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The impact of complementary and alternative medicine on hip development in children with cerebral palsy
Kate Willoughby1, Kim Jachno, Soon Ghee Ang
1Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Complementary and alternative medicine (CAM) did not prevent hip displacement progression in children with cerebral palsy. Most children required significant surgery despite CAM use, highlighting the need for evidence-based care.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Complementary and Alternative Medicine (CAM)
Background:
- Cerebral palsy (CP) frequently involves hip displacement, a condition often managed with surgery.
- Parents of children with CP may opt for CAM instead of recommended surgical interventions.
- The long-term impact of CAM on hip displacement in pediatric CP remains under-researched.
Purpose of the Study:
- To evaluate the efficacy of CAM in managing hip displacement in children with cerebral palsy.
- To assess the influence of CAM on long-term surgical needs and clinical outcomes.
- To compare outcomes in children using CAM versus those who underwent recommended surgery.
Main Methods:
- A cohort of 23 children with CP and hip displacement declined surgery for CAM.
- Follow-up averaged 10 years, assessing hip displacement progression (migration percentage) and surgical requirements.
- Outcomes were compared to a historical cohort of 46 children who received timely surgical intervention.
Main Results:
- Hip displacement progressed in all non-ambulant children (GMFCS IV-V) using CAM.
- Eight children required salvage surgery, and 11 needed late reconstructive surgery due to CAM use.
- CAM users had a higher likelihood of needing more complex surgery compared to the surgical group.
Conclusions:
- CAM therapy did not halt or reverse hip displacement progression in children with cerebral palsy.
- The majority of children pursuing CAM ultimately required significant reconstructive or salvage hip surgery.
- Evidence suggests CAM is not an effective substitute for recommended surgical management of hip displacement in pediatric CP.
Aim:
This study aimed to evaluate the effect of complementary and alternative medicine (CAM) approaches on long-term surgical requirements, and clinical and radiographic outcomes for children with cerebral palsy and hip displacement.
Method:
Twenty-three children with cerebral palsy and early hip displacement who were offered preventive hip surgery and whose parents declined in favour of CAM approaches were followed (13 males, 10 females; mean age 13 y 9 mo [SD 3 y 1 mo]; mean length of follow-up 10 y 2 mo [SD 2 y 11 mo]; 17 with spastic quadriplegia, two with spastic triplegia, and four with spastic diplegia; three with gross motor function classified at Gross Motor Function Classification System [GMFCS] level II, four at level III, six at level IV, and 10 at level V). Principal outcome measures were progression of hip displacement (measured by migration percentage: the percentage of the femoral head sitting outside of the acetabulum), eventual need for reconstructive or salvage surgery, and long-term hip morphology (classified by the Melbourne Cerebral Palsy Hip Classification Scale). The results were compared with a previously reported cohort of 46 children who had surgery when recommended (31 males, 15 females; mean age 13 y 11 mo [SD 1 y 6 mo]; mean length of follow-up 10 y 10 mo; 10 with diplegia and 36 with quadriplegia; three at GMFCS level II, 11 at level III, 20 at level IV, and 12 at level V).
Results:
Outcomes for 23 children who had pursued CAM were analysed (mean length of follow-up 10 y 2 mo). Hip displacement progressed in one or both hips in all non-ambulant children (GMFCS level IV or V). Of the 20 children with documented progressive hip displacement, eight developed pain and deformity requiring salvage surgery. An additional 11 children with progressive hip displacement had late reconstructive surgery when symptoms first started. There was strong evidence of a relationship between GMFCS and both progressive hip displacement (χ(2) =17.78; p=0.001) and final Melbourne Cerebral Palsy Hip Classification Scale grade (odds ratio 12.5; p=0.012; 95% confidence interval 1.7-90.4). There was also evidence of those children who pursued CAM requiring more complex surgery than the group who had surgery when recommended (odds ratio 2.5; p=0.002; 95% confidence interval 1.4-4.5).
Interpretation:
CAM therapy did not appear to influence the progression of hip displacement in children with cerebral palsy. Most children required major reconstructive surgery or salvage surgery despite pursuing CAM.
