Hip displacement in children with post-neonatal cerebral palsy and acquired brain injury: a systematic review
Errolyn Boettcher-Hunt1,2, Roslyn N Boyd3, Noula Gibson1,2,4
1Department of Physiotherapy, Perth Children's Hospital, Perth, Western Australia, Australia.
Insights
Children with post-neonatal (PNN) brain injury, especially those who are non-ambulant with spastic quadriplegia, face a high risk of hip displacement. Early hip surveillance is recommended for these vulnerable children.
Area of Science:
- Pediatric Neurology
- Orthopedic Surgery
- Rehabilitation Medicine
Background:
- Hip displacement is a significant concern in children with post-neonatal (PNN) brain injury.
- Understanding risk factors and timing of onset is crucial for effective management and improved outcomes.
Approach:
- Systematic review of studies reporting prevalence and risk factors for hip displacement in children with PNN brain injury.
- Searched major databases (PubMed, MEDLINE, Embase, CINAHL, Web of Science) for relevant literature.
- Analyzed data from six cohort studies (n=408) focusing on patient characteristics and risk factors.
Key Points:
- Hip displacement prevalence varied widely (1% to 100%) across studies.
- Higher risk observed in non-ambulant children with diffuse brain injury and spastic quadriplegia, particularly at an early age.
- Hip displacement and dislocation were identified as early as 1 and 3 months post-injury, respectively.
Conclusions:
- Evidence regarding hip displacement in PNN brain injury is limited and of low quality.
- Non-ambulant children with diffuse PNN brain injury before age five are at the highest risk.
- Proactive and earlier hip surveillance protocols are recommended for at-risk pediatric populations.
Aim:
To systematically review the prevalence, risk factors and timing of onset of hip displacement in children with a post-neonatal (PNN) brain injury with regards to hip surveillance recommendations.
Method:
A search of PubMed, MEDLINE, Embase, CINAHL and Web of Science was conducted on 22nd February 2022. Studies were included if they reported presence of, and risk factors for, hip displacement in children with PNN brain injury. Data was extracted on patient characteristics, and analyzed in terms of risk factors of interest and timing of development of hip displacement.
Results:
Six studies met the inclusion criteria (n = 408 participants). All were cohort studies: five retrospective and one prospective. Rates of hip displacement ranged from 1% to 100%, and were higher in children with diffuse brain injury at an early age, who were non-ambulant and had spastic quadriplegia. Hip displacement and hip dislocation were first identified at one and three months respectively following PNN brain injury.
Interpretation:
Evidence on hip displacement in children with PNN brain injury is sparse and low quality. Children who remain non-ambulant after diffuse PNN brain injury before five years of age appear most at risk of developing progressive hip displacement and earlier hip surveillance is recommended.
