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The impact of neurological impairment and tone on hip joint development

Sadettin Ciftci1, Luiz Carlos Almeida da Silva1, Jason J Howard1

  • 1Department of Orthopaedics, Nemours Children's Health, Wilmington, DE, USA.

Journal of Children'S Orthopaedics
|November 14, 2024
PubMed

Insights

Neuromuscular conditions like cerebral palsy and spinal muscular atrophy alter hip development in children. Force environments significantly impact hip geometry, highlighting the importance of motor function and muscle tone.

Area of Science:

  • Pediatric Orthopedics
  • Developmental Biology
  • Biomechanical Engineering

Background:

  • Cerebral palsy (CP) and spinal muscular atrophy (SMA) are neuromuscular conditions affecting motor function and muscle tone.
  • Altered force environments during skeletal development can lead to abnormal hip morphology.
  • Understanding these impacts is crucial for managing hip development in affected children.

Purpose of the Study:

  • To investigate how different neuromuscular force environments (hypertonic vs. hypotonic) influence proximal femoral and acetabular growth.
  • To compare hip geometry in children with CP and SMA to typically developing (TD) children.

Main Methods:

  • Retrospective case-control study including 184 children (58 CP, 32 SMA, 94 TD) aged 6 months to 11 years.
  • Pelvic radiographs were analyzed for hip geometry measures of the proximal femur and acetabulum.
  • General linear models were used to assess developmental patterns based on age and diagnosis.

Main Results:

  • Significant differences in proximal femoral development were observed between SMA and TD groups (e.g., neck length, epiphysis shape).
  • The ratio of acetabular width to proximal femoral epiphysis width differed significantly between TD and CP/SMA groups.
  • A negative correlation between hip migration and acetabular-epiphyseal width ratio was found in CP but not SMA.

Conclusions:

  • Hip geometry is significantly impacted by the force environment during childhood growth.
  • Gross motor function, muscle tone, and strength play critical roles in determining hip morphology.
  • These findings underscore the importance of considering neuromuscular status in pediatric hip development.
Abstract

Keywords:
Hip morphologycerebral palsyhypotoniaproximal femoral shapespasticityspinal muscular atrophy

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