Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: a cross sectional study in Sweden and Norway

Abstract

BackgroundHip dislocation is a serious complication among children with cerebral palsy (CP). The aim of this study was to compare the prevalence of hip dislocation among children with CP in an area providing regular care with an area providing hip surveillance services.MethodsThis is a cross-sectional study in seven Norwegian counties providing regular care and one Swedish healthcare region where a hip surveillance programme was introduced in 1994. Data were provided by the Norwegian Cerebral Palsy Register and the CP Register in Southern Sweden. Children born 1996 - 2003 with moderate to severe CP, defined as Gross Motor Classification System (GMFCS) levels III - V, were included. In all, 119 Norwegian and 136 Swedish children fulfilled the criteria. In Norway, data on hip operations and radiographs of the hips were collected from medical records, while these data are collected routinely in the Swedish register. The hip migration percentage was measured on the recent radiographs. Hip dislocation was defined as a migration percent of 100%.ResultsThe proportion of children at GMFCS levels III - V was 34% in the Norwegian and 38% in the Swedish population. In the Norwegian population, hip dislocation was diagnosed in 18 children (15.1%; CI: 9.8 - 22.6) compared with only one child (0.7%; 95% CI: 0.01 - 4.0) in Southern Sweden (p = < 0.001). Hip surgery was performed in 53 (44.5%) of the Norwegian children and in 43 (32%) of the Swedish children (p = 0.03). The total number of hip operations was 65 in Norway and 63 in Sweden. Norwegian children were first operated at a mean age of 7.6 years (SD: 2.9) compared with 5.7 years (SD: 2.3) in Sweden (p = 0.001).ConclusionsThe surveillance programme reduced the number of hip dislocations and the proportion of children undergoing hip surgery was lower. However, with the surveillance programme the first operation was performed at a younger age. Our results strongly support the effectiveness of a specifically designed follow-up programme for the prevention of hip dislocation in children with CP.

Hip surveillance and management of the displaced hip in cerebral palsy

“…Similar results have been shown from the Victorian Cerebral Palsy Register [19], Sweden [9] and Norway [20] (Fig. 3).…”

Development of a Cerebral Palsy Follow‐up Registry in Jordan (CPUP‐Jordan)

“…The motor dysfunction of children with CP is further complicated by development of secondary impairments such as joint deformities, muscle contractures, hip dislocation, and scoliosis (Murphy, Molnar, & Lankasky, ; Persson‐Bunke, Hägglund, Lauge‐Pedersen, Wagner, & Westbom, ). Secondary impairments have significant impact on restricting participation of children with CP in activities of daily living (Elkamil et al, ).…”

Parent preferences for neurodevelopmental screening in the neonatal intensive care unit

“…2 Early diagnosis can facilitate earlier intervention, which may maximize neuroplasticity and mitigate comorbidities in both motor and cognitive domains. [3][4][5] Yet, providers may be hesitant to adopt CP screening programmes in the neonatal intensive care unit (NICU) owing to concerns that it will overidentify infants who ultimately do not develop CP. There is also the potential that positive screening for neurodevelopmental risk could affect parenting and bonding for families of these infants.…”