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Risk Factors for Hip Displacement in Children With Cerebral Palsy: Systematic Review
Blazej Pruszczynski1, Julieanne Sees, Freeman Miller
1*Department of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland †Department of Orthopedics, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE.
Insights
Early screening for hip displacement in children with cerebral palsy (CP) using radiographs is crucial. This systematic review defines risk factors and proposes surveillance criteria to prevent dislocation and improve outcomes.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Early identification of hip displacement in children with cerebral palsy (CP) is vital for successful treatment.
- Radiographs measuring the migration index (MI) are the standard diagnostic tool.
- Understanding the natural history and risk factors of hip dislocation in CP is essential for developing effective screening protocols.
Purpose of the Study:
- To systematically review the natural history of hip dislocation in children with CP.
- To identify risk factors associated with hip displacement.
- To establish screening criteria for early recognition and intervention.
Main Methods:
- Systematic review of 10 studies involving children under 18 with CP.
- Inclusion criteria: sample size >20, no prior hip surgery or dislocation, minimum 2-year follow-up, recorded MI, pattern, and Gross Motor Function Classification System (GMFCS) level.
- Level III evidence.
Main Results:
- Proposed screening for GMFCS I and II: annual radiographs (ages 2-8) if MI > 30%, then biannually until age 18.
- Recommended screening for GMFCS III-V: annual radiographs (ages 2-8) if MI < 30%, or biannually if MI > 30%, then biannually until age 18.
- GMFCS level significantly impacts subluxation risk, which persists throughout skeletal growth.
Conclusions:
- Implementing a practical surveillance program for children with CP can prevent hip dislocation.
- Early treatment of hip dislocations leads to better outcomes compared to neglected cases.
- GMFCS level is a critical factor in predicting subluxation risk in children with CP.
Background:
When hip displacement in children with cerebral palsy (CP) is identified early, treatment is more successful. The standard test is a radiograph of the pelvis measuring the migration index (MI). Our study aims to review published literature of the natural history of hip dislocation among children with CP and to define related risk factors to develop screening criteria for early recognition.
Methods:
The review included 10 studies with sample sizes greater than 20 children with CP below18 years who had hips with no surgical intervention or dislocation at initial presentation, minimum 2-year follow-up, and recorded MI, pattern, and Gross Motor Function Classification System (GMFCS) level.
Results:
On the basis of this review, we suggest screening with 1 radiograph for GMFCS I and II, or, if MI>30%, an annual radiograph between ages 2 and 8 years, followed by a radiograph every 2 years until the age of 18 years. For GMFCS III, IV, and V, we recommend an annual radiograph if MI<30% or 1 every 6 months if MI>30% between ages 2 and 8 years, followed by radiograph every 2 years until the age of 18 years.
Conclusions:
Applying a practical surveillance program for children with CP can prevent hip dislocation, provide early treatment, and ultimately lead to consistently better outcomes than those of neglected hip dislocations. The GMFCS level has a strong impact on subluxation risk and that the risk continues to the end of growth.
Level Of Evidence:
Level III-systematic review.
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