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Hip Displacement in Spastic Hemiplegia: Increased Risk with Hip Internal Rotation and Adduction Irrespective of
Zhe Yuan1, Alexander Aretakis2, Chris Church1
1Nemours Children's Hospital, Wilmington, Delaware.
JB & JS Open Access
|March 19, 2026
Summary
Hip displacement is more common in spastic hemiplegia than previously thought, especially in Winter-Gage-Hicks type IV gait. Hip internal rotation and adduction are key risk factors requiring vigilant monitoring.
Area of Science:
- Orthopedics
- Neurology
- Pediatrics
Background:
- Hip displacement (HD) is a known complication in cerebral palsy (CP).
- Spastic hemiplegia is often considered lower risk for HD, with limited data on prevalence.
- The Winter-Gage-Hicks (WGH) classification is used to categorize gait patterns, with type IV potentially linked to increased HD risk.
Purpose of the Study:
- To determine the prevalence of HD in patients with hemiplegic CP based on WGH gait classification.
- To identify specific risk factors associated with HD in this patient population.
Main Methods:
- Retrospective cohort study of 144 patients with hemiplegic CP.
- Inclusion criteria: instrumented gait analysis (IGA), hip surveillance radiographs, and ≥2-year follow-up.
- Primary outcome: "unsuccessful hip" (migration percentage ≥30% or reconstructive surgery for HD).
Main Results:
- 11.8% of patients experienced an unsuccessful hip outcome.
- HD rates increased with WGH type, notably 24.1% for type IV.
- Independent risk factors identified: hip internal rotation (OR 4.7) and hip adduction (OR 5.2).
Conclusions:
- HD prevalence in spastic hemiplegia is higher than anticipated across all WGH types, particularly type IV.
- Patients with hip internal rotation and adduction require close monitoring with regular hip surveillance radiographs.
- Early detection and intervention are crucial, especially during preadolescence.
