Long-Term Follow-up of Hip Subluxation in Cerebral Palsy Patients

Bagg, Mark; Farber, Jeffery; Miller, Freeman

doi:10.1097/01241398-199301000-00007

Cited by 227 publications

(135 citation statements)

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“…We asked (1) whether hip abduction range correlates with hip displacement, (2) what the relationships are between proximal femoral deformities and hip displacement, and (3) if the patient with windblown posture has greater degrees of femoral anteversion.…”

Section: Introductionmentioning

confidence: 99%

“…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%

“…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.…”

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confidence: 99%

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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%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Determinants of Hip Displacement in Children With Cerebral Palsy

Chang

Wang

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…In another study, individuals with both unstable and stable hips were included and the results showed that 68% of stable hips in CP caused no pain, 25% caused mild pain, and 7% caused severe pain, whereas 39% of unstable hips in CP caused no pain, 42% caused mild pain, and 19% caused severe pain. 34 We adopted these results as baseline values of probabilities because the comparisons were made between unstable and stable hips.…”

Section: Probabilitiesmentioning

confidence: 99%

“…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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Hip

Cerebral Palsy

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The hip joint is the largest joint in the body and is the joint that causes the most problems both from a functional perspective and at the level of walking, sitting, and lying in children with cerebral palsy (CP). Hips in children with CP are normal at birth, and the problems develop slowly as the children grow and deform under the influence of abnormal forces caused by the CP. A second group of children with CP do not actually develop deformity; however, the infantile shape of their proximal femur does not resolve because there is not enough normal force present. In summary, these children develop contractures and increased abnormal forces that lead to dislocation and dysplasia, or alternatively, they fail to resolve the infantile torsional malalignment. After addressing the concerns of equinus contractures in children with CP, hip problems are the next main area of interest to orthopaedists treating these children. The treatment of hip problems has the largest literature base in the area of orthopaedic management of CP. A review of the abstract listings in the National Library of Medicine revealed 496 references published from 1963 to 2000 that address hip problems in children with CP. Although the literature is extensive, much of it does not include any standardized control or standardized radiographic measurements and has a poor description of specific patterns. A substantial body of this literature addresses the natural history of the problem of hip dysplasia, and its etiology has been fairly well understood. The evaluation of treatment outcomes suffers especially from poor categorization, poor standard evaluation procedures, and, most of all, very poor long-term follow-ups. Spastic HipsHip problems in children with CP first need to be divided by children's level of tone into either spastic children or those children who are hypotonic. The spastic (hypertonic) group should also include children with movement disorders such as athetosis and dystonia. The hypertonic hips can be subdivided further by the direction of the dysplasia or the abnormal force into posterosuperior, anterior, inferior and, additionally, by several contracture patterns that may be independent of or concurrent with dysplastic hips. These contracture patterns include windblown hips and hyperabducted hips. The hypotonic hips in children with CP are a little more diffuse and are harder to further categorize.

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Long-Term Follow-up of Hip Subluxation in Cerebral Palsy Patients

Cited by 227 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

Hip

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