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A Novel Method to Study Hip Growth and Development in Children with Cerebral Palsy
Luiz Carlos Almeida da Silva1, Yusuke Hori1, Burak Kaymaz1
1Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE 19803, USA.
Insights
This study used bisphosphonate bands in children with cerebral palsy (CP) to track hip development. Results show a 10% decrease in migration percentage, suggesting potential changes in hip stability.
Area of Science:
- Pediatric Orthopedics
- Developmental Biology
- Radiology
Background:
- Limited understanding of proximal femur and acetabulum growth in children.
- Growing interest in guided growth for hip dysplasia in neurological conditions.
- Bisphosphonate treatment in cerebral palsy (CP) creates unique growth markers.
Purpose of the Study:
- To develop a novel method for assessing hip development in children with CP.
- To analyze the impact of growth and maturation on hip development using bisphosphonate bands.
- To evaluate hip joint stability and acetabular dysplasia in CP patients.
Main Methods:
- Analysis of pelvic radiographs from children with CP (GMFCS IV/V) treated with bisphosphonates.
- Measurement of neck-shaft angle (NSA), head-shaft angle (HSA), and migration percentage (MP).
- Comparison of standard measurements with those derived from pamidronate bands (PamMP, PamNSA, PamHSA).
Main Results:
- Seven children (GMFCS IV/V) were analyzed (age 8-12 years).
- Migration percentage (MP) showed a significant decrease of 10.5% compared to pamidronate-based MP (PamMP) (p < 0.001).
- Neck-shaft angle (NSA) and head-shaft angle (HSA) did not differ significantly between standard and pamidronate-based measurements.
Conclusions:
- A novel method using bisphosphonate bands can assess hip development in children with CP.
- A 10% decrease in MP was observed in children with CP (GMFCS IV/V), potentially indicating normal development.
- Hip joint angles (HSA, NSA) remained unchanged, suggesting localized effects on acetabular ossification.
Background:
Knowledge of the relative contributions to different growth areas in the proximal femur and acetabulum is limited due to the complex anatomy and lack of growth markers in children. There is increasing interest in using guided growth to improve hip joint stability and decrease dysplasia in children with neurological disability. Some children with cerebral palsy (CP) are treated with bisphosphonates for bone insufficiency, which leaves a dense growth arrest band in the bone at the time of treatment. The aim of this study was to develop a novel approach to understand the growth and maturation impact on hip development in children with CP using this growth arrest band.
Methods:
Pelvic radiographs of children with CP Gross Motor Function Classification System (GMFCS) level IV/V treated with bisphosphonate were analyzed. We measured neck-shaft angle (NSA), head-shaft angle (HSA), and migration percentage (MP) based on pamidronate bands (PamMP), NSA based on pamidronate bands (PamNSA), and HSA based on pamidronate bands (PamHSA). These measurements were compared using t-test.
Results:
Seven children (two GMFCS IV and five GMFCS V) were included. The mean age of the radiographic assessment was 11.4 ± 1.3 (range, 8.6-12.5) years, mean MP 22 ± 7% (range, 13-39%), PamMP 33 ± 7% (range, 18-46%), NSA 151 ± 7° (range, 140-161°), PamNSA 153 ± 4° (range, 142-163°), HSA 164 ± 12° (range, 142-175°), and PamHSA 169 ± 8° (range, 154-175°). MP decreased by 10.5% compared with PamMP (p < 0.001). NSA compared with PamNSA (p = 0.117) and HSA compared with PamHSA (p = 0.325) were not statistically different.
Conclusions:
This novel assessment method demonstrates that ossification of the lateral acetabulum and femoral head in children with CP GMFCS IV/V from age 8 to 12 years undergoes a mean decrease of 10% MP. A decrease of 10% MP after proximal femoral-guided growth has been reported as a positive outcome. However, based on the current measurements, this may be due to normal development. HSA and NSA remained unchanged.
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