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Late Hip Displacement Identified in Children at Gross Motor Function Classification System II and III With Asymmetric
Stacey Miller1, Lise Leveille, Maria Juricic
1From BC Children's Hospital (Ms. Miller and Ms. Juricic); Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada (Ms. Miller and Ms. Juricic); the Department of Orthopaedic Surgery, BC Children's Hospital (Dr. Leveille and Dr. Mulpuri); and the Department of Orthopaedics, University of British Columbia (Dr. Leveille and Dr. Mulpuri).
Insights
Children with cerebral palsy (CP) face hip displacement risks tied to motor function. This study highlights potential gaps in current surveillance for asymmetric CP, suggesting a need for guideline review.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Hip displacement is a known risk in children with cerebral palsy (CP).
- Risk is typically associated with Gross Motor Function Classification System (GMFCS) levels and younger age.
- Asymmetric diplegia presents unique challenges in hip surveillance.
Purpose of the Study:
- To report on a series of children with asymmetric diplegic CP experiencing late-onset hip displacement.
- To evaluate the adequacy of current hip surveillance guidelines for this specific CP subgroup.
- To advocate for further research into hip displacement incidence in asymmetric diplegia.
Main Methods:
- Case series presentation of four children with asymmetric diplegic CP.
- Analysis of hip displacement progression in relation to GMFCS levels (II and III).
- Review of current hip surveillance protocols in the context of pelvic obliquity.
Main Results:
- Four children with asymmetric diplegic CP (GMFCS II-III) demonstrated rapid, progressive hip displacement at a later age than typically expected.
- Existing hip surveillance guidelines may not effectively detect displacement in this population, especially with pelvic obliquity.
- The GMFCS level alone may underestimate the risk of hip displacement in asymmetric diplegia.
Conclusions:
- Current hip surveillance guidelines may require modification for children with asymmetric diplegic CP.
- Further investigation is needed to determine the true incidence of hip displacement in this specific subgroup.
- Early and accurate identification of hip displacement is crucial for managing CP-related orthopedic complications.
Abstract:
Risk of hip displacement in children with cerebral palsy is directly related to a child's level of motor function as classified by the Gross Motor Function Classification System (GMFCS) and is reported to be greatest at a young age. In this study, we present a series of four children with asymmetric diplegic cerebral palsy at GMFCS levels II and III, with the more involved hip showing rapid, progressive displacement at a later age. Current hip surveillance guidelines may not adequately identify hip displacement in children with asymmetric diplegia and pelvic obliquity; modifications to surveillance guidelines may be warranted. Additional investigation of hip displacement in this subset of children is required to determine whether the incidence of displacement is higher than anticipated based on the GMFCS level alone.
