Natural History of Spastic Hip Disease

Hip displacement in children with cerebral palsy is common and related to a child's gross motor function. Progressive lateral hip displacement can result in severe pain, impaired function and quality of life. The purpose of this paper is to review the literature to identify the natural history of untreated spastic hip displacement in children with cerebral palsy.

A search of the literature was carried out using PubMed to identify papers describing the natural history of spastic hip displacement in children with cerebral palsy. Population-based studies, large retrospective cohort series, and randomized trials were included when available; expert opinion and case series were excluded.

A total of 79 articles were reviewed. Articles were then subdivided into 4 main categories: epidemiology, pathophysiology, outcome, and prevention. The prevalence of hip displacement as defined as a migration percentage >30% was found to be 33% in pooled population-based studies. The risk of hip displacement was found to be linked to a child's gross motor function. Hip surveillance programs have been shown to be sustainable and capable of preventing hip dislocation. The majority of children with hip dislocation do develop pain, decreased function, and impaired health-related quality of life (HRQOL).

Children with cerebral palsy are at risk of progressive lateral hip displacement proportional to their gross motor function. Untreated progressive lateral hip displacement has been shown to negatively impact a child's HRQOL and hip surveillance can decrease the incidence of hip dislocation.