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 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 Soft tissue surgery as an initial treatment for hip displacement in spastic cerebral palsy

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 38
Author(s):  
Luiz Antônio Angelo da Silva ◽  
Patricia Maria de Moraes Barros Fucs
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Small Sample ◽  
Acetabular Index ◽  
Soft Tissue Release ◽  
Spastic Cerebral Palsy ◽  
Hip Displacement ◽  
Migration Percentage ◽  
Soft Tissue Surgery

Objective: To use the measurement of migration percentage (MP) to evaluate the long-term radiographic results of soft tissue surgery as the first treatment for hip displacement in spastic bilateral cerebral palsy. A secondary objective was to identify predictive factors of stability (i.e., less than 30% of MP in the long term), after surgical correction. Methods: In this longitudinal cohort study, we reviewed the electronic medical records and radiographs of all consecutive patients with cerebral palsy operated for the correction of hip displacement between 1984 and 2013 in a referral orthopedic public hospital in Brazil. Patients were included if they had received, as the first surgical procedure, soft-tissue release. All surgeries were bilateral and symmetrical. We used the available radiographs to evaluate the migration percentage (MP), acetabular index (AI), pelvic obliquity (PO) angle, head-shaft angle (HSA), congruence and femoral head sphericity, and function using the GMFCS (Gross Motor Function Classification System). Results: we included 93 patients, all operated before being 12 years old, with follow-up of 10 years in average, 73 (78%) of them with good results (MP < 30%). We found association between preoperative MP ≤ 40%, AI ≤ 25°, and postoperative symmetry with good results, with a cut-off value of 38% of MP and 27° of acetabular index being predictive. Discussion: The role of soft tissue releases remains controversial owing to small sample sizes, heterogeneity, variety range of ages, definitions used for outcome, and lack of statistical quality. Our results were better in combined tenotomies, in diparetic patients aged more than six years, and in patients with lower initial values of MP and AI. Radiographic variables had good correlation with each other and association with results, with cut-off values for MP and AI PRE.

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 Outcome of Femoral Varus Derotational Osteotomy for the Spastic Hip Displacement: Implication for the Indication of Concomitant Pelvic Osteotomy

2020 ◽  
Vol 9 (1) ◽  
pp. 256
Author(s):  
Hoon Park ◽  
Sharkawy Wagih Abdel-Baki ◽  
Kun-Bo Park ◽  
Byoung Kyu Park ◽  
Isaac Rhee ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Roc Curve ◽  
Pelvic Osteotomy ◽  
Multivariate Regression Analysis ◽  
Roc Curve Analysis ◽  
Hip Displacement ◽  
Large Patient ◽  
Age At Surgery ◽  
Derotational Osteotomy ◽  
Migration Percentage

No previous studies have suggested a reliable criterion for determining the addition of a concomitant pelvic osteotomy by using a large patient cohort with quadriplegic cerebral palsy and a homogenous treatment entity of femoral varus derotational osteotomies (VDRO). In this retrospective study, we examined our results of hip reconstructions conducted without a concomitant pericapsular acetabuloplasty in patients with varying degrees of hip displacement. We wished to investigate potential predictors for re-subluxation or re-dislocation after the index operation, and to suggest the indications for a simultaneous pelvic osteotomy. We reviewed the results of 144 VDROs, with or without open reduction, in 72 patients, at a mean follow-up of 7.0 (2.0 to 16.0) years. Various radiographic parameters were measured, and surgical outcomes were assessed based on the final migration percentage (MP) and the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS) grades. The effects of potential predictive factors on the surgical outcome was assessed by multivariate regression analysis. A receiver operating characteristic (ROC) curve analysis was also performed to determine whether a threshold of each risk factor existed above which the rate of unsatisfactory outcomes was significantly increased. In total, 113 hips (78.5%) showed satisfactory results, classified as MCPHCS grades I, II, and III. Thirty-one hips (21.5%) showed unsatisfactory results, including six hip dislocations. Age at surgery and preoperative acetabular index had no effects on the results. Lower pre- and postoperative MP were found to be the influential predictors of successful outcomes. The inflection point of the ROC curve for unsatisfactory outcomes corresponded to the preoperative MP of 61.8% and the postoperative MP of 5.1%, respectively; these thresholds of the pre- and postoperative MP may serve as a guideline in the indication for a concomitant pelvic osteotomy. Our results also indicate that the severely subluxated or dislocated hip, as well as the hip in which the femoral head is successfully reduced by VDRO but is still contained within the dysplastic acetabulum, may benefit from concomitant pelvic osteotomy.

scholarly journals Effect of Botulinum Toxin Injection on the Progression of Hip Dislocation in Patients with Spastic Cerebral Palsy: A Pilot Study

Toxins ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 872
Author(s):  
Yookyung Lee ◽  
Seungeun Lee ◽  
Joonyoung Jang ◽  
Jiwoon Lim ◽  
Ju Seok Ryu
Keyword(s):  
Cerebral Palsy ◽  
Botulinum Toxin ◽  
Muscle Tone ◽  
Botulinum Toxin Injection ◽  
Hip Dislocation ◽  
Surface Emg ◽  
System Level ◽  
Spastic Cerebral Palsy ◽  
Adductor Muscles

Hip adductor spasticity is a contributing factor to hip dislocation in patients with cerebral palsy (CP). We hypothesized that botulinum toxin injected into the hip adductor muscles would reduce spasticity and help prevent hip dislocation. Twenty patients with bilateral spastic CP aged 2 to 10 years with gross motor function classification system level IV or V were included. Botulinum toxin was injected into the hip adductor muscles at baseline and at 6-month follow-up. Muscle tone was measured with an eight-channel surface electromyography (EMG) recorder. A hip X-ray was performed, and Reimer’s hip migration index (MI) was measured. The Wilcoxon signed-rank test was used to compare the surface EMG values of the hip muscles at baseline and follow-up. The mean root mean square surface EMG value of the hip adductor muscles was significantly reduced at 1, 2, 3, and 7 months after the first injection, up to approximately 53% of the baseline. The 1-year progression of the hip MI was −0.04%. Repeated sessions of botulinum toxin injections at the hip adductor muscles significantly reduced muscle tone and hip displacement. A botulinum toxin injection may be used as an adjunctive treatment in the prevention of hip dislocation.

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 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 Remodelling of femoral head deformity after hip reconstructive surgery in patients with cerebral palsy

2021 ◽  
Vol 103-B (1) ◽  
pp. 198-203
Author(s):  
Jae Jung Min ◽  
Soon-Sun Kwon ◽  
Ki Hyuk Sung ◽  
Kyoung Min Lee ◽  
Chin Youb Chung ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Femoral Head ◽  
Reconstructive Surgery ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Pelvic Osteotomy ◽  
System Level ◽  
Factors Affecting ◽  
Neck Shaft Angle ◽  
Hip Displacement

Aims Hip displacement, common in patients with cerebral palsy (CP), causes pain and hinders adequate care. Hip reconstructive surgery (HRS) is performed to treat hip displacement; however, only a few studies have quantitatively assessed femoral head sphericity after HRS. The aim of this study was to quantitatively assess improvement in hip sphericity after HRS in patients with CP. Methods We retrospectively analyzed hip radiographs of patients who had undergone HRS because of CP-associated hip displacement. The pre- and postoperative migration percentage (MP), femoral neck-shaft angle (NSA), and sphericity, as determined by the Mose hip ratio (MHR), age at surgery, Gross Motor Function Classification System level, surgical history including Dega pelvic osteotomy, and triradiate cartilage status were studied. Regression analyses using linear mixed model were performed to identify factors affecting hip sphericity improvement. Results A total of 108 patients were enrolled. The mean preoperative MP was 58.3% (SD 31.7%), which improved to 9.1% (SD 15.6%) at the last follow-up. NSA and MHR improved from 156.5° (SD 11.5°) and 82.3% (SD 8.6%) to 126.0° (SD 18.5°) and 89.1% (SD 9.0%), respectively. Factors affecting the postoperative MHR were preoperative MP (p = 0.005), immediate postoperative MP (p = 0.032), and history of Dega osteotomy (p = 0.046). Conclusion We found that hip sphericity improves with HRS. Preoperative MP, reduction quality, and acetabular coverage influence femoral head remodelling. We recommend that surgeons should consider intervention early before hip displacement progresses and that during HRS, definite reduction and coverage of the femoral head should be obtained. Cite this article: Bone Joint J 2021;103-B(1):198–203.

Sign in / Sign up

Export Citation Format

Share Document