Substantiation of the method for determining the clinical and radiographic parameters of the hip joint in patients with cerebral palsy

Background. The difficulties of diagnosis that arise when choosing therapeutic measures aimed at preventing sublu-xation, dislocation, and contractures of the hip joint in patients with cerebral palsy are a topical object of the research. The purpose was to improve the results of the diagnosis of the hip joint pathology by establishing objective radiographic parameters. Materials and methods. The total number of patients was 20 (40 joints), 10 boys and 10 girls aged 3 to 15 years. Sixteen joints were operated. Radiographically, we have determined neck-shaft angle and torsion of the thigh, projection and true according to Koval (using tables), acetabular angle, angle of inclination (Sharpe’s angle). Hip torsion was determined clinically according to Ruwe. Torsion was evaluated intraoperatively in our own way (patent No. a200512793). All patients were examined using our method (patent No. 137567). Results. Using the Student’s t-test for independent samples, the parameters of the hip joints were compared and significant differences were found between the neck-shaft angle in the standard position and the neck-shaft angle in our own position (p < 0.05), as well as between the neck-shaft angle in the standard position and the neck-shaft angle true according to Koval (p < 0.05). According to Fisher’s test, it was found that the torsion according to Ruwe and the torsion according to Koval are significantly different (p < 0.05): Femp 1.87 > Fkr 1.7. Using the method of odds ratio (OR), we determined that the sensitivity of torsion measurement by Ruwe was 0.7, the specificity of torsion measurement by Ruwe was 0.83 (OR = 11.67, confidence interval [1.94–70.18]) indicating that the chance of getting a coincidence by measuring torsion by Ruwe is 11.67 times higher than accor-ding to Koval, compared with intraoperative data. A well-defined amount of torsion of the thigh according to Ruwe provides true indicators of the hip joint using our own method. Conclusions. The own method provides the determination of objective clinical and radiographic (diagnostic) parameters in patients with patho-logy of the hip joint. When performing one roentgenogram, it is possible to define all basic parameters of the hip joint (torsion of the hip, neck-shaft angle, Wiberg’s angle, Reimers’ index, index of vertical migration, acetabular angle, angle of inclination) and to standardize examinations of patients with cerebral palsy who are subject to screening throughout the whole period of their development. In this way, you can get radiographic indicators of patients with severe neuromuscular disorders (Gross Motor Function Classification System levels III and IV).

Residual hip dysplasia in children: osseous and cartilaginous acetabular angles to guide further treatment—a pilot study

Purpose In case of residual hip dysplasia (RHD) in children, pelvic radiographs are sometimes insufficient to precisely evaluate the entire coverage of the femoral head, when trying to decide on the need for further reconstructive procedures. Methods This study retrospectively compares the bony and the cartilaginous acetabular angle of Hilgenreiner (HTE) of 60 paediatric hips on pelvic MRI separated in two groups. Group 1 included 31 hips with RHD defined by a bony HTE > 20°. Group 2 included 27 hips with a HTE < 20°. They were compared by introducing a new ratio calculated from the square of cartilaginous HTE above the bony HTE on frontal MRI. The normal upper limit for this acetabular angle ratio was extrapolated from the published normal values of cartilaginous HTE and bony HTE in children. Results The acetabular angle ratio was statistically significantly increased in the hips with RHD with a mean value of 7.1 ± 4.7 compared to the hips in the control group presenting a mean value of 2.1 ± 1.9 (p < 0.00001). Conclusions This newly introduced ratio seems to be a helpful tool to orientate the further treatment in children presenting borderline RHD.

Radiological Outcomes of Overhead Traction Therapy for Developmental Dysplasia of the Hip in Non-ambulatory Children

Background. Infants with a dislocated and unstable hip that does not lend itself to stabilisation may be treated using overhead traction to achieve gradual reduction of the hip joint. The aim of this paper was to analyse the radiological outcomes of overhead traction therapy and the effect of duration of traction on the occurrence of complications and final treatment outcomes. Material and methodd. A retrospective analysis of medical records of 26 children (34 affected hips) involved three independent observers assessing radiological parameters before the surgery and at follow-up visits at least two years after the therapy. Results. Overhead traction was used for an average of 35 days (range: 15-43 days). Twenty six hips were treated solely with reduction and immobilisation in a ‘human position’ plaster cast. Three hips were qualified for surgery immediately after a preliminary traction period. Five hips showed a suboptimal result following the immobilisation period. A MANOVA model revealed that the following factors had a significant effect on the treatment outcome: superior centring ratio of Smith (with the lowest values recorded in patients with residual hip dysplasia, p = 0.001) and acetabular angle of Sharp (with the lowest values found in patients requiring surgery, p = 0.01). Statistical tests did not show a correlation between the duration of traction and disturbance of proximal femoral metaphysis growth assessed according to Bucholz and Ogden classification. Fifteen hips were classified as type I, eight hips were graded as type II and also eight hips as type III. Conclusions. The lowest values of acetabular angle of Sharp were recorded in patients requiring surgery and the lowest superior centring ratio of Smith was found in those with residual hip dysplasia. The duration of overhead traction did not directly correlate with the final outcome; it only seemed to be an indicator of the severity of hip dysplasia. Routine use of overhead traction before undertaking closed reduction does not probably decrease the incidence of proximal femoral growth disturbance.

Radiological Evaluation of Hip in Cerebral Palsy: A Randomized Cross-sectional Study

ABSTRACT Introduction The incidence of hip abnormalities in cerebral palsy (CP) patients has been reported as low as 2.6% and as high as 28%. Hip displacement is the second most common deformity after equines. The objective of this study is to evaluate the radiological changes of hip in CP for detecting early features of hip instability. Materials and methods A total of 91 hips of 52 patients with CP who attended for rehabilitation management were randomly selected for the study. Hip surveillance was done in those cases where the clinical evaluation alone could not access stability. All the selected cases were evaluated radiologically with respect to acetabular angle, neck-shaft angles, degree of subluxation (migration percentage) and shape of femoral head. Results 38 hips showed grade I, 14 hips grade II, 6 hips grade III, and 2 hips grade IV stage of migration percentage. Flattening of femoral head was laterally seen in 16 cases, both medial and lateral flattening was seen in 8 cases of subluxated hip. Acetabular roof angle was increased in cases with grade III and IV migration percentage. Acetabular angle was within 12 to 75° with mean angle of 32°. The mean true neck-shaft angle was 145.5° ranging from 134° to 170° Conclusion Early detection of hip instability in Cerebral Palsy helps in timely intervention and that reduces or delays need for reconstructive surgery. How to cite this article Sahoo PK, Sahu MM, Chitapure T, Das SP. Radiological Evaluation of Hip in Cerebral Palsy: A Randomized Cross-sectional Study. Indian J Phy Med Rehab 2017;28(3):95-99.