The Role of Hip Surveillance in Cerebral Palsy
Introduction
In Cerebral Palsy (CP), the original brain lesion is non-progressive. Unfortunately, even though the original brain lesion does not worsen, the children’s musculoskeletal (muscles and bone) functions deteriorate as they get older and grow into adulthood. Hence, one of the greatest practical challenges in CP is maintaining and improving musculoskeletal function. The hip joint is a common site of musculoskeletal problems.[1]
Hip displacements is related directly to gross motor function as determined by the Gross Motor Function Classification System[2] with spastic hip displacement being the second most common deformity seen in children with Cerebral Palsy (CP) [3]. Hip displacement in CP often occurs already at 2–3 years of age. [4]
A user-friendly hip surveillance programme that allows for early identification and monitoring is the keystone of management. Hip Surveillance is the process of identifying and monitoring the critical early indicators of progressive hip displacement [5]. Early identification is an essential part of the strategy for the prevention of hip dislocation and its sequelae.[1]
Perils of Repetitive Hip Displacements
Repetitive hip displacement which can be a sequalae of orthopedic impairments related to cerebral palsy can cause[6]:
- Progressive hip displacements can lead to hip dislocations
- Severe pain
- Impaired function i.e. loss of mobility, inability to be correctly positioned, compromised personal and hygiene care
- Decrease in quality of life
Mechanism of Hip Displacement, Dislocation and sequelae
The actual mechanism is not fully understood. It is believed that the hip joint in CP children is normal at birth [7]. Hip displacement can be associated with muscle imbalances around the hip joint and changes to the shape of the acetabulum and femoral head.[6]
Progressive hip displacement refers to the gradual displacement of the femoral head laterally out of the acetabulum. This displacement is expressed as a migration percentage (MP).
Hip displacement/ subluxation: Refers to hip displacement where MP is between 10% to 99% [5]. Hip dislocation: refers to when the femoral head is completely displaced laterally out of the acetabulum. MP = 100% [7]
Risk Assessment Approach
Assessment of range of movement (ROM) of the hip. Unfortunately, hip ROM is not an indicator of risk and not useful for screening [4]. A screening program can be:
1. A screening programme based on Gross Motor Function Classification System (GMFCS).
2. X-ray of hips as early as possible.
3. Clinical assessment including relevant documentation, care, comfort, pain; child’s spine, pelvis and lower limbs.
3. Frequency of surveillance: Regularly until skeletal maturity or until discharge [7]
Recommended Frequency of Hip Surveillance According to GMFCS [8](Adapted from Wynter et al)
Conclusion
Hip screening can help avoid impairments and positively impact the quality of life in individuals diagnosed with cerebral palsy. It will also help create awareness about orthopedic sequelae associated with cerebral palsy, ultimately, leading to better treatment options for the impacted individuals.
References
- ↑ 1.0 1.1 Adams CT, Lakra A. Clinical and functional outcomes of total hip arthroplasty in patients with cerebral palsy: a systematic review. Journal of Orthopaedics. 2020 Sep 1;21:19-24.
- ↑ Thomason P. Functional Mobility and Gait in Children and Youth with Cerebral Palsy. Cerebral Palsy. 2020:2767-95.
- ↑ Shore B, Spence D, Graham H. The role for hip surveillance in children with cerebral palsy. Curr Rev Musculoskelet Med. 2012;5(2):126-134.
- ↑ 4.0 4.1 Hägglund G. Characteristics of children with hip displacement in cerebral palsy. BMC musculoskeletal disorders. 2007;8:101-101.
- ↑ 5.0 5.1 Wynter M, Gibson N, Willoughby K, et al. Australian hip surveillance guidelines for children with cerebral palsy: 5-year review. Dev Med Child Neurol. 2015;57(9):808-820.
- ↑ 6.0 6.1 Aroojis A, Mantri N, Johari AN. Hip displacement in cerebral palsy: the role of surveillance. Indian Journal of Orthopaedics. 2021 Feb;55:5-19.
- ↑ 7.0 7.1 7.2 Gibson N.CEREBRAL PALSY The importance of monitoring hips in Cerebral Palsy. Princess Margaret Hospital, Perth July 2012
- ↑ Battisti N, Cozzaglio M, Faccioli S, Perazza S, Groppi A, Menta L, Motta M, Piovesan R, Digennaro GL, Rodocanachi M, Ronchetti AB. Prevention of hip dislocation in severe cerebral palsy (GMFCS III-IV-V): an interdisciplinary and multi-professional Care Pathway for clinical best practice implementation. EuropEan Journal of physical and rEhabilitation MEdicinE. 2023 Dec;59(6):714.