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. 2014 Mar;8(2):129-34.
doi: 10.1007/s11832-014-0570-7. Epub 2014 Mar 5.

Hip displacement in relation to age and gross motor function in children with cerebral palsy

Per Larnert  1 , Olof Risto, Gunnar Hägglund, Philippe Wagner
Affiliations

Hip displacement in relation to age and gross motor function in children with cerebral palsy

Per Larnert et al. J Child Orthop. 2014 Mar.

Abstract

Purpose: Hip dislocation in cerebral palsy (CP) is a serious complication. By radiographic screening and prophylactic surgery of children at risk most dislocations can be prevented. CPUP, the Swedish CP registry and follow-up program, includes annual radiographic examinations of children at Gross Motor Function Classification System (GMFCS) levels III-V. Data from CPUP were analysed to assess the risk of hip displacement in relation to GMFCS levels and age.

Methods: All children at GMFCS levels III-V (N = 353) whose first radiographic screening occurred before 3 years of age were followed between the ages 2-7 years. Migration percentages (MPs) were recorded annually (1,664 pelvic radiographs) and analysed using discrete time survival analysis.

Results: The risk of hip displacement between 2 years and 7 years of age was significantly (p < 0.05) higher for children at GMFCS level V during the entire study period. The risk was highest at 2-3 years of age and decreased significantly (p < 0.001) with each year of age (OR = 0.71, 95 % CI 0.60-0.83). The cumulative risk at age 7 years for those at GMFCS V for MP ≥ 40 % was 47 % (95 % CI 37-58). The corresponding risk at GMFCS IV was 24 % (16-34) and at GMFCS III 23 % (12-42).

Conclusions: Children at GMFCS V have a significantly higher risk of hip displacement compared with children at GMFCS III-IV. The risk is highest at 2-3 years of age. The results support a surveillance program including radiographic hip examinations as soon as the diagnosis of severe CP is suspected.

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Figures

Fig. 1
Fig. 1
Measurement of Migration Percentage (MP). MP = A/B × 100. On the right hip with a “Gothic arch” formation of the lateral margin, the midpoint of the arch is used as reference point
Fig. 2
Fig. 2
Cumulative risk of hip displacement MP > 33 %
Fig. 3
Fig. 3
Cumulative risk of hip displacement MP ≥ 40 %
See this image and copyright information in PMC

References

    1. Cooperman DR, Bartucci E, Dietrick E, Millar EA. Hip dislocation in spastic cerebral palsy: long-term consequences. J Pediatr Orthop. 1987;7(3):268–276. doi: 10.1097/01241398-198705000-00005. - DOI - PubMed
    1. Moreau M, Drummond DS, Rogala E, Ashworth A, Porter T. Natural history of the dislocated hip in spastic cerebral palsy. Dev Med Child Neurol. 1979;21(6):749–753. doi: 10.1111/j.1469-8749.1979.tb01696.x. - DOI - PubMed
    1. Bagg MR, Farber J, Miller F. Long-term follow-up of hip subluxation in cerebral palsy patients. J Pediatr Orthop. 1993;13(1):32–36. doi: 10.1097/01241398-199301000-00007. - DOI - PubMed
    1. Samilson RL, Carson JJ, James P, Raney FL., Jr Results and complications of adductor tenotomy and obturator neurectomy in cerebral palsy. Clin Orthop Relat Res. 1967;54:61–73. - PubMed
    1. Rodby-Bousquet E, Czuba T, Hagglund G, Westbom L. Postural asymmetries in young adults with cerebral palsy. Dev Med Child Neurol. 2013 - PMC - PubMed

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