Hip Dislocation in Spastic Cerebral Palsy

Cooperman, Daniel R.; Bartucci, Eugene; Dietrick, Ellen; Millar, Edward A.

doi:10.1097/01241398-198705000-00005

Cited by 202 publications

(88 citation statements)

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“…Hip displacement is a common musculoskeletal disorder in patients with cerebral palsy [14,22,33], and it may progress to dislocation associated with chronic hip pain and have a negative effect on preexisting motor disability [2,10]. The goal of treatment for patients with spastic hip displacement has been to restore physiologic biomechanics for hip development; therefore, flexion-adduction contractures and skeletal deformities of the hip often result in surgery for hip displacement [15,20,25,27,29,31].…”

Section: Introductionmentioning

confidence: 99%

Determinants of Hip Displacement in Children With Cerebral Palsy

Chang

Wang

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Coxa valga and femoral anteversion often are seen in patients with spastic hip displacement and osteotomy is recommended. However, the relationship between femoral deformities and hip displacement has not been clearly defined and other factors, such as joint motion and posture, should be considered before recommending treatment. Questions For children with cerebral palsy with Gross Motor Function Classification System Level IV or V, we questioned (1) whether hip abduction range correlates with hip displacement, (2) what the relationships are between proximal femoral deformities and hip displacement, and (3) whether the patient with a windblown posture has greater degrees of femoral anteversion? Methods We retrospectively studied 31 consecutive children with cerebral palsy with Level IV or V gross motor function who underwent three-dimensional CT for preoperative assessment of hip displacement between January 2010 and December 2013. Among the children, 23 had a windblown posture and eight had symmetric hip motion. Femoral anteversion and true neck-shaft angle were measured from the three-dimensional CT images. Migration percentage was the dependent variable we chose to study in relation to femoral anteversion, neck-shaft angle, maximal hip abduction, and hip flexion contracture, using correlations and multiple linear regressions. Using ANOVA and Scheffé's post hoc tests, we analyzed and compared the data of 23 abducted hips and 23 adducted hips in the 23 children with windblown posture and in 16 displaced hips in the eight children with symmetric hip abduction. Results Greater migration percentage was associated with less hip abduction range (r = À0.86; p \ 0.001). Femoral anteversion had a weak correlation (r = 0.28; p \ 0.05) to migration percentage, and the association became insignificant after considering hip abduction motion. Adducted windblown hips had greater femoral anteversion

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Section: Introductionmentioning

confidence: 99%

Determinants of Hip Displacement in Children With Cerebral Palsy

Chang

Wang

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…11,12,24,[31][32][33][34][35] Knapp and Cortes 9 found that 18% of adults with CP with hip dislocation had significant hip pain and that 11% had mild Figure 1: Decision analysis tree with probability and utility variables. The decision-node branches into concurrent femoral varization osteotomy for contralateral stable hips and into an observation node.…”

Section: Probabilitiesmentioning

confidence: 99%

Prophylactic femoral varization osteotomy for contralateral stable hips in non‐ambulant individuals with cerebral palsy undergoing hip surgery: decision analysis

Park

Chung

Kwon

et al. 2012

Develop Med Child Neuro

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FVO Femoral varization osteotomyAIM This study was undertaken to determine the need for concurrent prophylactic femoral varization osteotomy (FVO) of contralateral stable hips at the time of hip reconstructive surgery on unstable hips in non-ambulant individuals with cerebral palsy (Gross Motor Function Classification System levels IV and V).METHOD A decision analysis model was constructed that included (1) the probability of unstable hips during observation of the contralateral stable hips, (2) unstable hip rate (subluxation or dislocation rate) after prophylactic FVO or after delayed reconstructive surgery (including FVO) for unstable hips, and (3) complication rates after concurrent prophylactic FVO or after hip reconstructive surgery. The final outcome score was based on pain utility measures. The probabilities of all cases and the utility score were obtained by literature review. RESULTSThe decision model favoured concurrent prophylactic FVO for the contralateral stable hips over observation (pain utility measure scores 0.814 vs 0.781). In a one-way sensitivity analysis, the decision model favoured concurrent prophylactic FVO when the unstable hip rate of contralateral stable hips during observation was 27% or over. Concurrent prophylactic surgery also demonstrated higher utility scores than observation when the unstable hip rate after FVO was between 0% and 29%.INTERPRETATION The decision analysis model demonstrated that concurrent prophylactic FVO for a contralateral stable hip in individuals with cerebral palsy undergoing hip reconstructive surgery was beneficial from a medical perspective, which was based on current evidence.Studies have reported that a considerable portion of radiographically stable contralateral hips eventually dislocate or subluxate in individuals with cerebral palsy (CP) with a unilateral unstable hip. 1-4 A recent study showed that 44% of severely involved individuals with CP undergoing unilateral femoral varization osteotomy (FVO) required subsequent bony surgical management of the contralateral hip for subluxation or dislocation before reaching skeletal maturity. 5 This high probability of dislocation of the contralateral stable hip during follow-up has generated interest in concurrent prophylactic FVO on the radiographically stable contralateral hip during reconstructive surgery of an unstable hip.Every medical practice must come to terms with the two opposing aspects of risk and benefit represented by optimal treatment and socio-economics. The merits of a procedure include increased life expectancy and improved healthrelated quality of life, and the demerits include complications and costs. Physicians usually weigh up these pros and cons when deciding whether to perform a medical procedure, although such assessments are invariably informal and subjective. These processes necessarily imply that analyses should be performed on the basis of the probabilities of various outcomes.Randomized controlled trials (RCTs) are most commonly used to verify the effectiveness of health-care se...

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“…Spasticity of hip adductors and flexors results in fixed contractures, muscle imbalance and progressive hip displacement [2,3]. Without intervention, this process may end in hip dislocation, the consequences of which may be pain, gait deterioration, difficulty in seating and problems with perineal hygiene [4,5]. Thus, these children often require intervention for spasticity and hip displacement before their gross motor prognosis is clear and before invasive spasticity management with an intrathecal baclofen pump [6,7], selective dorsal rhizotomy [8,9] or multilevel orthopaedic surgery [1,10] for fixed deformities can be considered.…”

Section: Introductionmentioning

confidence: 99%

Adductor release and chemodenervation in children with cerebral palsy: A pilot study in 16 children

Khot

Sloan

Desai

et al. 2008

Journal of Children's Orthopaedics

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Purpose A pilot study with short-term outcomes of a combined surgical and medical intervention for management of generalized lower limb spasticity, hip displacement and contractures of adductors in children with bilateral spastic cerebral palsy. Methods A prospective cohort study of 16 children (9 boys and 7 girls) aged 2-6 years with bilateral spastic cerebral palsy was performed. At entry, 5 were classified as level III and 11 as level IV, according to the Gross Motor Function Classification System (GMFCS). The intervention consisted of surgical lengthening of adductor longus and gracilis combined with the phenolization of the anterior branch of the obturator nerve, using 1 ml of 6% phenol, applied under direct vision at the time of lengthening of adductor longus. The hamstring and calf muscles were each injected with Botulinum neurotoxin A at a dose of 4 U/kg/muscle. Serial clinical (hip, knee, ankle joint range of motion), radiographic (migration percentage) and functional data-taken from a functional mobility scale (FMS) or GMFCS-were collected at 3, 6, 12 and 24 months post-operatively.

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Hip Dislocation in Spastic Cerebral Palsy

Cited by 202 publications

References 0 publications

Determinants of Hip Displacement in Children With Cerebral Palsy

Determinants of Hip Displacement in Children With Cerebral Palsy

Prophylactic femoral varization osteotomy for contralateral stable hips in non‐ambulant individuals with cerebral palsy undergoing hip surgery: decision analysis

Adductor release and chemodenervation in children with cerebral palsy: A pilot study in 16 children

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