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

Abstract

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

Prevalence and treatment of hip displacement in children with cerebral palsy in Finland

“…In comparison with the Scottish "pre-surveillance" and Scottish surveillance CPIPS cohorts 16 (Table 4), the mean age of the children in Scotland was 1.5 years lower at follow-up than that of the Finnish children (n = 253; p < 0.001). The proportion of children with hip displacement in Finland (8.3%) was lower than in the Scottish "pre-surveillance" cohort (10%, p = 0.41), but higher than in the Scottish CPIPS cohort (4.5%, p = 0.009).…”

“…This was done by analyzing those members of this study cohort who met the inclusion criteria in two previously published studies. 15,16 The 2011 study by Elkamil et al 15 compared a Norwegian cohort of children with CP not enrolled in a surveillance program to the children in a comparable Swedish cohort in the CPUP. This study included children 7-15 years of age in GMFCS levels III-V. Data on hip displacements/dislocation, hip surgeries, and radiographic examinations were collected from medical records in Norway and from the CPUP register in Sweden.…”

Risk factors for hip dislocation in dyskinetic cerebral palsy

“…2,3 The dyskinetic types are mostly caused by lesions in the bilateral deep grey matter, such as the thalamus and putamen (TP) and globus pallidus (GP). 4,5 The prevalence of hip dislocation was reported to be 15-35% in patients with CP of all types [6][7][8][9] and 10-48% in those with dyskinetic cerebral palsy (DCP). 10,11 Hip displacement or dislocation often results in the destruction of the hip joint cartilage, causing pain in the hip and limitations in range of motion.…”

PredictMed: A Machine Learning Model for Identifying Risk Factors of Neuromuscular Hip Dysplasia: A Multicenter Descriptive Study

“…Previous studies 2,4,25,31,38 have so far identified only SP and high levels of GMFCS as factors associated with NHD.…”