Dislocation of the hips in children with bilateral spastic cerebral palsy, 1985–2000

Abstract

The aim of this study was to assess the rate of hip dislocation at different ages in children with bilateral spastic cerebral palsy attending special schools in southern Derbyshire, UK, between 1985 and 2000. The medical notes of 110 individuals (68 males, 42 females) were obtained. They were divided into four groups according to the Gross Motor Function Classification System (GMFCS). We determined whether or not their hips were dislocated at the ages of 5, 10, and 15 years, and the kind of surgery performed in each case. The percentage of individuals with one or both hips dislocated increased with age and with severity of disease. Of those in GMFCS Level II (n=18), none had dislocations; Level III (n=16), none had dislocations at ages 5 and 10, but 11% had by the age of 15; Level IV (n=35), 8% had dislocations by age 5, 19% by age 10, and 30% by age 15; Level V (n=41), 22% had dislocations by age 5, 48% by age 10, and 50% by age 15. Forty-two per cent of individuals with hip dislocation had not had previous preventive surgery. Twenty-one per cent of hips operated on still proceeded to dislocation. We conclude that there was a high rate of hip dislocation, especially in GMFCS groups Levels IV and V, and that this often occurred very early. Preventive surgery avoided dislocation in many children. However, orthopaedic referral was often not made before dislocation was discovered, or the referral was made too late for surgery on soft tissue to be successful. These results may be compared with those from current programmes of hip management, involving radiological surveillance and early use of conservative and surgical interventions.

Australian hip surveillance guidelines for children with cerebral palsy: 5‐year review

“…After full text review, 15 papers remained. 1,[5][6][7][8]17,[22][23][24][25][26][27][28][29][30] A search of the reference lists of these articles, along with other key papers in the area, identified a further 24 potentially relevant articles. All of these newly sourced articles were excluded after application of inclusion and exclusion criteria to the full text.…”

“…Other studies also supported the need for surveillance at a young age. 5,26 Cases of displacement occurring from 8 months of age have been reported, 5 as has dislocation before 2 years of age. 28 No data were found that would assist in differentiating a congenital or neurogenic hip displacement in this population.…”

Musculoskeletal Complications of Neuromuscular Disease in Children

“…The prevalence of hip dysplasia in cerebral palsy varies from 2% to 60%, with higher prevalence among children who are quadriplegic or nonambulatory, or have severe spasticity [110][111][112]. In cerebral palsy, the risk for subluxation or [113].…”

Australian Cerebral Palsy Child Study: protocol of a prospective population based study of motor and brain development of preschool aged children with cerebral palsy

“…In the most severely impaired, non-ambulatory children, the incidence may be as high as 80% [11,15]. While children with CP are born with enlocated hips, progression to hip displacement is demonstrated in some children with CP from a very early age [13,14,16]. Hip surveillance programs and appropriately-timed interventions improve outcomes at skeletal maturity [14,15].…”

“…Although the final outcome of early intervention at skeletal maturity is not clear [17,18], early risk assessment might enable earlier referral for those children who may benefit from preventative intervention [19]. As clinical assessment of hip range of motion is a poor predictor of risk, several radiological and clinical measures are used to diagnose and monitor hip subluxation [13,16,17,19]. While functional disability, pain [20] and impaired ambulatory weight-bearing [12,16,18,19] are associated with risk of hip displacement and need for surgical intervention, the evidence regarding radiological characteristics is less clear [21,22].…”