Hip displacement in relation to age and gross motor function in children with cerebral palsy

Abstract

PurposeHip dislocation in cerebral palsy (CP) is a serious complication. By radiographic screening and prophylactic surgery of children at risk most dislocations can be prevented. CPUP, the Swedish CP registry and follow-up program, includes annual radiographic examinations of children at Gross Motor Function Classification System (GMFCS) levels III–V. Data from CPUP were analysed to assess the risk of hip displacement in relation to GMFCS levels and age.MethodsAll children at GMFCS levels III–V (N = 353) whose first radiographic screening occurred before 3 years of age were followed between the ages 2–7 years. Migration percentages (MPs) were recorded annually (1,664 pelvic radiographs) and analysed using discrete time survival analysis.ResultsThe risk of hip displacement between 2 years and 7 years of age was significantly (p < 0.05) higher for children at GMFCS level V during the entire study period. The risk was highest at 2–3 years of age and decreased significantly (p < 0.001) with each year of age (OR = 0.71, 95 % CI 0.60–0.83). The cumulative risk at age 7 years for those at GMFCS V for MP ≥ 40 % was 47 % (95 % CI 37–58). The corresponding risk at GMFCS IV was 24 % (16–34) and at GMFCS III 23 % (12–42).ConclusionsChildren at GMFCS V have a significantly higher risk of hip displacement compared with children at GMFCS III–IV. The risk is highest at 2–3 years of age. The results support a surveillance program including radiographic hip examinations as soon as the diagnosis of severe CP is suspected.

Determinants of Hip Displacement in Children With Cerebral Palsy

“…Gross motor function and hip abduction motion are strong global risk factors for spastic hip displacement, and they have been associated with femoral deformities [5,22,31,33]. In the relationships among motor function, hip abduction, femoral deformity, and hip displacement, femoral deformity is a proxy factor of the two strong risk factors and is associated with hip displacement [19].…”

“…Gross Motor Function Classification System levels also have been significantly correlated with incidence of hip displacement [22,33]. Thus, gross motor function could be a factor in the association between femoral deformities and hip displacement.…”

“…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].…”

Professionals’ Perceptions about the Need for Pain Management Interventions for Children with Cerebral Palsy in South African School Settings

“…Another strategy is to use a standardized, systematic follow-up surveillance program. Such a program for children with CP (CPUP) was introduced in Sweden two decades ago and has since successfully addressed the prevention of hip dislocations (Larnert, Risto, Hagglund, & Wagner, 2014).…”

“…It means, for example, to inform new educators and guide parents in how to meet a child's needs, which would effectively minimize or prevent pain in both school and home settings (Saloojee, Phohole, Saloojee, & Ijsselmuiden, 2007). In addition, the shortening of waiting times to extended services such as medication, surgery, and rehabilitation would be important means to reduce the harm to children with CP (Larnert et al, 2014) and extend their participation in school activities.…”