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Characteristics of Hip Dysplasia in Adults With Cerebral Palsy
Tomoko Sugiyama1, Edward A Hurvitz2
1Department of Physical Medicine and Rehabilitation, Showa University, Tokyo, Japan.
Insights
Hip dysplasia is common in adults with cerebral palsy (CP), particularly in higher Gross Motor Function Classification System (GMFCS) levels. Monitoring hip health is crucial for all CP patients as they age.
Area of Science:
- Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is increasingly recognized as a condition affecting adults, with orthopedic issues like hip dysplasia being highly prevalent.
- Hip dysplasia in adults with CP is under-researched, lacking clear follow-up guidelines.
- This study investigates the prevalence, severity, and contributing factors of hip dysplasia in adults with CP.
Purpose of the Study:
- To determine the prevalence and severity of hip dysplasia in adults with CP.
- To identify patient-specific factors associated with hip dysplasia progression.
- To establish a basis for developing targeted follow-up and screening strategies for at-risk individuals.
Main Methods:
- Retrospective analysis of hip radiographs from 331 adults with CP (age ≥ 18).
- Assessment of hip displacement using Migration Percentage (MP) and Melbourne Cerebral Palsy Hip Classification System (MCHCS).
- Statistical analysis of patient factors including age, sex, Gross Motor Function Classification System (GMFCS) level, pain, and spasticity management.
Main Results:
- A mean MP of 23.2% was observed, with 24.5% of participants exhibiting hip subluxation (MP > 30%).
- GMFCS level strongly correlated with hip displacement severity; GMFCS IV and V showed significantly higher MP values.
- MP increased with age in GMFCS I/II individuals, suggesting progressive displacement, while severe displacement was linked to higher GMFCS levels.
Conclusions:
- Hip dysplasia is a significant and prevalent orthopedic challenge for adults with CP.
- GMFCS level is the primary predictor of hip dysplasia severity in this population.
- Understanding the long-term hip progression in adults with CP across all GMFCS levels is essential for clinical management.
Background:
With increased life expectancy, cerebral palsy (CP) is no longer solely a pediatric condition. Among adults with CP, orthopaedic conditions and associated pain represent the most prevalent challenges. Hip dysplasia is one of the most common conditions affecting adults with CP; however, the research remains limited, and clear follow-up guidelines are currently lacking. This study aimed to investigate the prevalence and severity of hip dysplasia in adults with CP and identify related factors. Our goal is to create a foundation for developing follow-up methods and clinical screening for specific groups of adults with CP at risk for worsening hip dysplasia.
Methods:
This retrospective study examined hip radiographs of 331 adults with CP (aged 18 y or older) from (removed for blinding) between 2011 and 2021. Migration percentage (MP) and Melbourne Cerebral Palsy Hip Classification System (MCHCS) were used to assess hip displacement. Patient factors, including age, sex, Gross Motor Function Classification System (GMFCS) level, pain condition and treatment, and spasticity management were analyzed. Linear regression models examined associations between patient factors and MP, while ordered logistic regression assessed relationships between GMFCS and MCHCS.
Results:
The mean MP across all participants was 23.2% (SD: 15.3), with 24.5% showing hip subluxation (MP>30%). GMFCS level was strongly associated with hip displacement, with GMFCS IV and V showing significantly higher MP values (Parameter Estimate=16.29 and PE=14.20, respectively; both P <0.01). Among GMFCS I/II, MP increased with age (PE=0.10, P =0.046), while no significant age associations were found in other GMFCS groups. MCHCS was also associated with GMFCS level, especially GMFCS IV and V (both P <0.0001). Notably, 21.6% of GMFCS I/II subjects were MCHCS 4 or higher.
Conclusions:
Hip dysplasia remains prevalent in adults with CP, with GMFCS level being the strongest predictor of displacement severity. Those with GMFCS I/II may experience progressive displacement with aging, while severe displacement in higher GMFCS levels may develop earlier. These findings emphasize the potential importance of understanding the natural history of the hip in CP into adulthood for all GMFCS levels.
Level Of Evidence:
Prognostic study level II-retrospective study.
