Top

Journal of Children's Orthopaedics

Published in:

Open Access 01-12-2016 | Original Clinical Article

Is head–shaft angle a valuable continuous risk factor for hip migration in cerebral palsy?

Authors: Sanjay Chougule, John Dabis, Aviva Petrie, Karen Daly, Yael Gelfer

Published in: Journal of Children's Orthopaedics | Issue 6/2016

Abstract

Background

Reimer’s migration percentage (MP) is the most established radiographic risk factor for hip migration in cerebral palsy (CP), and it assists surgical decision-making. The head–shaft angle (HSA) measures the valgus of the head and neck in relation to the shaft and may also be a useful predictor of hip migration at a young age. This study first defined normal values and investigated whether the head–shaft angle (HSA) is a continuous risk factor for hip migration in CP.

Methods

Three hundred and fifty AP pelvic radiographs of 100 consecutive children comprising the hip surveillance programme in our region were analysed for MP and HSA. Inclusion criteria were children with spastic CP and Gross Motor Function Classification System (GMFCS) levels of III–V, along with a minimum follow-up of 5 years. The mean age was 8.8 (range 3–18) years and the mean follow-up time was 7.5 (range 5–10) years. Radiographs of 103 typically developing children (TDC) were selected for the control group. The reliability of the measurements was determined. A random effects analysis was used to assess the relationship between MP and HSA for all data and for MP > 40 %.

Results

The TDC cohort had a mean HSA of 157.7° whilst that for the CP cohort was 161.7°. The value declined with age in both groups but remained consistently higher in the CP group. A random effects analysis considering the longitudinal data showed that there was no significant effect of HSA on MP. Similarly, when excluding CP patients with MP < 40 %, there was no significant effect of HSA on MP.

Conclusions

This study found no correlation between HSA and hip migration in children with CP in this age group. Using the HSA as a routine radiographic measure in the management pathway across childhood does not offer any added value. Early enrolment onto the hip surveillance programme could offer a better prediction of hip migration using the HSA at a very young age.

Level of evidence

II retrospective prognostic study.

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

Soo B, Howard JJ, Boyd RN, Reid SM, Lanigan A, Wolfe R, Reddihough D, Graham HK (2006) Hip displacement in cerebral palsy. J Bone Jt Surg Am 88(1):121–129

Hägglund G, Alriksson-Schmidt A, Lauge-Pedersen H, Rodby-Bousquet E, Wagner P, Westbom L (2014) Prevention of dislocation of the hip in children with cerebral palsy: 20-year results of a population-based prevention programme. Bone Jt J 96(11):1546–1552CrossRef

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 Jt Surg Br 90(10):1372–1379CrossRef

Dobson F, Boyd RN, Parrott J, Nattrass GR, Graham HK (2002) Hip surveillance in children with cerebral palsy. Impact on the surgical management of spastic hip disease. J Bone Jt Surg Br 84(5):720–726CrossRef

Kentish M, Wynter M, Snape N, Boyd R (2011) Five-year outcome of state-wide hip surveillance of children and adolescents with cerebral palsy. J Pediatr Rehabil Med 4(3):205–217PubMed

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 184:1–100CrossRefPubMed

Onimus M, Allamel G, Manzone P, Laurain JM (1991) Prevention of hip dislocation in cerebral palsy by early psoas and adductors tenotomies. J Pediatr Orthop 11(4):432–435CrossRefPubMed

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 ten years experience of a population based prevention program. Bone Jt J 87(1):95–101

10.

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 Pediatric Orthop 22(5):660–667

11.

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

12.

Lee KM, Kang JY, Chung CY, Kwon DG, Lee SH, Choi IH, Cho TJ, Yoo WJ, Park MS (2010) Clinical relevance of valgus deformity of proximal femur in cerebral palsy. J Pediatr Orthop 30(7):720–725CrossRefPubMed

13.

Foroohar A, McCarthy JJ, Yucha D, Clarke S, Brey J (2009) Head-shaft angle measurement in children with cerebral palsy. J Pediatr Orthop 29(3):248–250CrossRefPubMed

14.

Van der List JP, Witbreuk MM, Buizer AI, van der Sluijs JA (2015) The prognostic value of the head-shaft angle on hip displacement in children with cerebral palsy. J Child Orthop 9(2):129–135CrossRefPubMedPubMedCentral

15.

Hermanson M, Hägglund G, Riad J, Wagner P (2015) Head-shaft angle is a risk factor for hip displacement in children with cerebral palsy. Acta Orthop 86(2):229–232CrossRefPubMedPubMedCentral

16.

van der List J, Witbreuk M, Buizer A, van der Sluijs J (2015) The head-shaft angle of the hip in early childhood a comparison of reference values for children with cerebral palsy and normally developing hips. Bone Jt J 97(9):1291–1295CrossRef

17.

Southwick WO (1967) Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Jt Surg Am 49(5):807–835CrossRef

18.

Robb JE, Hägglund G (2013) Hip surveillance and management of the displaced hip in cerebral palsy. J Paediatr Orthop 7(5):407–413

19.

Faraj S, Atherton WG, Stott NS (2004) Inter- and intra-measurer error in the measurement of Reimers’ hip migration percentage. J Bone Jt Surg Br 86(3):434–437CrossRef

20.

Parrott J, Boyd RN, Dobson F et al (2002) Hip displacement in spastic cerebral palsy: repeatability of radiologic measurement. J Pediatr Orthop 22:660–667PubMed

21.

Craven A, Pym A, Boyd RN (2014) Reliability of radiologic measures of hip displacement in a cohort of preschool-aged children with cerebral palsy. J Pediatr Orthop 34(6):597–602PubMed

22.

Pons C, Rémy-Néris O, Médée B, Brochard S (2013) Validity and reliability of radiological methods to assess proximal hip geometry in children with cerebral palsy: a systematic review. Dev Med Child Neurol 55(12):1089–1102CrossRefPubMed

23.

Miller F, Liang Y, Merlo M, Harcke HT (1997) Measuring anteversion and femoral neck-shaft angle in cerebral palsy. Dev Med Child Neurol 39(2):113–118CrossRefPubMed

24.

Shands Jr AR, Steele MK (1958) Torsion of the femur: a follow-up report on the use of the dunlap method for its determination. J Bone Jt Surg Am 40(4):803–816

25.

Kinch K, Campbell DM, Maclean JG, Read HS, Barker SL, Robb JE, Gaston MS (2015) How critical is patient positioning in radiographic assessment of the hip in cerebral palsy when measuring migration percentage? J Pediatr Orthop 35:756–761CrossRefPubMed

26.

Bobroff ED, Chambers HG, Sartoris DJ, Wyatt MP, Sutherland DH (1999) Femoral anteversion and neck-shaft angle in children with cerebral palsy. Clin Orthop Relat Res 364:194–204CrossRef

27.

Dhawale AA, Karatas AF, Holmes L, Rogers KJ, Dabney KW, Miller F (2013) Long-term outcome of reconstruction of the hip in young children with cerebral palsy. Bone Jt J 95-B(2):259–265CrossRef

28.

Fabry G, MacEwen GD, Shands Jr AR (1973) Torsion of the femur. A follow-up study in normal and abnormal conditions. J Bone Jt Surg Am 55(8):1726–1738CrossRef

29.

Fabry G (1997) Normal and abnormal torsional development of the lower extremities. Acta Orthop Belg 63(4):229–232PubMed

30.

Henriksson L (1980) Measurement of femoral neck anteversion and inclination: a radiographic study in children. Acta Orthop Scand Suppl 186:1–59

31.

Józwiak M, Marciniak W, Piontek T, Pietrzak S (2000) Dega’s transiliac osteotomy in the treatment of spastic hip subluxation and dislocation in cerebral palsy. J Pediatr Orthop B 9:257–264CrossRefPubMed

32.

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 26:1–7CrossRefPubMed

Title: Is head–shaft angle a valuable continuous risk factor for hip migration in cerebral palsy?
Authors: Sanjay Chougule
John Dabis
Aviva Petrie
Karen Daly
Yael Gelfer
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Journal of Children's Orthopaedics / Issue 6/2016
Print ISSN: 1863-2521
Electronic ISSN: 1863-2548
DOI: https://doi.org/10.1007/s11832-016-0774-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Is head–shaft angle a valuable continuous risk factor for hip migration in cerebral palsy?

Abstract

Background

Methods

Results

Conclusions

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 6/2016

Cosmetic lengthening: what are the limits?

Forearm lengthening: management of elbow and wrist

Evaluation of functional outcomes and preliminary results in a case series of 15 children treated with arthroscopic release for internal rotation contracture of the shoulder joint after Erb’s palsy

Long bone deformity correction and bone lengthening procedures

Epidemiology of developmental dysplasia of the hip within the UK: refining the risk factors

Avascular necrosis following closed reduction for treatment of developmental dysplasia of the hip: a systematic review