Validity and reliability of radiological methods to assess proximal hip geometry in children with cerebral palsy: a systematic review
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Published on: July 2, 2021
Christelle Pons1, Olivier Rémy-Néris, Béatrice Médée
1Physical Medicine and Rehabilitation Department, University Hospital of Brest, Brest.
Insights
Radiological methods for measuring hip geometry in children with cerebral palsy (CP) show good reliability. X-rays are reliable for hip migration and neck shaft angle, but more evidence is needed for femoral anteversion.
Area of Science:
- Pediatric Orthopedics
- Medical Imaging
- Biomechanical Analysis
Background:
- Cerebral palsy (CP) often involves hip joint abnormalities.
- Accurate measurement of proximal hip geometry is crucial for managing CP.
- Radiological methods are commonly used but require validation.
Purpose of the Study:
- To systematically review the validity and reliability of radiological measurements of proximal hip geometry in children with CP.
- To evaluate current metrological evidence for different imaging techniques.
Main Methods:
- Systematic literature search across multiple databases (MEDLINE, CINALH Plus, Embase, Web of Science, etc.).
- Inclusion/exclusion criteria applied to identify relevant studies.
- Assessment of reliability and validity of radiological measurements.
Main Results:
- X-ray migration percentage demonstrated excellent reliability and concurrent validity with 3D CT scans.
- Acetabular index (X-ray) showed good reliability but moderate validity with 3D CT.
- Neck shaft angle (X-ray) exhibited excellent reliability and concurrent validity with 3D CT.
- Femoral anteversion measurements had mixed evidence, with some CT studies showing good results, while others questioned CT ultrasound utility.
Conclusions:
- Most X-ray-based hip geometry measurements possess good to excellent metrological properties.
- Further research is required to establish robust metrological evidence for femoral anteversion assessment.
- MRI and ultrasound show promise but currently have limited supporting metrological data.
Aim:
The aim of this systematic review was to assess the current validity and reliability of radiological methods used to measure proximal hip geometry in children with cerebral palsy.
Method:
A search was conducted using relevant keywords and inclusion/exclusion criteria of the MEDLINE, CINALH Plus, Embase, Web of Science, Academic Search Premier, The Cochrane Library, and PsychINFO databases.
Results:
The migration percentage using X-rays showed excellent reliability and concurrent validity with three-dimensional (3D) measurements from computed tomography (CT) scans. The acetabular index, measured using X-rays had good reliability but moderate concurrent validity with 3D CT measurements; 3D CT scan indexes had greater reliability. The measurement of the neck shaft angle using X-rays showed excellent concurrent validity with measurements from 3D CT scans and excellent reliability. Regarding femoral anteversion, one study found an excellent correlation between two-dimensional CT and clinical assessment and excellent reliability. Two others showed less evidence for the use of CT ultrasounds.
Interpretation:
Most of the X-ray-based measurements showed good to excellent metrological properties. More metrological evidence is needed for the assessment of femoral anteversion. Magnetic resonance imaging and ultrasound-based measurements have great potential although very little metrological evidence is available.
