Hip subluxation in Italian cerebral palsy children and its determinants: a retrospective cohort study

Abstract

The study’s aim was two-fold: to describe the trend of hip subluxation in the largest sample of Italian nonambulatory cerebral palsy (CP) children ever published; to investigate its determinants. This single-centre retrospective cohort study included patients with spastic or dyskinetic CP, Gross Motor Function Classification System (GMFCS) level IV or V, age 0–18 years, having been referred to our unit before March 2020. The hip subluxation was measured by means of the migration percentage (MP). Other data were gathered such as sex, CP subtype, GMFCS level, presence of drug-resistant epilepsy, age, use of walkers with weight relief or standing devices, previous botulinum injection or hip surgery, oral or intrathecal baclofen and hip pain. Multiple linear stepwise regression was performed and descriptive statistics are provided. Spastic CP had MP maximum increase in early ages, with GMFCS level V values persistently higher than level IV. The dyskinetic subtype showed a slower increase of the MP, with GMFCS level IV presenting similar or higher values, compared to level V. Age, CP severity and spastic subtype are the main determinants. The stepwise multiple regression analysis demonstrated that weight relief walking and standing assistive devices, combined with botulinum contributed to reduce the MP progression. Dyskinetic CP showed overall lower MP values and a more variable behaviour relative to age and GMFCS level, compared to the spastic subtype. Standing and walking assistive devices, with partial or total weight relief, combined with individually targeted botulinum injections, should be considered in the management of bilateral nonambulatory CP patients, to prevent hip subluxation or its recurrence after surgery.

Sitting Postural Management to Prevent Migration Percentage Progression in Non-Ambulatory Children with Cerebral Palsy: Randomized Controlled Trial Preliminary Data

“…Based on the regression analysis, only two factors were significantly related to MP progression: age and drug-resistant epilepsy. This is in line with results from previous studies [ 3 , 5 , 32 ]. The risk of hip luxation is higher in the first years of life, when MP increases more quickly than it does in older children.…”

“…Surprisingly, no significant correlation was found between GMFCS level and MP during multiple linear regression analysis. This is at odds with previous findings [ 5 , 32 , 33 ] and will need to be verified based on our final results. Epilepsy has already been indicated among the determinants of hip displacement, in particular drug-resistant epilepsy [ 5 , 32 ].…”

“…More severe non-ambulatory bilateral patients (GMFCS IV and V) are known to be the most vulnerable to hip subluxation [ 2 , 3 ]. Spastic and dyskinetic subtypes are more often involved than ataxic CP [ 3 , 4 ], with MP increasing mostly in early ages in spastic CP while having a more variable trend in the dyskinetic subtype [ 5 ].…”

Treatment of Chronic Degenerative Hip Pain in a Male Patient With Cerebral Palsy Four Decades After Reverse Osteotomy

“…Hip subluxation in patients with CP is measured by the migration percentage (MP). This patient’s CP was classified as the spastic subtype, which often presents with subluxation at an earlier age than other CP subtypes [ 5 ].…”

“…Late-adulthood chronic hip pain and associated gait disturbances in patients with CP can be treated by conservative management, including bracing, botulinum toxin A injections, and heel lifts. If these are not sufficient to improve gait and quality of life, surgical reconstruction or revision of prior hardware may be required [ 3 , 5 ]. The patient in this case experienced chronic hip pain and gait disturbances 44 years after the initial surgical intervention.…”