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Patterns of hip migration in non-ambulant children with cerebral palsy: A prospective cohort study
Isabelle Poirot1, Valérie Laudy2, Muriel Rabilloud3
1Service de médecine physique et réadaptation pédiatrique, hospices civils de Lyon, 69677 Bron, France.
Insights
Hip migration in children with cerebral palsy (CP) is often stable, with a low prevalence requiring surgery. Most children with CP experience minimal changes in hip migration over time.
Area of Science:
- Pediatric Orthopedics
- Cerebral Palsy Research
- Hip Development
Background:
- Limited data exists on hip migration (HM) onset, causes, progression, and prevention in children with cerebral palsy (CP).
- Understanding these factors is crucial for managing hip displacement and avoiding surgical interventions.
Purpose of the Study:
- To determine the prevalence of hip migration percentage (HMP) >40% in non-ambulant children with CP.
- To model changes in HMP over a mean follow-up of 2.6 years.
Main Methods:
- An observational, prospective, multicenter cohort study included 235 non-ambulant children (3-10 years) with CP (GMFCS levels IV-V).
- Yearly HMP measurements using the Reimers index were recorded.
- Trajectory modeling analyzed HMP changes, including children with baseline HMP ≤40%.
Main Results:
- The prevalence of at least one hip with HMP >40% was 24.3%.
- Pelvic obliquity was more common in asymmetric HMP.
- Trajectory modeling revealed three patterns of HMP change; a 'stable' trajectory applied to most hips (67.4% right, 79.3% left).
Conclusions:
- The prevalence of hip migration requiring surgery in non-ambulant children with CP is low.
- The majority of hips in this population demonstrate stable migration patterns over time.
Background:
In children with cerebral palsy (CP), we have little information on when hip migration (HM) starts, what causes hip displacement, how HM changes over time, and how to halt this migration to avoid surgery.
Objectives:
We aimed to estimate the prevalence of HM percentage (HMP)>40% in a homogeneous population of non-ambulant children with CP and model the changes in HMP over a 2.6-year mean follow-up.
Methods:
From September 2009 to September 2015, this observational, prospective, multicenter cohort study recruited 235 children from 51 centers who were 3 to 10 years old and had levels IV and V of the Gross Motor Function Classification System for CP. The outcomes were yearly HMP measurements by the Reimers index. Only children with at least one hip with HMP≤40% at baseline were included in trajectory modeling. Comparisons of chidren's characteristics between trajectory groups were adjusted by the false discovery rate method.
Results:
The prevalence of children with at least one hip with HMP>40% was estimated at 24.3% (95% confidence interval 18.6-30.0). Pelvic obliquity was observed in 51.4% and 24.4% of children with asymmetric and symmetric HMP (P=0.002). The trajectory modelling identified 3 types of MP changes over time. Many children (67.4% and 79.3% for the right and left hip) could be assigned to the "stable" trajectory group.
Conclusions:
In non-ambulant children with CP, the prevalence of HM requiring surgery is low and most hips remain practically stable over time.
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