scholarly journals Hip displacement in children with cerebral palsy in Scotland: a total population study

2018 ◽  
Vol 12 (6) ◽  
pp. 635-639 ◽  
Author(s):  
K. E. Bugler ◽  
M. S. Gaston ◽  
J. E. Robb
Keyword(s):  
Cerebral Palsy ◽  
Total Population ◽  
Hip Dislocation ◽  
Level Of Evidence ◽  
Surveillance Programme ◽  
Hip Displacement ◽  
Number Of Children ◽  
Children With Cerebral Palsy ◽  
Migration Percentage ◽  
Gmfcs Level

Purpose The purpose of this study is to report the number of children from a total population of children with cerebral palsy (CP) in Scotland who had a displaced or dislocated hip at first registration in a national surveillance programme. Methods Migration percentage (MP), laterality, Gross Motor Function Classification System (GMFCS) level, CP subtype, distribution of CP and age were analyzed in 1171 children. Relative risk was calculated with 95% confidence intervals. Hip displacement and dislocation were defined as a MP of 40 to 99 and > 100 respectively. Results Radiographs were available from the first assessment of 1171 children out of 1933 children registered on the system. In all, 2.5% of children had either one or both hips dislocated (29/1171) and dislocation only occurred in children of GMFCS levels IV and V. A total of 10% of children had a MP 40 to 99 in one or both hips (117/1171). An increasing GMFCS level was strongly associated with an abnormal MP. Hip dislocation was unusual in patients under the age of seven years. A MP of 40 to 99 was not seen in children with isolated dystonia. Displacement was more frequent in children with bilateral involvement and dislocation was only seen in spastic and mixed tone groups. Conclusion This data gives an overview of the number of CP children who have hip displacement/dislocation in Scotland and who will possibly require surgery. Level of Evidence I

Hip displacement and dislocation in a total population of children with cerebral palsy in Scotland

2020 ◽  
Vol 102-B (3) ◽  
pp. 383-387 ◽  
Author(s):  
Sarah J. Wordie ◽  
James E. Robb ◽  
Gunnar Hägglund ◽  
Kate E. Bugler ◽  
Mark S. Gaston
Keyword(s):  
Cerebral Palsy ◽  
Total Population ◽  
Hip Surgery ◽  
Surveillance Programme ◽  
Hip Displacement ◽  
Initial Surgery ◽  
Radiological Data ◽  
Children With Cerebral Palsy ◽  
Before And After ◽  
Second Procedure

Aims The purpose of this study was to compare the prevalence of hip displacement and dislocation in a total population of children with cerebral palsy (CP) in Scotland before and after the initiation of a hip surveillance programme. Patients A total of 2,155 children with CP are registered in the Cerebral Palsy Integrated Pathway Scotland (CPIPS) surveillance programme, which began in 2013. Physical examination and hip radiological data are collected according to nationally agreed protocols. Methods Age, Gross Motor Function Classification System (GMFCS) level, subtype of CP, migration percentage (MP), and details of hip surgery were analyzed for all children aged between two and 16 years taken from a time of census in March 2019 and compared to the same data from the initial registration of children in the CPIPS. Displacement of the hip was defined as a MP of between 40% and 99%, and dislocation as a MP of 100%. Results A total of 1,646 children were available for analysis at the time of the census and 1,171 at their first registration in CPIPS. The distribution of age, sex, and GMFCS levels were similar in the two groups. The prevalence of displacement and dislocation of the hip before surveillance began were 10% (117/1,171) and 2.5% (29/1,171) respectively, and at the time of the census were 4.5% (74/1,646) and 1.3% (21/1,646), respectively. Dislocation was only seen in GMFCS levels IV and V and displacement seen in 90.5% (67/74) of these levels and 9.5% (7/74) in levels I to III. In total, 138 children had undergone hip surgery during the study period. The hip redisplaced after the initial surgery in 15 children; seven of these had undergone a second procedure and at the time of the census the hips in all seven had a MP < 40. Conclusion Hip surveillance appears to be effective and has reduced the prevalence of hip displacement by over half and dislocation almost by half in these children. Cite this article: Bone Joint J 2020;102-B(3):383–387

scholarly journals Development of hip displacement in cerebral palsy: a longitudinal register study of 1,045 children

2021 ◽  
Author(s):  
Philippe Wagner ◽  
Gunnar Hägglund
Keyword(s):  
Cerebral Palsy ◽  
Hip Dislocation ◽  
System Level ◽  
Surveillance Programme ◽  
Hip Displacement ◽  
Preventive Surgery ◽  
Radiographic Measurements ◽  
Migration Percentage ◽  
Derotation Osteotomy ◽  
The Mean

Background and purpose — Hip surveillance in children with cerebral palsy (CP) includes repeated radiographic hip examinations and measurements of the hip migration percentage (MP) to identify hips in need of surgery early, to prevent dislocation with the fewest number of radiographic examinations possible. We analyzed the early development of the MP in hips operated on to prevent hip dislocation and hips stabilized without surgery Patients and methods — From the Swedish Surveillance Programme for CP, 5,899 radiographic measurements from 1,045 children with a Gross Motor Function Classification System level III–V born in 1996–2011 were analyzed. For children operated on to prevent hip dislocation, measurements up to the most recent preoperative radiograph were included. The hip with highest MP was analyzed for each child. A mixed-effects model was used to estimate the development of the MP at each age for each child and the population mean. Results — In the 702 children who did not undergo preventive surgery, the mean MP increased with decreasing velocity up to age 6 years. Here it reached 24% (95% confidence interval [CI] 24–25), with a velocity of 0.3%/year (CI 0.0–0.5), remaining approximately stable up to age 12 years. In the 343 children who underwent preventive surgery (219 adductor–psoas lengthening, 124 varus derotation osteotomy of proximal femur), the mean MP increased with an increasing velocity from a mean of 30% (CI 27–32) 3 years before the operation. Interpretation — An increasing rate of hip displacement in hips with an MP > 24% indicates the need for preventive surgery. Hips stabilized without preventive surgery had a decreasing displacement rate and were usually stabilized with an MP < 30% at age 6 years.

scholarly journals Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project

2021 ◽  
pp. 1-9
Author(s):  
Robert M. Kay ◽  
Kristan Pierz ◽  
James McCarthy ◽  
H. Kerr Graham ◽  
Henry Chambers ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Rectus Femoris ◽  
Delphi Consensus ◽  
Level Of Evidence ◽  
Modified Delphi ◽  
International Panel ◽  
Children With Cerebral Palsy ◽  
Stiff Knee ◽  
Paediatric Orthopaedic ◽  
Gmfcs Level

Purpose The purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method. Methods The panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached. Results Consensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade. Conclusion This study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP. Level of evidence V

scholarly journals Reliability and efficiency of three methods of calculating migration percentage on radiographs for hip surveillance in children with cerebral palsy

2018 ◽  
Vol 12 (2) ◽  
pp. 145-151 ◽  
Author(s):  
V. A. Kulkarni ◽  
J. R. Davids ◽  
A. D. Boyles ◽  
N. Q. Cung ◽  
A. Bagley
Keyword(s):  
Cerebral Palsy ◽  
Absolute Difference ◽  
Measurement Tool ◽  
Digital Measurement ◽  
Level Of Evidence ◽  
Digital Templating ◽  
Children With Cerebral Palsy ◽  
Migration Percentage ◽  
The Mean ◽  
Time Required

Purpose Hip surveillance programmes for children with cerebral palsy (CP) utilize the migration percentage (MP) measurement to initiate referrals and recommend treatment. This study assesses the reliability and efficiency of three methods of MP measurement on anteroposterior (AP) pelvis radiographs. Methods A total of 20 AP pelvis radiographs (40 hips) of children with CP were measured by three raters on two occasions using three methods: digital measurement (DM) on a Picture Archiving and Communication System monitor, computer-aided measurement (CA) using a digital templating tool and mobile device application measurement (MA) using a freely available MP measurement tool. For each method, the time required to complete the MP measurement of both hips on each AP pelvis radiograph was measured. Intra-class correlation coefficient (ICC) was used to determine reliability, and analysis of variance was used to compare groups. Results All three methods of determining MP showed excellent inter-rater and intra-rater reliability (ICC 0.976 to 0.989). The mean absolute difference in MP measurement was not significant between trials for a single rater (DM 2.8%, CA 1.9%, MA 2.2%) or between raters (DM 3.6%, CA 2.9%, MA 3.6%). The mean time to complete MP measurement was significantly different between methods, with DM = 151 seconds, CA = 73 seconds and MA = 80 seconds. Conclusion All three MP measurement methods were highly reliable with clinically acceptable measurement error. The time required to measure a hip surveillance radiograph can be reduced by approximately 50% by utilizing a computer-based or mobile application-based MP measurement tool. Level of Evidence III

scholarly journals The unstable hip in children with cerebral palsy: does an acetabuloplasty add midterm stability?

2021 ◽  
pp. 1-7
Author(s):  
Matthias W. Axt ◽  
Danielle L. Wadley
Keyword(s):  
Cerebral Palsy ◽  
Classification System ◽  
Group Versus ◽  
Level Of Evidence ◽  
Hip Stability ◽  
Children With Cerebral Palsy ◽  
Migration Percentage ◽  
Outcome Difference ◽  
Retrospective Comparative Study

Purpose This study addresses whether an additional pelvic procedure is superior to a varus derotation osteotomy femur (VDRO) alone in unstable hips in children with cerebral palsy (CP). Methods All patients had unstable hips utilising the Melbourne Cerebral Palsy Hip Classification System (MCPHCS). We compared one group that underwent VDRO alone with one that had a combination of VDRO and Dega osteotomy (VDRO+). Measurements were taken before surgery, postoperatively, two years after surgery and at latest follow-up. Generalised estimating equations were used to account for known and unknown correlations between hips from bilateral cases. Results In total, 74 hips in 57 children fulfilled the inclusion criteria. There was no outcome difference between Gross Motor Function Classification System levels III, IV and V. Age at time of operation ranged from three to 16 years (mean 9.8 years). Mean follow-up was 49.1 months. In the VDRO group (28 hips) migration percentage (MP) changed from 61% preoperative to a final value of 35.7%. In the VDRO+ group (46 hips) the MP changed from 64.4% to 19.3%. At final follow-up 15 hips (54%) were stable in the VDRO group, 37 hips (83%) in the VDRO+ group. The odds ratio (OR) of hip stability at final follow-up was 3.5-times higher in the VDRO+ group versus the VDRO group (OR = 3.9; 95% confidence interval = 1.5 to 9.7; p = 0.004). Conclusion Reconstruction of unstable hips via VDRO + Dega in children with CP provides a higher likelihood of long-term stability than an isolated VDRO. Level of Evidence Level III, retrospective comparative study

scholarly journals Is the Gothic Arch a reliable radiographic landmark for migration percentage in children with cerebral palsy?

2020 ◽  
Vol 14 (5) ◽  
pp. 397-404
Author(s):  
Caesar Wek ◽  
Piyal Chowdhury ◽  
Christian Smith ◽  
Michail Kokkinakis
Keyword(s):  
Cerebral Palsy ◽  
Acetabular Dysplasia ◽  
Classical Method ◽  
Level Of Evidence ◽  
Observer Reliability ◽  
Modified Method ◽  
Children With Cerebral Palsy ◽  
Migration Percentage ◽  
Hip Migration ◽  
Gothic Arch

Introduction Reimers migration percentage (MP) is the gold standard for measuring hip displacement in children with cerebral palsy (CP). Hip surveillance registries proposed using the top of the Gothic arch (GA) as a modification in patients with acetabular dysplasia because the classical method (CM) described by Reimers may underestimate hip migration. The aim of this study is to assess the inter- and intra-observer reliability of the modified method (MM) versus the CM and identify their effect on the MP. Methods We performed a retrospective review of 50 children with CP, who had a hip radiograph at our institution between 1st April 2014 and 28th February 2018. All hip radiographs were carefully selected to show the presence of a GA. Four observers measured the MP using the CM and MM for each patient. Interclass coefficient was used to estimate inter- and intra-observer reliability. Results Inter-observer reliability was excellent for the CM with ICC 0.96 (95% CI 0.94 to 0.97) and good for the MM, ICC 0.78 (95% CI 0.51 to 0.89) p < 0.001. Intra-observer reliability was excellent for both methods raging from ICC 0.94 to 0.99 for the CM and ICC 0.89 to 0.95 for the MM. The mean MP was 19% for the CM and 28% for the MM (p < 0.001). Conclusion The CM is more reliable than the MM to measure hip migration in children with CP. If the CM is used and acetabular dysplasia with a GA are present on the hip radiograph, then a 9% hip migration underestimation should be considered on decisions for both referral and surgical management. Level of evidence II

scholarly journals Cerebral palsy with dislocated hip and scoliosis: what to deal with first?

2020 ◽  
Vol 14 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Ilkka J. Helenius ◽  
Elke Viehweger ◽  
Rene M. Castelein
Keyword(s):  
Cerebral Palsy ◽  
Early Identification ◽  
Hip Dislocation ◽  
Pelvic Obliquity ◽  
Neuromuscular Scoliosis ◽  
Function Score ◽  
Hip Reconstruction ◽  
Surveillance Programme ◽  
Children With Cerebral Palsy ◽  
Similar Programme

Purpose Hip dislocation and scoliosis are common in children with cerebral palsy (CP). Hip dislocation develops in 15% and 20% of children with CP, mainly between three and six years of age and especially in the spastic and dyskinetic subtypes. The risk of scoliosis increases with age and increasing disability as expressed by the Gross Motor Function Score. Methods A hip surveillance programme and early surgical treatment have been shown to reduce the hip dislocation, but it remains unclear if a similar programme could reduce the need for neuromuscular scoliosis. When hip dislocation and neuromuscular scoliosis are co-existent, there appears to be no clear guidelines as to which of these deformities should be addressed first: hip or spine. Results Hip dislocation or windswept deformity may cause pelvic obliquity and initiate scoliosis, while neuromuscular scoliosis itself leads to pelvic obliquity and may increase the risk of hip dislocation especially on the high side. It remains unclear if treating imminent hip dislocation can prevent development of scoliosis and vice versa, but they may present at the same time for surgery. Current expert opinion suggests that when hip dislocation and scoliosis present at the same time, scoliosis associated pelvic obliquity should be corrected before hip reconstruction. If the patient is not presenting with pelvic obliquity the more symptomatic condition should be addressed first. Conclusion Early identification of hip displacement and neuromuscular scoliosis appears to be important for better surgical outcomes.

scholarly journals Prevalence of Scoliosis in Cerebral Palsy

2021 ◽  
Vol 07 (03) ◽  
pp. 20-25
Author(s):  
Anushree Kailas Gurav ◽  
Keyword(s):  
Cerebral Palsy ◽  
Inverse Relationship ◽  
Care Setting ◽  
Total Population ◽  
Skeletal Maturity ◽  
Sitting Balance ◽  
Spastic Quadriplegia ◽  
Children With Cerebral Palsy ◽  
Structural Deformity ◽  
Gmfcs Level

Background: Significant structural deformity of the spine often accompanies cerebral palsy. Progression of curve will eventually lead to pain, loss of ambulation, sitting balance. The aetiology of scoliosis in CP has yet to be well defined. Objective: The objective of this study was to find incidence of scoliosis in different sub-types of cerebral palsy. Method: A total population of 30 children with cerebral palsy aged 5 to 20 years followed with examination and assessment for scoliosis in a health care setting was analysed. GMFCS level, CP subtype, age at diagnosis, gender dominance of the condition were correlates registered. Effect of 5 factors on progression of the curve and type of scoliosis dominant in cerebral palsy was studied. Results: Of the 30 subjects initially enrolled in the study, 19 of them with scoliosis in which incidence of 28% was found among spastic quadriplegia followed by 24% in diplegia. The risk of scoliosis increased with GMFCS level and age. 22% of children showed moderate scoliosis with respect to scoliosis appearance questionnaire. Conclusions: Scoliosis was most common in the spastic group with the highest incidence in the spastic quadriplegics. There was a definite inverse relationship between the level of ambulation and scoliosis: the higher the level of ambulation the lower the incidence of scoliosis. Moderate scoliosis was found because progression of curve is expected to continue until skeletal maturity.

scholarly journals Risk factors for hip dislocation in dyskinetic cerebral palsy

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110011
Author(s):  
Kyoko Okuno ◽  
Yukihiro Kitai ◽  
Toru Shibata ◽  
Hiroshi Arai
Keyword(s):  
Risk Factors ◽  
Cerebral Palsy ◽  
Birth Weight ◽  
Gestational Age ◽  
Brain Mri ◽  
Brain Lesion ◽  
Brain Lesions ◽  
Lesion Location ◽  
Hip Displacement ◽  
Gmfcs Level

Purpose: To investigate the risk factors for hip displacement in patients with dyskinetic cerebral palsy (DCP). Methods: We evaluated 81 patients with DCP, 45 males and 36 females, aged 10–22 years, risk factors for hip displacement were evaluated using multivariate logistic regression analysis with primary brain lesions, Gross Motor Function Classification System (GMFCS) level, gestational age, birth weight, Cobb’s angle, and complication of epilepsy as independent factors. Hip displacement was defined as migration percentage >30%. Primary brain lesions were classified into globus pallidus (GP), thalamus and putamen (TP), and others using brain magnetic resonance imaging (MRI). Perinatal and clinical features were compared between patients with GP lesions and those with TP lesions. Results: Hip displacement was observed in 53 patients (67%). Higher GMFCS levels (p = 0.013, odds ratio [OR] 2.6) and the presence of GP lesions (p = 0.04, OR 16.5) were independent risk factors for hip displacement. Patients with GP lesions showed significantly higher GMFCS levels, more frequent hip displacement, and lower gestational age and birth weight than those with TP lesions. Conclusion: Primary brain lesion location may be an important factor in predicting hip displacement among patients with DCP. Appropriate risk assessment using brain MRI may contribute to the early detection and intervention of hip displacement because brain lesion location can be assessed during infancy before GMFCS level is decided.

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