Hip surveillance and management of the displaced hip in cerebral palsy

Abstract

Introduction This article provides an overview of the management of a displaced hip in children with cerebral palsy and considers surveillance programmes, principles of surgical reconstruction and options for the salvage of an unreconstructable hip in these children. Conclusion Hip dislocation in CP is potentially preventable if children are included from an early age in a surveillance programme that includes repeat radiographic and clinical examinations, and preventive treatment for hips that are displacing. A surveillance programme should be based on the child's age, GMFCS level and migration percentage (MP), and surgical prevention may be considered in children with a MP exceeding 33 %.

Salvage Options in the Cerebral Palsy Hip: A Systematic Review

“…Salvage options include femoral head and neck resection, VO with or without resection of the femoral head and neck, arthrodesis, and total joint replacement or prosthetic interposition. 3 Our systematic review included 722 hips treated by a variety of procedures in both ambulators and nonambulators, including FHR (369, 51.1%), VO (160, 22.2%), THA (139, 19.3%), SPI (32, 4.4%), and arthrodesis (22, 3%). Our analysis was limited by the fact that many studies did not separate ambulators from nonambulators, 18,23,27,29,31 and some studies did not separate pain relief by type of procedure performed.…”

“…3 The available literature comparing options for salvage is limited and consists mainly of case series of relatively small numbers of 501 articles. Screening based upon title and abstract yielded 100 articles.…”

Hip Reconstruction in Children With Unilateral Cerebral Palsy and Hip Dysplasia

“…4,5,7,22 Therefore, hip surveillance programs have not recommended ongoing radiologic surveillance for this group of patients. 4,22,23 However, it is not clear from previous studies how common hip dysplasia is among children who are classified as having hemiplegia type IV according to Winters classification for spastic hemiplegia 24 indicating that they have motor dysfunction of the entire lower limb including a restricted motion of the hip. It has been reported as high as 10% 5,8 ; however, this is mild dysplasia in young children.…”

Unfavorable Hip Stress Distribution in a Patient with Cerebral Palsy as a Cause for Hip Dislocation

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Hip dislocation is a relatively common complication in cerebral palsy [1]. Surgical intervention in the early phase is the preferred choice of treatment which however requires following the migration of femoral head with respect to acetabulum in hips at risk [1].

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“…Surgical intervention in the early phase is the preferred choice of treatment which however requires following the migration of femoral head with respect to acetabulum in hips at risk [1]. Standard anteroposterior radiograms are used to assess the Reimers index (RI) which expresses the percent of epiphyseal ossific nucleus located outside the acetabular roof ( Figure 1a); the hip is considered displaced if RI is greater than 0.3 [1].…”