Hip Surveillance in Children With Cerebral Palsy

Abstract

Hip dysplasia is common in children with cerebral palsy (CP), especially in those children with notable functional impairment. Severity of hip dysplasia has been shown to correlate with higher Gross Motor Function Classification System levels. Migration percentage measured on AP pelvis radiographs is the key radiographic measure quantifying hip displacement in CP. Hip surveillance programs for children with CP exist in Europe, Australia, and parts of Canada and have been adopted as standard of care. These programs have demonstrated improved detection of hip subluxation and appropriate early intervention with a resultant decrease in the number of painful dislocations. Hip surveillance programs provide healthcare providers with guidance for a schedule of obtaining hip radiographs based on patients' age, Gross Motor Function Classification System level, and migration percentage. Although systematic surveillance programs have yet to be adopted in the United States, several centers and organizations are currently investigating the potential and efficacy of hip screening in CP.

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

“…Surgery at a younger age can lead to better results because younger children have greater remodeling potential of the acetabulum [13,16,46]. On the contrary, delaying surgery at an older age has been supported by others [7,38,39] due to rebound coxa valga seen in patients treated with VDRO. Although age at the time of our index operation was found to be not a predictive factor for the satisfactory outcome, we think that the discrepancy on the age effects among the studies may be due to multiple factors; such as altered potential of the acetabular remodeling in patients with CP and progressive valgus deformity of the proximal femur caused by persistent weakness of the hip abductors resulting in growth retardation through the greater trochanter [47].…”

“…The primary goals of treatment for the spastic hip diseases are obtaining painless, flexible, and well-located hips to facilitate easy transfer of the patients, and their comfort sitting in a wheelchair [3]. Hip surveillance programs for children with CP have been adopted to prevent dislocation by early detection and early preventive surgery [7]. In both the Australian and Swedish settings, the prevalence of late dislocation had decreased, and the need for salvage surgery has been reduced [8,9].…”

Serebral palsi tedavisinde ortopedik cerrahide yenilikler: Alt ekstremite

“…Başarı oranının daha düşük olduğu KMFSS IV-V hastalarda da aynı yaklaşım işlevsel gerekçelerle rutin olarak uygulanabilir. [11,[25][26][27] değerlendirilen SP'li diplejik hareketli çocukta multimodal bir tedavi planı oluşturarak kas-iskelet deformitesi gelişimi önlenebilir (Şekil 3).…”

“…amacıyla aynı seansta yumuşak doku ve kemik ameliyatları ile restorasyonu sağlamak ve en kısa zamanda cerrahiye özel, erken dönemde pasif ve geç dönemde aktif rehabilitasyon programı uygulamak güncel yaklaşımdır (Tablo 3). [3,11,21,22,[25][26][27][28][29] Büyük çaba ile karmaşık cerrahi yapıldığında, her zaman SP'li hastaların büyük kazançlar elde edeceği düşünülmemelidir. [11,16,28,29]…”

Physical Therapists Are Key to Hip Surveillance for Children with Cerebral Palsy: Evaluating the Effectiveness of Knowledge Translation to Support Program Implementation

“…Hip surveillance for children with CP has become the recommended standard of care to identify progressive hip displacement (Shrader et al, 2019). Hip surveillance, which includes clinical and radiological exams at standardized intervals, is the process of identifying and monitoring early indicators of hip displacement (Wynter et al, 2011).…”