Determinants of Hip and Femoral Deformities in Children With Spastic Cerebral Palsy

Abstract

ObjectiveTo find factors affecting hip and femoral deformities in children with spastic cerebral palsy (CP) by comparing various clinical findings with imaging studies including plain radiography and computed tomography (CT) imaging.MethodsMedical records of 709 children with spastic CP who underwent thorough baseline physical examination and functional assessment between 2 to 6 years old were retrospectively reviewed. Fifty-seven children (31 boys and 26 girls) who had both plain radiography of the hip and three-dimensional CT of the lower extremities at least 5 years after baseline examination were included in this study.ResultsThe mean age at physical examination was 3.6 years (SD=1.6; range, 2–5.2 years) and the duration of follow-up imaging after baseline examination was 68.4 months (SD=22.0; range, 60–124 months). The migration percentage correlated with motor impairment and the severity of hip adductor spasticity (R1 angle of hip abduction with knee flexion). The femoral neck and shaft angle correlated with the ambulation ability and severity of hip adductor spasticity (R1 and R2 angles of hip abduction with both knee flexion and extension).ConclusionHip subluxation and coxa valga deformity correlated with both dynamic spasticity and shortening of hip adductor muscles. However, we found no correlation between femoral deformities such as femoral anteversion, coxa valga, and hip subluxation.

Hip subluxation in Italian cerebral palsy children and its determinants: a retrospective cohort study

“…Femoral and combined osteotomies were confirmed to significantly reduce MP values in both groups, as demonstrated by many studies [16,17,20,28]. Nonetheless, not all the luxated hips, in our population, were addressed to reconstructive surgery.…”

“…This indicates that spasticity is an aetiological factor, consistent with the findings by Cho et al . [28], who demonstrated a strong association between MP and adductor muscle spasticity. However, according to our results, spasticity treatment alone (BoNT-A, oral or intrathecal baclofen) did not have a significant role in reducing neither the MP nor the MP progression.…”

3-D acetabular morphology of the neuromuscular hip: implications for preoperative planning

“…Neuromuscular hip dysplasia has long been thought to be a disease of altered mechanics related to abnormal spasticity in certain muscle groups [12,[19][20][21]. Wiberg, in his seminal 1939 monograph, posited that decreased femoral head coverage would result in increased joint reactive forces, resulting in accelerated cartilage wear and osteoarthritis [22].…”

Efficacy and safety of onabotulinumtoxinA with standardized physiotherapy for the treatment of pediatric lower limb spasticity: A randomized, placebo-controlled, phase III clinical trial

“…Spasticity causes muscle shortening ( Lieber et al, 2004 ) and prevents physiologic derotation of bone because spasticity alters the normal forces affecting bony remodeling with typical ambulation resulting in poor bone development. Therefore, chronic spasticity can result in bony deformity such as coxa valga ( Cho et al, 2018 ), and persistent femoral anteversion ( Karabicak et al, 2016 ), requiring multiple orthopedic surgeries for joint contractures and can worsen quality of life in children with CP ( Arnaud et al, 2008 ; Ostensjø et al, 2004; Parkinson et al, 2010 ).…”