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 Effect of clinician's experience and expertise on the inter- and intra-observer reliability of hip migration index in children with cerebral palsy

Medicine ◽  
2021 ◽  
Vol 100 (10) ◽  
pp. e24538
Author(s):  
Necdet Demir ◽  
Mehmet Demirel ◽  
Önder Turna ◽  
Derya Yildizlar ◽  
Önder Demirbaş ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Migration Index ◽  
Observer Reliability ◽  
Children With Cerebral Palsy ◽  
Hip Migration

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

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

Hip migration percentage in children with cerebral palsy treated with botulinum toxin type A

2005 ◽  
Vol 86 (3) ◽  
pp. 431-435 ◽  
Author(s):  
Frank S. Pidcock ◽  
David E. Fish ◽  
Doug Johnson-Greene ◽  
Isabel Borras ◽  
John McGready ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Botulinum Toxin ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Children With Cerebral Palsy ◽  
Migration Percentage ◽  
Hip Migration

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 An evidence-based review of hyperbaric oxygen for children with cerebral palsy

2001 ◽  
Vol 57 (4) ◽  
pp. 21-22
Author(s):  
F. M. Bischof
Keyword(s):  
Cerebral Palsy ◽  
Pilot Study ◽  
Motor Function ◽  
Controlled Trial ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Children With Cerebral Palsy ◽  
High Level

This paper reviews the evidence in the literature for the use of hypebaric oxygen (HBO) in the treatment of cerebral palsy (CP). To date there are only two published studies on the outcome of HBO administration in CP. A pilot study showed significant improvement in gross motor function but provided a low level of evidence. A recent multicentre, double blind, placebo controlled trial reported similar improvements in both HBO and placebo groups, but no difference between the groups. This study had a high level of evidence. The results suggest that participation in the trial produced clinically important gains in function. The outcome of the study implies that HBO may have a placebo effect in CP.

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