Hip Displacement in Cerebral Palsy
1/2006
By
The Journal of Bone & Joint Surgery
"Background: Hip displacement is
considered to be common in children with cerebral palsy but the reported
incidence and the proposed risk factors vary widely. Knowledge regarding its
overall incidence and associated risk factors can facilitate treatment of these
children.
Methods: An inception cohort was generated from the Victorian Cerebral
Palsy Register for the birth years 1990 through 1992, inclusive, and multiple
data sources pertaining to the cohort were reviewed during 2004. Gross motor
function was assessed for each child and was graded according to the Gross Motor
Function Classification System (GMFCS), which is a valid, reliable, five-level
ordinal grading system. Hip displacement, defined as a migration percentage of
>30%, was measured on an anteroposterior radiograph of the pelvis with use of a
reliable technique.
Results: A full data set was obtained for 323 (86%) of 374 children in
the Register for the birth years 1990 through 1992. The mean duration of
follow-up was eleven years and eight months. The incidence of hip displacement
for the entire birth cohort was 35%, and it showed a linear relationship with
the level of gross motor function. The incidence of hip displacement was 0% for
children with GMFCS level I and 90% for those with GMFCS level V. Compared with
children with GMFCS level II, those with levels III, IV, and V had significantly
higher relative risks of hip displacement (2.7, 4.6, and 5.9, respectively).
Conclusions: Hip displacement is common in children with cerebral palsy,
with an overall incidence of 35% found in this study. The risk of hip
displacement is directly related to gross motor function as graded with the
Gross Motor Function Classification System. This information may be important
when assessing the risk of hip displacement for an individual child who has
cerebral palsy, for counseling parents, and in the design of screening programs
and resource allocation.
Level of Evidence: Prognostic Level II. See Instructions to Authors for a
complete description of levels of evidence. "
Read Study Brendan
Soo, MBBS1, Jason J. Howard, MD, FRCS(C)1,
Roslyn N. Boyd, PhD, MSc(Physiotherapy)1, Susan M.
Reid, MClinEpi1, Anna Lanigan, RN1,
Rory Wolfe, PhD2, Dinah Reddihough, MD, FRACP,
FAFRM1 and H. Kerr Graham, MD, FRCS(Ed), FRACS1
1 Departments of Orthopaedic Surgery
(B.S., J.J.H., R.N.B., and H.K.G.) and Child Development and Rehabilitation (S.M.R.,
A.L., and D.R.), Royal Children's Hospital, Flemington Road, Parkville, Victoria
3052, Australia. E-mail address for H.K. Graham:
kerr.graham@rch.org.au
2 Monash University, Alfred Hospital, Commercial Road, Prahran,
Victoria 3004, Australia |
