinum toxin injections, in the intervention group was significantly less compared to the historical control group (two-tailed Fisher's exact p = 0.001).
Conclusion:
The early provision of postural management equipment has a role to play in reducing the number of hip problems and therefore the need for treatment of hip subluxation/dislocation in cerebral palsy at five years of age.
