Prevalence and predictive factors of hip displacement in children with cerebral palsy at Paediatric Institute, Kuala Lumpur Hospital

Objective: We aim to study the prevalence and predictive factors for hip displacement, in order to justify a hip surveillance programme for children with cerebral palsy (CP) in Malaysia. Methods: Children aged 2 to18 years old with CP were recruited from September 2013 till June 2014. The hip joint migration percentage (MP) and acetabular index (AI) were measured on all hip radiographs. The CP subtype was determined and gross motor function was classified according to the gross motor function classification system (GMFCS). Results: Seventy-five children were recruited. Fifty-five percent of them had marked hip displacement with MP > 30% and 15% developed hip dislocation (MP=100%). Marked hip displacement occurred as early as age of 2 years and most hip dislocations were detected by age of 10 years. The risk of marked hip displacement was directly related to the GMFCS level, from none in GMFCS I to 75% in GMFCS V. There was a moderate positive correlation between the initial AI and initial MP. Conclusions: One in every two children with CP was at risk of hip displacement, with GMFCS level and initial AI as significant predictive factors. We recommend a hip surveillance programme for Malaysian children with CP, based on the child’s age and GMFCS level, with both MP and AI as indicators for hip surveillance.

Developmental Dysplasia of Spastic Hip in Children with Cerebral Palsy in Southern India.

We studied the proportion of developmental dysplasia of spastic hip in children with cerebral palsy. Children with cerebral palsy aged 2-12 years were enrolled. Migration percentage was measured on pelvic radiographs. Hip dysplasia was seen in 15 (12.7%) children.

Progression of Hip Displacement during Radiographic Surveillance in Patients with Cerebral Palsy

Progression of hip displacement is common in patients with cerebral palsy (CP). We aimed to investigate the rate of progression of hip displacement in patients with CP by assessing changes in radiographic indices according to Gross Motor Function Classification System (GMFCS) level during hip surveillance. We analyzed the medical records of patients with CP aged < 20 years who underwent at least 6 months interval of serial hip radiographs before any surgical hip intervention, including reconstructive surgery. After panel consensus and reliability testing, radiographic measurements of migration percentage (MP), neck-shaft angle (NSA), acetabular index (AI), and pelvic obliquity (PO) were obtained during hip surveillance. For each GMFCS level, annual changes in radiographic indices were analyzed and adjusted for affecting factors, such as sex, laterality, and type of CP. A total of 197 patients were included in this study, and 1,097 radiographs were evaluated. GMFCS classifications were as follows: 100 patients were level I-III, 48 were level IV, and 49 were level V. MP increased significantly over the duration of hip surveillance in patients with GMFCS levels I-III, IV, and V by 0.3%/year (P < 0.001), 1.9%/year (P < 0.001), and 6.2%/year (P < 0.001), respectively. In patients with GMFCS level IV, NSA increased significantly by 3.4°/year (P < 0.001). Our results suggest that periodic monitoring and radiographic hip surveillance is warranted for patients with CP, especially those with GMFCS level IV or V. Furthermore, physicians can predict and inform parents or caregivers regarding the progression of hip displacement in patients with CP.