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Factors associated with hip deformity in children with nonambulatory spastic cerebral palsy
Ju Seok Ryu1, Yulhyun Park2, Joonyoung Jang3
1Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Insights
Hip deformities are common in children with spastic cerebral palsy (CP). Reduced hip abduction range of motion (ROM) and muscle imbalance are linked to these issues, highlighting the need for early intervention.
Area of Science:
- Orthopedics
- Pediatric Rehabilitation
- Neurology
Background:
- Hip deformities like subluxation and dislocation are prevalent in nonambulatory children with spastic cerebral palsy (CP), particularly those in Gross Motor Function Classification System (GMFCS) levels IV and V.
- These conditions significantly impair daily functioning and overall quality of life for affected children.
Purpose of the Study:
- To identify key factors associated with hip deformities in nonambulatory children with spastic CP (GMFCS IV-V).
- To explore potential rehabilitation strategies for preventing hip complications and improving outcomes.
Main Methods:
- A cross-sectional study involving 46 nonambulatory children with spastic CP (GMFCS IV-V, aged 2-10 years).
- Utilized radiographic assessments (Reimer's migration index, femoral neck-shaft angle, acetabular index, pelvic obliquity) and physical measurements (hip abduction ROM, spasticity, muscle strength, surface electromyography).
- Statistical analyses included multiple regression and Pearson correlation to examine relationships between variables.
Main Results:
- A negative correlation was observed between the migration index and hip abduction range of motion (ROM) at 90-degree flexion.
- The femoral neck-shaft angle showed a negative correlation with the abductor-to-adductor muscle strength ratio.
- Findings indicate that decreased hip abduction ROM and imbalanced muscle strength are associated with hip deformities in this population.
Conclusions:
- Reduced hip abduction ROM and muscle strength imbalance are significant factors contributing to hip deformities in nonambulatory children with spastic CP.
- Maintaining hip abduction ROM and muscle balance is critical for prevention.
- Further interventional studies are required to validate the efficacy of strengthening hip abductors and improving ROM in reducing subluxation risk. Noninvasive methods like ROM and surface electromyography are valuable for early detection, minimizing radiation exposure.
Abstract:
Hip deformities, including subluxation, dislocation, and coxa valga, are common in nonambulatory children with spastic cerebral palsy (CP), especially those classified as Gross Motor Function Classification System IV and V. These deformities impact daily activities and quality of life. This study aimed to identify factors associated with hip deformity and explore rehabilitation strategies to prevent complications. A cross-sectional study (August 2018-May 2020) included 46 children with spastic CP (Gross Motor Function Classification System IV-V, aged 2-10 years). Radiographic and physical measurements, including range of motion, spasticity, muscle strength, and surface electromyography, were analyzed using multiple regression and Pearson correlation. Hip deformities were assessed via Reimer's migration index, femoral neck-shaft angle, acetabular index, and pelvic obliquity. Migration index was negatively correlated with hip abduction range of motion (ROM) at 90-degree flexion. The femoral neck-shaft angle showed a negative correlation with the abductor-to-adductor muscle strength ratio. These findings suggest that reduced hip abduction ROM and muscle strength imbalance are associated with hip deformities in nonambulatory children with spastic CP. Hip abduction ROM and muscle strength balance are crucial for preventing hip deformities in nonambulatory children with spastic CP. While strengthening hip abductors and improving ROM may be potentially beneficial, interventional studies are needed to confirm whether these strategies reduce subluxation risk. Early identification using noninvasive methods like ROM and surface electromyography can help minimize radiation exposure from frequent radiographic evaluations.
