Prevention of dislocation of the hip in children with cerebral palsy

Abstract

In 1994, a register for cerebral palsy and a health-care programme were started in southern Sweden with the aim of preventing dislocation of the hip in children with cerebral palsy. It involved all children with cerebral palsy born in 1992 or later. None of the 206 affected children born between 1992 and 1997 has developed a dislocation following the introduction of the prevention programme. Another 48 children moved into the area and none developed any further dislocation. Of the 251 children with cerebral palsy, aged between five and 11 years, living in the area on January 1, 2003, only two had a dislocated hip. One boy had moved into the area at age of nine with a dislocation and a girl whose parents chose not to participate in the programme developed bilateral dislocation. One boy, whose condition was considered to be too poor for preventative surgery, developed a painful dislocation of the hip at the age of five years and died three years later. Eight of 103 children in a control group, consisting of all children with cerebral palsy living in the area between 1994 and 2002, and born between 1990 and 1991, developed a dislocation of the hip before the age of six years. The decreased incidence of dislocation after the introduction of the prevention programme was significant (p < 0.001). Dislocation of the hip in cerebral palsy remains a serious problem, and prevention is important. Our screening programme and early intervention when lateral displacement of the femoral head was detected appear to be successful.

Parents’ experience of pain in children with cerebral palsy and multiple disabilities – An interview study

“…This is supported by a study highlighting pain from spasticity and muscle spasms in children (19), and further by a study demonstrating that hip dislocation in CP sufferers can result in serious problems such as pain, contractions, discomfort when seated, misaligned pelvis and scoliosis (22). The results of our study also show that parents experience the children's pain to diminish after hip and scoliosis operations.…”

“…The results of our study also show that parents experience the children's pain to diminish after hip and scoliosis operations. Since 1994, the Cerebral Palsy standardized follow-up program (CPUP) has been in existence for children with CP in Sweden (22,23). Results show a decrease in hip luxation and other complications such as contractions, skeletal deformation and scoliosis (22,23).…”

“…Since 1994, the Cerebral Palsy standardized follow-up program (CPUP) has been in existence for children with CP in Sweden (22,23). Results show a decrease in hip luxation and other complications such as contractions, skeletal deformation and scoliosis (22,23). Since 2005, the majority of county councils and regions in Sweden are connected to the CPUP quality register (24).…”

Hip dislocation in cerebral palsy

“…A prevention programme involving 206 children with cerebral palsy at 5 years of age reported that none had developed hip dislocation 13. However, many of these children were walking, and many had had surgery (48 soft tissue or bone surgical interventions, 9 selective dorsal rhizotomies, and the insertion of 3 intrathecal baclofen delivery systems).…”

“…Many studies on both soft tissue and bone surgery have a short follow-up, and studies cannot be compared because they lack valid functional outcomes, pain is not measured systematically before and after surgery, or they use different combinations of procedures 8 13…”