How Critical is Patient Positioning in Radiographic Assessment of the Hip in Cerebral Palsy When Measuring Migration Percentage?

Kinch, Katie; Campbell, Dan H.; Maclean, J. G. B.; Read, Heather S.; Barker, Simon; Robb, James; Gaston, Mark S.

doi:10.1097/bpo.0000000000000372

Cited by 16 publications

(11 citation statements)

References 8 publications

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“…LHC demonstrated a strong correlation with RMP, with 74% of the variation in LHC being explained by RMP. Further, both the inter‐ and intra‐assessor reliability of LHC were excellent, and similar to that reported for RMP 10,12,15 . The SEMs and corresponding MDDs for LHC were also comparable with those reported for RMP (SEM range 2.98–3.9%, MDD=8.3–11.5%) 10,12 …”

Section: Discussionsupporting

confidence: 80%

“…Further, both the inter- and intra-assessor reliability of LHC were excellent, and similar to that reported for RMP. 10,12,15 The SEMs and corresponding MDDs for LHC were also comparable with those reported for RMP (SEM range 2.98-3.9%, MDD=8.3-11.5%). 10,12 LHC is a measure that is simply constructed using both the sagittal and coronal planes of the ultrasound volume.…”

Section: Discussionsupporting

confidence: 79%

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3D ultrasound to quantify lateral hip displacement in children with cerebral palsy: a validation study

Kay

Noble

Johnston

et al. 2020

Develop Med Child Neuro

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ABBREVIATIONS LHC Lateral head coverage MDD Minimal detectable difference RMP Reimer's migration percentage AIM To assess the validity of a new index, lateral head coverage (LHC), for describing hip dysplasia in a population of children with cerebral palsy (CP). METHOD LHC is derived from 3D ultrasound assessment. Twenty-two children (15 males, seven females; age 4-15y) with CP undergoing routine hip surveillance were recruited prospectively for the study. Each participant had both a planar radiograph acquired as part of their routine care and a 3D ultrasound assessment within 2 months. Reimer's migration percentage (RMP) and LHC were measured by the same assessor, and the correlation between them calculated using Pearson's correlation coefficient. The repeatability of LHC was investigated with three assessors, analysing each of 10 images three times. Inter-and intraassessor variation was quantified using intraclass correlation coefficients. RESULTS LHC was strongly correlated with RMP (Pearson's correlation coefficient=−0.86, p<0.001). LHC had similar inter-assessor reliability to that reported for RMP (intraclass correlation coefficient=0.97 and intra-assessor intraclass correlation coefficient=0.98). INTERPRETATION This is an initial validation of the use of 3D ultrasound in monitoring hip development in children with CP. LHC is comparable with RMP in estimating hip dysplasia with similar levels of reliability that are reported for RMP.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 79%

3D ultrasound to quantify lateral hip displacement in children with cerebral palsy: a validation study

Kay

Noble

Johnston

et al. 2020

Develop Med Child Neuro

View full text Add to dashboard Cite

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“…The measured NSA has a predictable error, which potentially prevents its use as another predictor of hip migration. The HSA incorporates the position of the head compared to the neck and is less influenced by femoral anteversion [13, 15, 25]. …”

Section: Discussionmentioning

confidence: 99%

Is head–shaft angle a valuable continuous risk factor for hip migration in cerebral palsy?

Chougule

Dabis

Petrie

et al. 2016

Journal of Children's Orthopaedics

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BackgroundReimer’s migration percentage (MP) is the most established radiographic risk factor for hip migration in cerebral palsy (CP), and it assists surgical decision-making. The head–shaft angle (HSA) measures the valgus of the head and neck in relation to the shaft and may also be a useful predictor of hip migration at a young age. This study first defined normal values and investigated whether the head–shaft angle (HSA) is a continuous risk factor for hip migration in CP.MethodsThree hundred and fifty AP pelvic radiographs of 100 consecutive children comprising the hip surveillance programme in our region were analysed for MP and HSA. Inclusion criteria were children with spastic CP and Gross Motor Function Classification System (GMFCS) levels of III–V, along with a minimum follow-up of 5 years. The mean age was 8.8 (range 3–18) years and the mean follow-up time was 7.5 (range 5–10) years. Radiographs of 103 typically developing children (TDC) were selected for the control group. The reliability of the measurements was determined. A random effects analysis was used to assess the relationship between MP and HSA for all data and for MP > 40 %.ResultsThe TDC cohort had a mean HSA of 157.7° whilst that for the CP cohort was 161.7°. The value declined with age in both groups but remained consistently higher in the CP group. A random effects analysis considering the longitudinal data showed that there was no significant effect of HSA on MP. Similarly, when excluding CP patients with MP < 40 %, there was no significant effect of HSA on MP.ConclusionsThis study found no correlation between HSA and hip migration in children with CP in this age group. Using the HSA as a routine radiographic measure in the management pathway across childhood does not offer any added value. Early enrolment onto the hip surveillance programme could offer a better prediction of hip migration using the HSA at a very young age.Level of evidenceII retrospective prognostic study.

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“…Children receive a pelvic radiograph on first registration in the programme. This is taken in a standardised position which is used across Scotland [ 9 ]. Subsequent radiographs are taken according to a protocol based on age and GMFCS.…”

Section: Methodsmentioning

confidence: 99%

The head shaft angle is associated with hip displacement in children at GMFCS levels III-V - a population based study

Finlayson

Czuba

Gaston

et al. 2018

BMC Musculoskelet Disord

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BackgroundAn increased Head Shaft Angle (HSA) has been reported as a risk factor for hip displacement in children with cerebral palsy (CP) but opinions differ in the literature. The purpose of this study was to re-evaluate the relationship between HSA and hip displacement in a different population of children with CP.MethodsThe Cerebral Palsy Integrated Pathway Scotland surveillance programme includes 95% of all children with CP in Scotland. The pelvic radiographs from 640 children in GMFCS levels III-V were chosen. The most displaced hip was analysed and the radiographs used were those taken at the child’s first registration in the database to avoid the potential effects of surveillance on subsequent hip centration. A logistic regression model was used with hip displacement (migration percentage [MP] ≥40%) as outcome and HSA, GMFCS, age and sex as covariates.ResultsThe MP was ≥40% in 118 hips with a mean HSA of 164° (range 121–180°) and < 40% in 522 hips with a mean HSA of 160° (range 111–180°). The logistic regression analysis showed no significant influence of age and sex on MP in this population but a high GMFCS level was strongly associated with hip displacement. An increased HSA was also associated with hip displacement, a 10° difference in HSA for children adjusted for age, sex, and GMFCS gave an odds ratio of 1.26 for hip displacement equal or above 40% (p = 0.009) and hips with HSA above 164.5 degrees had an odds ratio of 1.96 compared with hips with HSA below 164.5 degrees (p = 0.002).ConclusionThese findings confirm that HSA is associated with hip displacement in children in GMFCS levels III-V.

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How Critical is Patient Positioning in Radiographic Assessment of the Hip in Cerebral Palsy When Measuring Migration Percentage?

Abstract: Poor positioning did not appear to be the main reason for the variation in reliability of MP. Repeat measurements were reliable although standardized technique, training, and familiarity with software measuring programmes did influence outcomes.

Cited by 16 publications

References 8 publications

3D ultrasound to quantify lateral hip displacement in children with cerebral palsy: a validation study

3D ultrasound to quantify lateral hip displacement in children with cerebral palsy: a validation study

Is head–shaft angle a valuable continuous risk factor for hip migration in cerebral palsy?

The head shaft angle is associated with hip displacement in children at GMFCS levels III-V - a population based study

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