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

Finlayson, Laura; Czuba, Tomasz; Gaston, Mark S.; Hägglund, Gunnar; Robb, James

doi:10.1186/s12891-018-2275-4

Cited by 12 publications

(8 citation statements)

References 10 publications

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“…GMFCS level V was significantly associated with hip displacement during follow-up, supporting previous studies that severely reduced functional capacity is an important risk factor 4,8,17,18. We found no significant association between HSA at the first radiograph, taken at the time of diagnosis, and later clinically relevant hip displacement, defined as MP≥40%.…”

Section: Discussionsupporting

confidence: 87%

The Femoral Head-Shaft Angle Is Not a Predictor of Hip Displacement in Children Under 5 Years With Cerebral Palsy: A Population-based Study of Children at GMFCS Levels III-V

Terjesen

Horn

2021

Journal of Pediatric Orthopaedics

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Background: The aim of this study was to evaluate whether the femoral head-shaft angle (HSA) is a predictor of hip displacement in children with cerebral palsy (CP). Methods: The patients were recruited from a population-based hip surveillance program. Inclusion criteria were age under 5 years, bilateral CP, Gross Motor Function Classification System (GMFCS) levels III-V, and migration percentage (MP) of both hips <40% at the primary radiograph. With these criteria, 101 children (61 boys) were included. GMFCS was level III in 26 patients, level IV in 23, and level V in 52. An anteroposterior radiograph of the pelvis was taken at diagnosis and at the last follow-up. Only the worst hip of each patient (the hip with the largest MP) was used for the analyses. Results: The mean age at the primary radiograph was 2.4 years (range, 0.8 to 4.9 y). The mean primary HSA was 171.0 degrees (range, 152 to 190 degrees). The mean follow-up time was 4.3 years (range, 0.9 to 11.8 y). The mean MP at the primary radiograph was 17.5% (range, 0% to 39%) and at the last follow-up 41.9% (range, 0% to 100%). At that point, MP was <40% in 54 hips and ≥40% in 47 hips. There was no significant difference in primary HSA between patients with final MP<40% and those with final MP≥40% (170.8 and 171.3 degrees, respectively; P =0.761). At the last follow-up, the mean HSA was significantly larger in hips with final MP≥40% than in hips with final MP<40% (171.1 vs. 167.4 degrees; P =0.029). Conclusions: There was a markedly increased valgus position of the proximal femur in nonambulatory children with CP. However, the primary HSA in children below 5 years of age was not a predictor of later hip displacement, defined as MP≥40%. Clinical Relevance: Measurement of HSA is not necessary in routine hip surveillance in children below 5 years. Level of Evidence: Level I—investigating a diagnostic test.

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Section: Discussionsupporting

confidence: 87%

The Femoral Head-Shaft Angle Is Not a Predictor of Hip Displacement in Children Under 5 Years With Cerebral Palsy: A Population-based Study of Children at GMFCS Levels III-V

Terjesen

Horn

2021

Journal of Pediatric Orthopaedics

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“…14,15 Increased NSA and HSA have been associated with progressive hip subluxation. 14,[16][17][18] Our study demonstrates that PFSH can successfully change the geometry of the proximal femur via NSA and HSA, and effectively improve hip subluxation in children with CP.…”

Section: Discussionmentioning

confidence: 65%

Proximal Femoral Screw Hemiepiphysiodesis in Children With Cerebral Palsy Improves the Radiographic Measures of Hip Subluxation

Zakrzewski

McCarthy

2022

Journal of Pediatric Orthopaedics

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Background: Proximal femoral screw hemiepiphysiodesis (PFSH) is a promising technique for treatment of hip subluxation in children with cerebral palsy (CP). The aim of this study is to report radiographic outcomes of PFSH and to evaluate its role in changing the natural history of hip displacement in children with CP. Methods: This is a single center retrospective chart review of children with CP that underwent PFSH with at least 2 years of radiographic follow-up. Demographic information, surgical details, complications, additional surgical procedures, and need for screw exchange were recorded. Radiographs were assessed for migration percentage (MP), neck shaft angle (NSA), head shaft angle (HSA), and articular trochanter distance preoperatively as well as at 6 months, 1 year, 2 year, and latest follow-up postoperatively. Hips were divided into group 1 (no previous hip surgery) and group 2 (PFSH performed after hip reconstruction). Hips with 2 years of preoperative radiographic data were included in the natural history cohort. Results: Twenty-three patients (44 hips) met inclusion criteria with an average age of 7.3±1.7 years and a mean follow-up of 33.5 months. Group 1 and group 2 had 32 and 12 hips, respectively. Group 1 had significant improvement in all parameters (ΔMP=5%, ΔNSA=13 degrees, ΔHSA=15 degrees) group 2 showed improvements in NSA and HSA (ΔNSA=4 degrees ΔHSA=8 degrees) with only HSA reaching significance and MP remaining unchanged. All radiographic measurements worsened in the 2 years before surgery (N=25, natural history group) and improved after PFSH. Screw exchange occurred in 12 hips (27.2%) at an average of 33 months (range 27 to 42 mo) with 2 hips also undergoing pelvic osteotomy at that time. Three hips had a MP >50% at follow-up with 2 hips in group 1 undergoing hip reconstruction. No complications were noted. Conclusion: PFSH effectively alters proximal femoral growth and can improve hip subluxation in children with CP. Screws often need to be exchanged and hips should be carefully monitored. Level of Evidence: Level III—retrospective comparative study.

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“…Despite the debate surrounding its utility, its contribution to the CPUP hip score adds to its value. 24 , 34 , 35 The CPUP hip score has been assessed in multiple populations, achieving a high discriminatory accuracy in evaluating risk of hip displacement. 24 , 36 Prospectively, the automatic calculation of core radiological measurements and hip displacement risk scores stand as an essential requirement for a fully-autonomous hip surveillance system; omitting head-shaft angle from the CMS could limit the potential application of such a system.…”

Section: Discussionmentioning

confidence: 99%

Radiological assessment of hip disease in children with cerebral palsy: development of a core measurement set

Joseph,

Khattak,

Masudi

et al. 2023

Bone Jt Open

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AimsHip disease is common in children with cerebral palsy (CP) and can decrease quality of life and function. Surveillance programmes exist to improve outcomes by treating hip disease at an early stage using radiological surveillance. However, studies and surveillance programmes report different radiological outcomes, making it difficult to compare. We aimed to identify the most important radiological measurements and develop a core measurement set (CMS) for clinical practice, research, and surveillance programmes.MethodsA systematic review identified a list of measurements previously used in studies reporting radiological hip outcomes in children with CP. These measurements informed a two-round Delphi study, conducted among orthopaedic surgeons and specialist physiotherapists. Participants rated each measurement on a nine-point Likert scale (‘not important’ to ‘critically important’). A consensus meeting was held to finalize the CMS.ResultsOverall, 14 distinct measurements were identified in the systematic review, with Reimer’s migration percentage being the most frequently reported. These measurements were presented over the two rounds of the Delphi process, along with two additional measurements that were suggested by participants. Ultimately, two measurements, Reimer’s migration percentage and femoral head-shaft angle, were included in the CMS.ConclusionThis use of a minimum standardized set of measurements has the potential to encourage uniformity across hip surveillance programmes, and may streamline the development of tools, such as artificial intelligence systems to automate the analysis in surveillance programmes. This core set should be the minimum requirement in clinical studies, allowing clinicians to add to this as needed, which will facilitate comparisons to be drawn between studies and future meta-analyses.Cite this article: Bone Jt Open 2023;4(11):825–831.

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

Cited by 12 publications

References 10 publications

The Femoral Head-Shaft Angle Is Not a Predictor of Hip Displacement in Children Under 5 Years With Cerebral Palsy: A Population-based Study of Children at GMFCS Levels III-V

The Femoral Head-Shaft Angle Is Not a Predictor of Hip Displacement in Children Under 5 Years With Cerebral Palsy: A Population-based Study of Children at GMFCS Levels III-V

Proximal Femoral Screw Hemiepiphysiodesis in Children With Cerebral Palsy Improves the Radiographic Measures of Hip Subluxation

Radiological assessment of hip disease in children with cerebral palsy: development of a core measurement set

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