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The natural history of hip development in cerebral palsy
1Department of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway. terje.terjesen@rikshospitalet.no
Insights
Hip displacement is common in children with cerebral palsy (CP), especially those with severe motor impairments. Early radiographic surveillance from age 1-2 years is crucial for timely intervention and improved outcomes.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Radiology
Background:
- Cerebral palsy (CP) affects motor function and can lead to hip displacement.
- Hip surveillance programs aim to monitor and manage this complication.
- Understanding the natural history of hip displacement in CP is essential for effective management.
Purpose of the Study:
- To evaluate a population-based radiographic hip surveillance program for children with CP.
- To assess the natural history of hip displacement in this population.
Main Methods:
- A cohort of 335 children with CP (born 2002-2006) in Norway were studied.
- Radiographic parameters including Migration Percentage (MP) were measured.
- Children were classified by CP type and Gross Motor Function Classification System (GMFCS) levels.
Main Results:
- Hip displacement (MP>33%) was observed in 26% of all children, and 63% in GMFCS levels IV-V.
- Dislocation occurred in 14 children, with a mean age of 4 years 5 months.
- Progression of hip displacement increased significantly with lower GMFCS levels.
Conclusions:
- Nonambulant children with CP show a high risk of hip displacement.
- Early surveillance (ages 1-2 years) is vital for identifying optimal timing for surgical intervention.
- Current hip surveillance protocols require enhancement to prevent dislocation in nonambulant children.
Aim:
The purpose of this study was to evaluate a population-based radiographic hip surveillance programme for children with cerebral palsy (CP) and to assess the natural history of hip displacement.
Method:
The study comprised 335 children (188 males, 147 females), born during 2002 to 2006 in the 10 south-eastern counties in Norway. Their mean age at the first radiograph was 3 years (range 6mo-7y 11mo) and the mean age at the most recent follow-up was 5 years 5 months. Distribution according to CP type was spastic hemiplegia in 38%, diplegia in 27%, quadriplegia in 21%, dyskinesia in 10%, and ataxia in 3%; Gross Motor Function Classification System (GMFCS) levels I to V were, 44%, 14%, 8%, 11%, and 23% respectively. Migration percentage (MP), acetabular index, and pelvic obliquity were measured on the radiographs.
Results:
Hip displacement (MP>33%) occurred in 26% of all children (subluxation in 22% and dislocation in 4%) and in 63% of those in GMFCS levels IV or V. Dislocation occurred in 14 children at a mean age of 4 years 5 months (range 1y 10mo-9y 7mo). The mean migration percentage was 20.4% at the initial radiographs and 34.0% at the last follow-up. Mean progression in migration percentage increased markedly with decreasing functional level, from 0.2% per year at GMFCS level I to 9.5% at level V.
Interpretation:
There is a pronounced trend towards hip displacement in nonambulant children. Close surveillance from age 1 to 2 years is needed to find the appropriate time for preventive surgery. Since 12% of the nonambulant children developed dislocation, our routines for hip surveillance need improvement.
