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The approach to hip instability in children with cerebral palsy: an umbrella review
Ana Paula Tedesco1, Alessandro Melanda2, Davi Moshe3
1Instituto de Neuro-Ortopedia, Caxias do Sul, RS, Brazil.
Insights
Hip surveillance effectively reduces hip dislocation in children with cerebral palsy (CP). However, other interventions like tone management show limited preventive effects, and surgical outcomes vary significantly, indicating areas for improved clinical care.
Area of Science:
- Pediatric Orthopedics
- Rehabilitation Medicine
- Evidence Synthesis
Background:
- Children with cerebral palsy (CP) face a high risk of progressive hip displacement, impacting quality of life.
- Effective hip care is crucial for managing this condition in pediatric CP populations.
Purpose of the Study:
- To conduct an umbrella review of systematic reviews on the evaluation, prevention, and treatment of hip displacement in children with CP.
- To synthesize current evidence and identify knowledge gaps in hip management for pediatric CP.
Main Methods:
- Systematic search of nine databases for English-language systematic reviews published between 2004 and 2024.
- Inclusion of studies on children with CP aged 0-18 years.
- Methodological quality assessment using AMSTAR 2 and JBI criteria; PROSPERO registration (CRD42024618645).
Main Results:
- Hip surveillance demonstrated efficacy in reducing hip dislocation rates and the need for salvage surgery.
- Combined pelvic and femoral osteotomies yielded better results than isolated procedures; soft-tissue surgeries had high recurrence rates.
- Salvage procedures like valgus osteotomy relieved pain, while total hip arthroplasty improved function but had high complication rates.
Conclusions:
- Evidence-based practices for hip instability in CP were identified.
- Significant knowledge gaps in current hip management strategies for children with CP were highlighted.
- Findings support the need for future research and enhanced clinical care protocols.
Purpose:
Children with cerebral palsy (CP) are at a high risk of progressive hip displacement, defined as lateral migration of the femoral head measured by the Reimers migration percentage. This condition may impair quality of life, highlighting the need for improved hip care. This umbrella review assessed current evidence on the evaluation, prevention, and treatment of hip displacement in children with CP by synthesizing systematic reviews.
Methods:
Systematic reviews published in English between 2004 and 2024 were included, focusing on children with CP aged 0-18 years. Searches were conducted in nine databases: PubMed, MEDLINE, Web of Science, Scopus, BVS, CINAHL, Cochrane Library, PEDro, LILACS, and EMBASE. Methodological quality was assessed using AMSTAR 2 for interventional studies and JBI criteria for non-interventional studies. This review has been registered at PROSPERO (registration number: CRD42024618645).
Results:
In total, 25 systematic reviews addressed key aspects of hip management, including hip surveillance; tone management; preventive, reconstructive, and salvage procedures; and antifibrinolytic use. Hip surveillance reduced hip dislocation rates and the need for salvage surgery, whereas postural and tone management showed no consistent preventive effect. Combined pelvic and femoral osteotomies achieved better outcomes than isolated procedures, while soft-tissue surgeries had high recurrence rates. Proximal femoral hemiepiphysiodesis improved radiographic outcomes but frequently required revision. Salvage procedures such as valgus osteotomy and femoral head resection relieved pain, whereas hip arthrodesis showed poor outcomes. Total hip arthroplasty improved pain and function but was associated with high complication rates.
Conclusions:
This umbrella review highlights evidence-based practices and important knowledge gaps in the management of hip instability in children with CP, supporting future research and improved clinical care.
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