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Journal of Children's Orthopaedics

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01-11-2013 | Current Concept Review

Hip surveillance and management of the displaced hip in cerebral palsy

Authors: J. E. Robb, G. Hägglund

Published in: Journal of Children's Orthopaedics | Issue 5/2013

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 %.

Tachdjian MO, Minear WL (1956) Hip dislocation in cerebral palsy. J Bone Joint Surg Am 38A:1358–1364

Miller F (2005) In: Cerebral palsy. Springer, Berlin, pp 524–525

Brown JK, Minns RA (1989) Mechanisms of deformity in children with cerebral palsy. Sem Orthop 4:236–255

Sanger TD, Kukke SN (2007) Abnormalities of tactile sensory function in children with dystonic and diplegic cerebral palsy. J Child Neurol 22:289–293CrossRef

Brunner R, Picard C, Robb JE (1997) Morphology of the acetabulum in hip dislocations due to cerebral palsy. J Pediatr Orthop B 6:207–211CrossRef

Brunner R, Baumann JU (1997) Long-term effects of intertrochanteric varus-derotation osteotomy on femur and acetabulum in spastic cerebral palsy. J Pediatr Orthop 17:585–591CrossRef

Chang CH, Kuo KN, Wang CJ, Chen YY, Cheng HY, Kao HK (2011) Acetabular deficiency in spastic hip subluxation. J Pediatr Orthop 31:648–654CrossRef

Gordon GS, Simkiss DE (2006) A systematic review of the evidence for hip surveillance in children with cerebral palsy. J Bone Joint Surg Br 88B:1492–1496

Hägglund G, Lauge-Pedersen H, Wagner P (2007) Characteristics of children with hip displacement in cerebral palsy. BMC Musculoskelet Disord 8:101CrossRef

10.

Hägglund G, Lauge-Pedersen H, Persson M (2007) Radiographic threshold values for hip screening in cerebral palsy. J Child Orthop 1:43–47CrossRef

11.

Howard CB, Williams LA (1984) A new radiological sign in the hips of cerebral palsy patients. Clin Radiol 35:317–319CrossRef

12.

Dobson F, Boyd RN, Parrott J, Nattrass GR, Graham HK (2002) Hip surveillance in children with cerebral palsy. J Bone Joint Surg Br 84B:720–726

13.

Parrott J, Boyd RN, Dobson F, Lancaster A, Love S, Oates J, Wolfe R, Nattrass GR, Graham HK (2002) Hip displacement in spastic cerebral palsy: repeatability of radiologic measurement. J Pediatr Orthop 22:660–667

14.

Reimers J (1980) The stability of the hip in children: a radiological study of the results of muscle surgery in cerebral palsy. Acta Orthop Scand Suppl 184:1–100

15.

Faraj S, Atherton WG, Stott NS (2004) Inter- and intra-measurer error in the measurement of Reimer’s hip migration percentage. J Bone Joint Surg Br 86B:434–437

16.

Hägglund G, Andersson S, Düppe H, Lauge Pedersen H, Nordmark E, Westbom L (2005) Prevention of dislocation of the hip in children with cerebral palsy. First 10 years experience of a population based prevention program. J Bone Joint Surg Br 87B:95–101

17.

Stanley F, Blair E, Alberman E (2000) Cerebral palsies: epidemiology and causal pathways. Mac Keith, London, pp 14–21

18.

Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39:214–223CrossRef

19.

Soo B, Howard JJ, Boyd R, Reid SM, Lanigan A, Wolfe R, Reddihough D, Graham K (2006) Hip displacement in cerebral palsy. J Bone Joint Surg Am 88A:121–129

20.

Elkamil AI, Andersen GL, Hägglund G, Lamvik T, Skranes J, Vik T (2011) Prevalence of hip dislocation in children with cerebral palsy in regions with and without a surveillance programme. A cross sectional study in Sweden and Norway. BMC Musculoskelet Disord 12:284CrossRef

21.

Wood E, Rosenbaum P (2000) The gross motor function classification system for cerebral palsy: a study of reliability and stability over time. Dev Med Child Neurol 42:292–296CrossRef

22.

Palisano R, Cameron D, Rosenbaum P, Walter SD, Russel D (2006) Stability of the gross motor function classification system. Dev Med Child Neurol 48:424–428CrossRef

23.

Rosenbaum P, Walter SD, Hanna SE, Palisano RJ, Russel DJ, Parminder R, Wood E, Bartlett DJ, Galuppi B (2002) Prognosis for gross motor function in children with cerebral palsy: creation of motor development curves. JAMA 288:1357–1363CrossRef

24.

Hedberg A et al. (2013) CPUP website. www.cpup.se

25.

Australasian Academy of Cerebral Palsy and Developmental Medicine (2013) Website. www.ausacpdm.org.au

26.

Brunner R, Baumann JU (1994) Clinical benefit of reconstruction of dislocated and subluxated hip joints in patients with spastic cerebral palsy. J Pediatr Orthop 14:290–294CrossRef

27.

Cooperman DR, Bartucci E, Dierrick E, Millar EA (1987) Hip dislocation in spastic cerebral palsy: long-term consequences. J Pediatr Orthop 7:268–276CrossRef

28.

Noonan KJ, Jones J, Pierson J, Honkamp NJ, Leverson G (2004) Hip function in adults with severe cerebral palsy. J Bone Joint Surg Am 86A:2607–2613

29.

Poutney TE, Mandy A, Green E, Gard PR (2009) Hip subluxation and dislocation in cerebral palsy: a prospective study on the effectiveness of postural management programmes. Physiother Res Int 14:116–127CrossRef

30.

Martinsson C, Himmelmann K (2011) Effect of weight-bearing in abduction and extension on hip stability in children with cerebral palsy. Pediatr Phys Ther 23:150–157CrossRef

31.

Graham HK, Boyd RN, Carlin JB, Dobson F, Lowe K, Nattrass G, Thomason P, Wolfe R, Reddihough D (2008) Does botulinum toxin A combined with bracing prevent hip displacement in children with cerebral palsy and ‘hips at risk’? A randomized, controlled trial. J Bone Joint Surg Am 90A:23–33

32.

Bialik GM, Pierce R, Dorociak R, Lee TS, Aiona MD, Susman MD (2009) Iliopsoas tenotomy at the lesser trochanter versus at the pelvic brim in ambulatory children with cerebral palsy. J Pediatr Orthop 29:252–255CrossRef

33.

Samilson RL, Carson JJ, James P, Raney FL Jr (1967) Results and complications of adductor tenotomy and obturator neurectomy in cerebral palsy. Clin Orthop Relat Res 54:61–73

34.

Silver RL, Rang M, Chan J, de la Garza J (1985) Adductor release in non-ambulant children with cerebral palsy. J Pediatr Orthop 5:672–677CrossRef

35.

Stott NS, Piedrahita L (2004) Effects of surgical adductor releases for hip subluxation in cerebral palsy: an AACPDM evidence report. Dev Med Child Neurol 46:628–645CrossRef

36.

Shore BJ, Yu X, Desai S, Selber P, Wolfe R, Graham HK (2012) Adductor surgery to prevent hip displacement in children with cerebral palsy: the predictive role of the gross motor function classification system. J Bone Joint Surg Am 94A:326–334

37.

Robin J, Graham HK, Selber P, Dobson F, Smith K, Baker R (2008) Proximal femoral geometry in cerebral palsy. A population based cross sectional study. J Bone Joint Surg Br 90B:1372–1379

38.

Schmale GA, Eilert RE, Chang F, Seidel K (2006) High reoperation rates after early treatment of the subluxating hip in children with spastic cerebral palsy. J Pediatr Orthop 26:617–623CrossRef

39.

Huh K, Rethlefsen SA, Wren TA, Kay RM (2011) Surgical management of hip subluxation and dislocation in children with cerebral palsy: isolated VDRO or combined surgery? J Pediatr Orthop 8:858–863CrossRef

40.

Owers KL et al (2001) Bilateral hip surgery in severe cerebral palsy a preliminary review. J Bone Joint Surg Br 83B:1161–1167

41.

Pemberton PA (1965) Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip. J Bone Joint Surg Am 47A:65–86

42.

Dega W (1974) Transiliac osteotomy in the treatment of congenital hip dysplasia. Chir Narzadow Ruchu Ortop Pol 39:601–613

43.

Mubarak SJ, Valencia FG, Wenger DR (1992) One-stage correction of the spastic dislocated hip. Use of pericapsular acetabuloplasty to improve coverage. J Bone Joint Surg Am 74A:1347–1357

44.

Miller F, Girardi H, Lipton G, Ponzio R, Klaumann M, Dabney KW (1997) Reconstruction of the dysplastic spastic hip with peri-ilial pelvic and femoral osteotomy followed by immediate mobilization. J Pediatr Orthop 17:592–602CrossRef

45.

Robb JE, Brunner R (2006) A Dega-type osteotomy after closure of the triradiate cartilage in non-walking patients with severe cerebral palsy. J Bone Joint Surg Br 88B:933–937

46.

Sankar WN, Spiegel DA, Gregg JR, Sennett BJ (2006) Long-term follow up after one stage reconstruction of dislocated hips in patients with cerebral palsy. J Pediatr Orthop 26:1–7CrossRef

47.

Al-Ghadir M, Masquijo JJ, Guerra LA, Willis B (2009) Combined femoral and pelvic osteotomies versus femoral osteotomy alone in the treatment of hip dysplasia in children with cerebral palsy. J Pediatr Orthop 29:779–783CrossRef

48.

Miller F (2005) In: Cerebral palsy. Springer, Berlin, pp 550–551

49.

Castle ME, Schneider C (1978) Proximal femoral resection-interposition arthroplasty. J Bone Joint Surg Am 60A:1051–1054

50.

Egermann M, Döderlein L, Schläger E, Müller S, Braatz F (2009) Autologous capping during resection arthroplasty of the hip in patients with cerebral palsy. J Bone Joint Surg Br 91B:1007–1012

51.

Knaus A, Terjesen T (2009) Proximal femoral resection arthroplasty for patients with cerebral palsy and dislocated hips: 20 patients followed for 1–6 years. Acta Orthop 80:32–36CrossRef

52.

Muthusamy K, Chu HY, Friesen RM, Chou PC, Eilert RE, Chang FM (2008) Femoral head resection as a salvage procedure for the severely dysplastic hip in non-ambulatory children with cerebral palsy. J Pediatr Orthop 28:884–889CrossRef

53.

Lampropulos M, Puigdevall MH, Zapozko D, Malvárez HR (2008) Proximal femoral resection and articulated hip distraction with an external fixator for the treatment of painful spastic hip dislocations in paediatric patients with spastic quadriplegia. J Pediatr Orthop B 17:27–31CrossRef

54.

Abu-Rajab RB, Bennet GC (2007) Proximal femoral resection-interposition arthroplasty in cerebral palsy. J Pediatr Orthop B 16:181–184CrossRef

55.

Leet AI, Chhor K, Launay F, Kier-York J, Sponseller PD (2005) Femoral head resection for painful hip subluxation in cerebral palsy: is valgus osteotomy in conjunction with femoral head resection preferable to proximal femoral head resection and traction? J Pediatr Orthop 25:70–73

56.

Widmann RF, Do TT, Doyle SM, Burke SW, Root L (1999) Resection arthroplasty of the hip for patients with cerebral palsy: an outcome study. J Pediatr Orthop 19:805–810

57.

McHale KA, Bagg M, Nason SS (1990) Treatment of the chronically dislocated hip in adolescents with cerebral palsy with femoral head resection and subtrochanteric valgus osteotomy. J Pediatr Orthop 10:504–509CrossRef

58.

McCarthy RE, Simon S, Douglas B, Zawacki R, Reese N (1988) Proximal femoral resection to allow adults who have severe cerebral palsy to sit. J Bone Joint Surg Am 70A:1011–1016

59.

Baxter MP, D’Astous JL (1986) Proximal femoral resection-interposition arthroplasty: salvage hip surgery for the severely disabled child with cerebral palsy. J Pediatr Orthop 6:681–685CrossRef

60.

Koffman M (1981) Proximal femoral resection or total hip replacement in severely disabled cerebral-spastic patients. Orthop Clin North Am 12:91–100

61.

Perlmutter MN, Synder M, Miller F, Bisbal R (1993) Proximal femoral resection for older children with spastic hip disease. Dev Med Child Neurol 35:525–531CrossRef

62.

Queally JM, Abdulkarim A, Mulhall KJ (2009) Total hip replacement in patients with neurological conditions. J Bone Joint Surg Br 91B:1267–1273

63.

Schroeder K, Hauck C, Wiedenhöfer B, Braatz F, Aldinger PR (2010) Long-term results of hip arthroplasty in ambulatory patients with cerebral palsy. Int Orthop 34:335–339CrossRef

64.

Blake SM, Kitson J, Howell JR, Gie GA, Cox PJ (2006) Constrained total hip arthroplasty in a paediatric patient with cerebral palsy and painful dislocation of the hip. A case report. J Bone Joint Surg Br 88B:655–657

65.

Weber M, Cabanela ME (1999) Total hip arthroplasty in patients with cerebral palsy. Orthopedics 22:425–427

66.

Root L, Goss JR, Mendes J (1986) The treatment of the painful hip in cerebral palsy by total hip replacement or hip arthrodesis. J Bone Joint Surg Am 68A:590–598

67.

Skoff HD, Keggi K (1986) Total hip replacement in the neuromuscularly impaired. Orthop Rev 15:154–159

68.

Root L (1982) Total hip replacement in young people with neurological disease. Dev Med Child Neurol 24:186–188CrossRef

69.

Buly RL, Huo M, Root L, Binzer T, Wilson PD Jr (1993) Total hip arthroplasty in cerebral palsy. Long-term follow-up results. Clin Orthop Relat Res 296:148–153

70.

Prosser GH, Shears E, O’Hara JN (2012) Hip resurfacing with femoral osteotomy for painful subluxed or dislocated hips in patients with cerebral palsy. J Bone Joint Surg Br 94B:483–487

71.

Gabos PG, Miller F, Galban MA, Gupta GG, Dabney K (1999) Prosthetic interposition arthroplasty for the palliative treatment of end-stage spastic hip disease in nonambulatory patients with cerebral palsy. J Pediatr Orthop 19:796–804

72.

Schejbalova A, Havlas V, Trc T (2009) Irreducible dislocation of the hip in cerebral palsy patients treated by Schanz proximal femoral valgus osteotomy. Int Orthop 33:1713–1717CrossRef

73.

Hogan KA, Blake M, Gross RH (2006) Subtrochanteric valgus osteotomy for chronically dislocated, painful spastic hips. J Bone Joint Surg Am 88A:2624–2631

Title: Hip surveillance and management of the displaced hip in cerebral palsy
Authors: J. E. Robb
G. Hägglund
Publication date: 01-11-2013
Publisher: Springer Berlin Heidelberg
Published in: Journal of Children's Orthopaedics / Issue 5/2013
Print ISSN: 1863-2521
Electronic ISSN: 1863-2548
DOI: https://doi.org/10.1007/s11832-013-0515-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Hip surveillance and management of the displaced hip in cerebral palsy

Abstract

Introduction

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Conclusion

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