Abstract
Spastic hip displacement is the second most common deformity seen in children with cerebral palsy (CP), and the long-term effects can be debilitating. Progressive hip displacement leading to dislocation can result in severe pain as well as impaired function and quality of life. Recent population-based studies have demonstrated that a child’s Gross Motor Functional Classification System (GMFCS) level is most predictive for identifying hips “at-risk” for progressive lateral displacement. As a result, in many developed countries, hip surveillance has now been adopted as an integral piece of the comprehensive care puzzle for the management of children with spastic hip displacement. This paper reviews the spectrum of treatments available for progressive hip displacement, examines the current literature on the success of hip surveillance, and illustrates an example of a current hip surveillance program stratified by the GMFCS level.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Bax M, Goldstein M, Rosenbaum P, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. 2005;47:571–6.
Soo B, Howard JJ, Boyd RN, et al. Hip displacement in cerebral palsy. J Bone Joint Surg Am. 2006;88:121–9.
Lonstein JE, Beck K. Hip dislocation and subluxation in cerebral palsy. J Pediatr Orthop. 1986;6:521–6.
Bagg MR, Farber J, Miller F. Long-term follow-up of hip subluxation in cerebral palsy patients. J Pediatr Orthop. 1993;13:32–6.
Hagglund G, Lauge-Pedersen H, Wagner P. Characteristics of children with hip displacement in cerebral palsy. BMC Musculoskelet Disord. 2007;8:101.
Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39:214–23.
Howard CB, McKibbin B, Williams LA, Mackie I. Factors affecting the incidence of hip dislocation in cerebral palsy. J Bone Joint Surg Br. 1985;67:530–2.
Terjesen T. Development of the hip joints in unoperated children with cerebral palsy: a radiographic study of 76 patients. Acta Orthop. 2006;77:125–31.
Flynn JM, Miller F. Management of hip disorders in patients with cerebral palsy. J Am Acad Orthop Surg. 2002;10:198–209.
Dobson F, Boyd RN, Parrott J, et al. Hip surveillance in children with cerebral palsy. Impact on the surgical management of spastic hip disease. J Bone Joint Surg Br. 2002;84:720–6.
Cooperman DR, Bartucci E, Dietrick E, Millar EA. Hip dislocation in spastic cerebral palsy: long-term consequences. J Pediatr Orthop. 1987;7:268–76.
Scrutton D, Baird G. Surveillance measures of the hips of children with bilateral cerebral palsy. Arch Dis Child. 1997;76:381–4.
Scrutton D, Baird G, Smeeton N. Hip dysplasia in bilateral cerebral palsy: incidence and natural history in children aged 18 months to 5 years. Dev Med Child Neurol. 2001;43:586–600.
Hagglund G, Andersson S, Duppe H, et al. Prevention of dislocation of the hip in children with cerebral palsy. The first ten years of a population-based prevention programme. J Bone Joint Surg Br. 2005;87:95–101.
Connelly A, Flett P, Graham HK, Oates J. Hip surveillance in Tasmanian children with cerebral palsy. J Paediatr Child Health. 2009;45:437–43.
Beals RK. Spastic paraplegia and diplegia. An evaluation of non-surgical and surgical factors influencing the prognosis for ambulation. J Bone Joint Surg Am. 1966;48:827–46.
Samilson RL, Carson JJ, James P, Raney Jr FL. Results and complications of adductor tenotomy and obturator neurectomy in cerebral palsy. Clin Orthop Relat Res. 1967;54:61–73.
•• Wynter M, Gibson N, Kentish M, et al. The development of Australian Standards of Care for Hip Surveillance in Children with Cerebral Palsy: How did we reach consensus? J Pediatr Rehabil Med. 2011;4:171-182. This study reviews the evidence in favor of hip surveillance in children and adolescents with CP and discusses the process of developing the Consensus Statement on Hip Surveillance in Children with Cerebral Palsy which has been adopted and endorsed by the Australian Academy of Cerebral Palsy and Developmental Medicine.
Kentish M, Wynter M, Snape N, Boyd R. Five-year outcome of state-wide hip surveillance of children and adolescents with cerebral palsy. J Pediatr Rehabil Med. 2011;4:205–17.
Gordon GS, Simkiss DE. A systematic review of the evidence for hip surveillance in children with cerebral palsy. J Bone Joint Surg Br. 2006;88:1492–6.
Cornell MS, Hatrick NC, Boyd R, et al. The hip in children with cerebral palsy. Predicting the outcome of soft tissue surgery. Clin Orthop Relat Res. 1997;340:165–71.
Letts M, Shapiro L, Mulder K, Klassen O. The windblown hip syndrome in total body cerebral palsy. J Pediatr Orthop. 1984;4:55–62.
Graham HK. Painful hip dislocation in cerebral palsy. Lancet. 2002;359:907–8.
Sharrard WJ, Allen JM, Heaney SH. Surgical prophylaxis of subluxation and dislocation of the hip in cerebral palsy. J Bone Joint Surg Br. 1975;57:160–6.
Dunlap K, Shands Jr AR, Hollister Jr LC, et al. A new method for determination of torsion of the femur. J Bone Joint Surg Am. 1953;35-A:289–311.
Laplaza FJ, Root L, Tassanawipas A, Glasser DB. Femoral torsion and neck-shaft angles in cerebral palsy. J Pediatr Orthop. 1993;13:192–9.
Robin J, Graham HK, Selber P, et al. Proximal femoral geometry in cerebral palsy: a population-based cross-sectional study. J Bone Joint Surg Br. 2008;90:1372–9.
Cooke PH, Cole WG, Carey RP. Dislocation of the hip in cerebral palsy. Natural history and predictability. J Bone Joint Surg Br. 1989;71:441–6.
Wynter M, Gibson N, Kentish M, et al. The consensus statement on hip surveillance for children with cerebral palsy: australian standards of care. J Pediatr Rehabil Med. 2011;4:183–95.
Graham HK, Boyd R, Carlin JB, et al. 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. 2008;90:23–33.
Krach LE, Kriel RL, Gilmartin RC, et al. Hip status in cerebral palsy after one year of continuous intrathecal baclofen infusion. Pediatr Neurol. 2004;30:163–8.
Shore B, Yu X, Desai S, et al. 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. 2012; in press.
Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67:206–7.
Hodgkinson I, Jindrich ML, Duhaut P, et al. Hip pain in 234 non-ambulatory adolescents and young adults with cerebral palsy: a cross-sectional multicentre study. Dev Med Child Neurol. 2001;43:806–8.
Boyd R, Graham HK. Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy. Eur J Neurol. 1999;6:23–35.
Bartlett MD, Wolf LS, Shurtleff DB, Stahell LT. Hip flexion contractures: a comparison of measurement methods. Arch Phys Med Rehabil. 1985;66:620–5.
Grohmann JE. Comparison of two methods of goniometry. Phys Ther. 1983;63:922–5.
Delp SL, Arnold AS, Speers RA, Moore CA. Hamstrings and psoas lengths during normal and crouch gait: implications for muscle-tendon surgery. J Orthop Res. 1996;14:144–51.
Schutte LM, Hayden SW, Gage JR. Lengths of hamstrings and psoas muscles during crouch gait: effects of femoral anteversion. J Orthop Res. 1997;15:615–21.
Trost J. Clinical assessment. London: Mac Keith Press; 2009.
Yam WK, Leung MS. Interrater reliability of Modified Ashworth Scale and Modified Tardieu Scale in children with spastic cerebral palsy. J Child Neurol. 2006;21:1031–5.
Reimers J. The stability of the hip in children. A radiological study of the results of muscle surgery in cerebral palsy. Acta Orthop Scand Suppl. 1980;184:1–100.
Parrott J, Boyd RN, Dobson F, et al. Hip displacement in spastic cerebral palsy: repeatability of radiologic measurement. J Pediatr Orthop. 2002;22:660–7.
Miller F, Bagg MR. Age and migration percentage as risk factors for progression in spastic hip disease. Dev Med Child Neurol. 1995;37:449–55.
Faraj S, Atherton WG, Stott NS. Inter- and intra-measurer error in the measurement of Reimers’ hip migration percentage. J Bone Joint Surg Br. 2004;86:434–7.
Tonnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res. 1976:39-47.
• Robin J, Graham HK, Baker R, et al. A classification system for hip disease in cerebral palsy. Dev Med Child Neurol. 2009;51:183-192. This study reviewed one hundred and thirty-four radiographs of adolescents with CP at or near maturity and developed a new classification system that encapsulates the full spectum of hip morphology.
Murnaghan ML, Simpson P, Robin JG, et al. The cerebral palsy hip classification is reliable: an inter- and intra-observer reliability study. J Bone Joint Surg Br. 2010;92:436–41.
Severin E. Congenital dislocation of the hip; development of the joint after closed reduction. J Bone Joint Surg Am. 1950;32-A:507–18.
• Gose S, Sakai T, Shibata T, et al. Verification of the Robin and Graham classification system of hip disease in cerebral palsy using three-dimensional computed tomography. Dev Med Child Neurol. 2011;53:1107-1112. This study validated the Robin and Graham classification system of hip disease in children with CP using three-dimensional computed topography. By studying ninety-one children between the ages of two and six, the authors demonstrated that this classification system not only applies to adolescents but also children under the age of seven.
Kim YJ, Jaramillo D, Millis MB, et al. Assessment of early osteoarthritis in hip dysplasia with delayed gadolinium-enhanced magnetic resonance imaging of cartilage. J Bone Joint Surg Am. 2003;85-A:1987–92.
Beals RK. Developmental changes in the femur and acetabulum in spastic paraplegia and diplegia. Dev Med Child Neurol. 1969;11:303–13.
Kalen V, Bleck EE. Prevention of spastic paralytic dislocation of the hip. Dev Med Child Neurol. 1985;27:17–24.
Harris NH, Lloyd-Roberts GC, Gallien R. Acetabular development in congenital dislocation of the hip. With special reference to the indications for acetabuloplasty and pelvic or femoral realignment osteotomy. J Bone Joint Surg Br. 1975;57:46–52.
Dare C, Clarke N. (v) Proximal femoral osteotomy in childhood. Curr Orthop. 2007;21:115–21.
Houkom JA, Roach JW, Wenger DR, et al. Treatment of acquired hip subluxation in cerebral palsy. J Pediatr Orthop. 1986;6:285–90.
Miller F, Dabney K, Rang M. Complications in cerebral palsy treatment. Philadelphia: Lippincott Company; 1995.
Khot A, Sloan S, Desai S, et al. Adductor release and chemodenervation in children with cerebral palsy: a pilot study in 16 children. J Child Orthop. 2008;2:293–9.
Presedo A, Oh CW, Dabney KW, Miller F. Soft-tissue releases to treat spastic hip subluxation in children with cerebral palsy. J Bone Joint Surg Am. 2005;87:832–41.
Samilson RL, Tsou P, Aamoth G, Green WM. Dislocation and subluxation of the hip in cerebral palsy. Pathogenesis, natural history and management. J Bone Joint Surg Am. 1972;54:863–73.
Barrie JL, Galasko CS. Surgery for unstable hips in cerebral palsy. J Pediatr Orthop B. 1996;5:225–31.
Pirpiris M, Trivett A, Baker R, et al. Femoral derotation osteotomy in spastic diplegia. Proximal or distal? J Bone Joint Surg Br. 2003;85:265–72.
Brunner R, Baumann JU. Clinical benefit of reconstruction of dislocated or subluxated hip joints in patients with spastic cerebral palsy. J Pediatr Orthop. 1994;14:290–4.
Mubarak SJ, Valencia FG, Wenger DR. One-stage correction of the spastic dislocated hip. Use of pericapsular acetabuloplasty to improve coverage. J Bone Joint Surg Am. 1992;74:1347–57.
Cornell MS. The hip in cerebral palsy. Dev Med Child Neurol. 1995;37:3–18.
Miller F, Girardi H, Lipton G, et al. Reconstruction of the dysplastic spastic hip with peri-ilial pelvic and femoral osteotomy followed by immediate mobilization. J Pediatr Orthop. 1997;17:592–602.
McNerney NP, Mubarak SJ, Wenger DR. One-stage correction of the dysplastic hip in cerebral palsy with the San Diego acetabuloplasty: results and complications in 104 hips. J Pediatr Orthop. 2000;20:93–103.
Leet AI, Chhor K, Launay F, et al. 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. 2005;25:70–3.
Baxter MP, D’Astous JL. Proximal femoral resection-interposition arthroplasty: salvage hip surgery for the severely disabled child with cerebral palsy. J Pediatr Orthop. 1986;6:681–5.
McCarthy RE, Simon S, Douglas B, et al. Proximal femoral resection to allow adults who have severe cerebral palsy to sit. J Bone Joint Surg Am. 1988;70:1011–6.
McHale KA, Bagg M, Nason SS. Treatment of the chronically dislocated hip in adolescents with cerebral palsy with femoral head resection and subtrochanteric valgus osteotomy. J Pediatr Orthop. 1990;10:504–9.
Widmann RF, Do TT, Doyle SM, et al. Resection arthroplasty of the hip for patients with cerebral palsy: an outcome study. J Pediatr Orthop. 1999;19:805–10.
Minear WL, Tachdjian MO. Hip dislocation in cerebral palsy. J Bone Joint Surg Am. 1956;38-A:1358–64.
Moreau M, Drummond DS, Rogala E, et al. Natural history of the dislocated hip in spastic cerebral palsy. Dev Med Child Neurol. 1979;21:749–53.
Vidal J, Deguillaume P, Vidal M. The anatomy of the dysplastic hip in cerebral palsy related to prognosis and treatment. Int Orthop. 1985;9:105–10.
Scrutton D. The early management of hips in cerebral palsy. Dev Med Child Neurol. 1989;31:108–16.
Little DG, Aiona M, Sussman M. Late hip subluxation in spastic diplegia associated with unrecognized hydrocephalus. J Pediatr Orthop. 1995;15:368–71.
Miller CJ. The speech therapist and the group treatment of young cerebral palsied children. Br J Disord Commun. 1972;7:176–83.
Pountney T, Green EM. Hip dislocation in cerebral palsy. BMJ. 2006;332:772–5.
Persson-Bunke M, Hagglund G, Lauge-Pedersen H. Windswept hip deformity in children with cerebral palsy. J Pediatr Orthop B. 2006;15:335–8.
Disclosures
B. Shore: none; D. Spence: none; HK Graham: consultant for Merz Pharmaceuticals.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shore, B., Spence, D. & Graham, H. The role for hip surveillance in children with cerebral palsy. Curr Rev Musculoskelet Med 5, 126–134 (2012). https://doi.org/10.1007/s12178-012-9120-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12178-012-9120-4