Natural History of the Dislocated Hip in Spastic Cerebral Palsy

Moreau, Marc; Drummond, Denis S.; Rogala, Eugene; Ashworth, Alan; Porter, Tim

doi:10.1111/j.1469-8749.1979.tb01696.x

Cited by 133 publications

(65 citation statements)

References 5 publications

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“…Literature review and determination of probable events based on consensus building A literature review was performed with a focus on the following: the natural history of unstable hips in CP, [9][10][11][12] operative complications of FVO 13 and delayed hip reconstruction including pelvic osteotomy, [14][15][16] contralateral hip instability after unilateral FVO in individuals with CP, 1,5,17,18 and pain utility measures in the hips. 19 Each event was reviewed on the basis of probability.…”

Section: Methodsmentioning

confidence: 99%

“…11,12,24,[31][32][33][34][35] Knapp and Cortes 9 found that 18% of adults with CP with hip dislocation had significant hip pain and that 11% had mild Figure 1: Decision analysis tree with probability and utility variables. The decision-node branches into concurrent femoral varization osteotomy for contralateral stable hips and into an observation node.…”

Section: Probabilitiesmentioning

confidence: 99%

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Prophylactic femoral varization osteotomy for contralateral stable hips in non‐ambulant individuals with cerebral palsy undergoing hip surgery: decision analysis

Park

Chung

Kwon

et al. 2012

Develop Med Child Neuro

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FVO Femoral varization osteotomyAIM This study was undertaken to determine the need for concurrent prophylactic femoral varization osteotomy (FVO) of contralateral stable hips at the time of hip reconstructive surgery on unstable hips in non-ambulant individuals with cerebral palsy (Gross Motor Function Classification System levels IV and V).METHOD A decision analysis model was constructed that included (1) the probability of unstable hips during observation of the contralateral stable hips, (2) unstable hip rate (subluxation or dislocation rate) after prophylactic FVO or after delayed reconstructive surgery (including FVO) for unstable hips, and (3) complication rates after concurrent prophylactic FVO or after hip reconstructive surgery. The final outcome score was based on pain utility measures. The probabilities of all cases and the utility score were obtained by literature review. RESULTSThe decision model favoured concurrent prophylactic FVO for the contralateral stable hips over observation (pain utility measure scores 0.814 vs 0.781). In a one-way sensitivity analysis, the decision model favoured concurrent prophylactic FVO when the unstable hip rate of contralateral stable hips during observation was 27% or over. Concurrent prophylactic surgery also demonstrated higher utility scores than observation when the unstable hip rate after FVO was between 0% and 29%.INTERPRETATION The decision analysis model demonstrated that concurrent prophylactic FVO for a contralateral stable hip in individuals with cerebral palsy undergoing hip reconstructive surgery was beneficial from a medical perspective, which was based on current evidence.Studies have reported that a considerable portion of radiographically stable contralateral hips eventually dislocate or subluxate in individuals with cerebral palsy (CP) with a unilateral unstable hip. 1-4 A recent study showed that 44% of severely involved individuals with CP undergoing unilateral femoral varization osteotomy (FVO) required subsequent bony surgical management of the contralateral hip for subluxation or dislocation before reaching skeletal maturity. 5 This high probability of dislocation of the contralateral stable hip during follow-up has generated interest in concurrent prophylactic FVO on the radiographically stable contralateral hip during reconstructive surgery of an unstable hip.Every medical practice must come to terms with the two opposing aspects of risk and benefit represented by optimal treatment and socio-economics. The merits of a procedure include increased life expectancy and improved healthrelated quality of life, and the demerits include complications and costs. Physicians usually weigh up these pros and cons when deciding whether to perform a medical procedure, although such assessments are invariably informal and subjective. These processes necessarily imply that analyses should be performed on the basis of the probabilities of various outcomes.Randomized controlled trials (RCTs) are most commonly used to verify the effectiveness of health-care se...

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Section: Methodsmentioning

confidence: 99%

Section: Probabilitiesmentioning

confidence: 99%

Prophylactic femoral varization osteotomy for contralateral stable hips in non‐ambulant individuals with cerebral palsy undergoing hip surgery: decision analysis

Park

Chung

Kwon

et al. 2012

Develop Med Child Neuro

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“…Problems with perineal hygiene are mentioned most frequently in the literature [8] and it is known that seating problems often occur in patients with severe CP [9]. Decubitus ulcers are reported in patients who are totally bed-bound [8].…”

Section: Introductionmentioning

confidence: 99%

“…Decubitus ulcers are reported in patients who are totally bed-bound [8]. Patients with severe CP are also prone to fractures [10].…”

Section: Introductionmentioning

confidence: 99%

Radiographic hip disorders and associated complications in severe cerebral palsy

Boldingh¹,

Bruggen

Bos

et al. 2007

Journal of Pediatric Orthopaedics B

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e We performed a cross-sectional study of 160 adult patients with severe cerebral palsy to study the relationship between radiographic hip disorders (migration and deformity of the femoral head), on the one hand, and complications such as handling problems, seating problems, decubitus ulcers, fractures and contractures, on the other hand. Both migration and deformity were positively related to the need for a special seat in the wheelchair and adduction contractures of the hip. We conclude that migration and deformity of the femoral head, if possible, should be prevented in patients with severe cerebral palsy.

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“…Spasticity of hip adductors and flexors results in fixed contractures, muscle imbalance and progressive hip displacement [2,3]. Without intervention, this process may end in hip dislocation, the consequences of which may be pain, gait deterioration, difficulty in seating and problems with perineal hygiene [4,5]. Thus, these children often require intervention for spasticity and hip displacement before their gross motor prognosis is clear and before invasive spasticity management with an intrathecal baclofen pump [6,7], selective dorsal rhizotomy [8,9] or multilevel orthopaedic surgery [1,10] for fixed deformities can be considered.…”

Section: Introductionmentioning

confidence: 99%

Adductor release and chemodenervation in children with cerebral palsy: A pilot study in 16 children

Khot

Sloan

Desai

et al. 2008

Journal of Children's Orthopaedics

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Purpose A pilot study with short-term outcomes of a combined surgical and medical intervention for management of generalized lower limb spasticity, hip displacement and contractures of adductors in children with bilateral spastic cerebral palsy. Methods A prospective cohort study of 16 children (9 boys and 7 girls) aged 2-6 years with bilateral spastic cerebral palsy was performed. At entry, 5 were classified as level III and 11 as level IV, according to the Gross Motor Function Classification System (GMFCS). The intervention consisted of surgical lengthening of adductor longus and gracilis combined with the phenolization of the anterior branch of the obturator nerve, using 1 ml of 6% phenol, applied under direct vision at the time of lengthening of adductor longus. The hamstring and calf muscles were each injected with Botulinum neurotoxin A at a dose of 4 U/kg/muscle. Serial clinical (hip, knee, ankle joint range of motion), radiographic (migration percentage) and functional data-taken from a functional mobility scale (FMS) or GMFCS-were collected at 3, 6, 12 and 24 months post-operatively.

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Natural History of the Dislocated Hip in Spastic Cerebral Palsy

Cited by 133 publications

References 5 publications

Prophylactic femoral varization osteotomy for contralateral stable hips in non‐ambulant individuals with cerebral palsy undergoing hip surgery: decision analysis

Prophylactic femoral varization osteotomy for contralateral stable hips in non‐ambulant individuals with cerebral palsy undergoing hip surgery: decision analysis

Radiographic hip disorders and associated complications in severe cerebral palsy

Adductor release and chemodenervation in children with cerebral palsy: A pilot study in 16 children

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