https://www.orthopedic.theclinics.com/article/S0030-5898(10)00065-9/pdf

Management of Hip Deformities in Cerebral Palsy

The purpose of our investigation was to study the relationship between radiographic results of the femoral head and pain in people with severe cerebral palsy. We conducted a cross-sectional study on hip radiography results and pain in 160 patients with severe cerebral palsy. Eighteen percent of our patients had hip pain in hip-loading situations. Migration and deformity were closely related. There was a significant association with hip pain (odds ratio, 2.79; 95% confidence interval 1.01-7.70). There is a high prevalence of hip pain after unsuccessful femoral bone surgery. Migration and deformity of the femoral head are strongly interrelated, and are associated with pain

/pdf/determinants-of-hip-pain-in-adult-patients-with-severe-32mrdo9k7e.pdf

Determinants of hip pain in adult patients with severe cerebral palsy.

The aim of this study was to assess whether hip pain was associated with radiographic hip displacement (migration percentage, MP) in a population-based cohort of children with cerebral palsy. Seventy-seven children, mean age 9.5 (SD 1.6) years and Gross Motor Function Classification System level III-V, were assessed. Caregivers responded to the Child Health Questionnaire pain questions and located recurrent pain on a body map. Hip pain was reported in 22 children (29%) and 27 hips (18%). Hip pain was significantly more frequent in hips with MP more than or equal to 50%, in children with spastic quadriplegia, and in those with Gross Motor Function Classification System level V. We conclude that severe hip displacement with MP more than or equal to 50% was associated with hip pain, whereas slight or moderate subluxation did not influence the occurrence of such pain.

Hip pain is more frequent in severe hip displacement: a population-based study of 77 children with cerebral palsy.

Background No preferred procedure exists for the chronically painful, unreconstructable subluxated or dislocated hip in cerebral palsy. The purpose of this study was to compare pain relief and complication rates of salvage procedures in cerebral palsy for ambulatory and nonambulatory populations. Methods We searched Medline, Embase, and Cochrane databases using the search terms "cerebral palsy" and "hip dislocation." Inclusion and exclusion criteria were established to maintain data quality for analysis. A systematic review yielded 28 studies. Relevant information for postoperative pain and complications were extracted from each study and described. Our initial search identified 721 articles. Two hundred twenty duplications were excluded. Five hundred one were screened by title and abstract. One hundred articles underwent further full text and reference evaluation, yielding 25 studies. An additional 3 studies were then identified from the list of 25, yielding a total of 28 studies, which met our inclusion criteria. Results Among nonambulators, femoral head resection (FHR), valgus osteotomy (VO), and total hip arthroplasty (THA) were found to relieve pain better than arthrodesis [odds ratio (OR) 7.3, 95% confidence interval (CI), 2.2-24.8; OR 5.9, 95% CI, 1.6-22.8; OR 11.7, 95% CI, 1.1-297.5, respectively]. Arthrodesis had a significantly higher complication rate than FHR, VO, THA, and shoulder prosthetic interposition. No significant differences in complication rate were found between FHR and VO. Pain relief rates among nonambulators for FHR, VO, THA, shoulder prosthetic interposition, and arthrodesis were 90.4%, 88.4%, 93.8%, 90.9%, and 56.3%, respectively. Complication rates among nonambulators were 24.0%, 33.3%, 35.3%, 28.6%, and 106.3%, respectively. Comparison of pain relief and complication rates among ambulatory cerebral palsy patients in all procedures except THA was not possible because the populations could not be separated from nonambulators in numbers sufficient to perform statistical analysis. Data were available for 32 confirmed cases of THA in ambulators and was associated with a 93.3% pain relief rate and a 38.2% complication rate. Conclusions Among nonambulators, the available literature suggests that FHR, VO, and THA may be superior at relieving pain than arthrodesis. FHR had the lowest absolute percentage of complications; however, no significant differences in complication rate or pain relief were found in nonambulators undergoing FHR or VO. Most of the complications for VO were implant related, and potentially amenable to hardware removal versus complications in FHR, which were related to the procedure itself such as proximal migration and heterotopic bone formation. THA in nonambulators was associated with complications such as dislocation and revision. Arthrodesis in nonambulators was associated with >100% complication rate and inferior pain relief compared with other procedures. Ambulatory patients had excellent pain relief with THA; however, the complication rate is higher than can be expected with non-neurological populations. Insufficient data exist to support use of other salvage procedures in ambulators. These conclusions should be interpreted with caution as all studies involved level IV evidence. Level of evidence IV (systematic review of level IV studies).

Salvage Options in the Cerebral Palsy Hip: A Systematic Review.

Background and purpose - Hip displacement is common in children with severe cerebral palsy (CP) and can cause problems such as pain, contractures, and nursing difficulties. Caregiver priorities and child health index of life with disabilities (CPCHILD) is a recently developed measure of health-related quality of life (HRQL) in children with severe CP. The associations between CPCHILD scores and hip displacement have not been investigated. We explored the effect of hip displacement on HRQL. Patients and methods - 67 children were recruited from the population-based Norwegian CP register. Mean age was 9 (7-12) years. There were 40 boys. Gross motor function classification system (GMFCS) distribution was 12 level III, 17 level IV, and 38 level V. Hip displacement was assessed by radiographic migration percentage (MP). The criterion for hip displacement was MP of the worst hip of ≥40%. Primary caregivers responded to 5 of the 6 domains of the CPCHILD questionnaire. Results - Hip displacement was found in 18 children and it was significantly associated with lower scores on the CPCHILD domains 3 (Comfort and Emotions) and 5 (Health), but not with domains 1 (Activities of Daily Living/Personal Care), 2 (Positioning, Transfer, and Mobility), and 6 (Overall Quality of Life). GMFCS level V was a significant predictor of low scores in all the domains. Interpretation - For the assessment of HRQL in children with severe CP and hip problems, we propose a modified and simplified version of the CPCHILD consisting of 14 of 37 questions. This would reduce the responders' burden and probably increase the response rate in clinical studies without losing important information.

https://www.tandfonline.com/doi/pdf/10.1080/17453674.2016.1262685

Severe hip displacement reduces health-related quality of life in children with cerebral palsy.

The purpose of this study was to evaluate the problems associated with hip dislocation in adults with cerebral palsy. Twenty-nine subjects with dislocated hips and no prior hip surgery were identified. There were a total of 38 dislocated hips. Age range was 21 to 52 years (average 34). Seven dislocated hips (18%) were definitely painful and four hips (11%) produced only mild or intermittent pain. Twenty-seven hips (71%) were not painful. The seven painful hips underwent proximal femoral resection, resulting in excellent range of motion and no pain. In conclusion, for established nonpainful hip dislocation in the severely involved spastic quadriplegic patient, aggressive surgical treatment should be undertaken only after careful consideration of the natural history. If a dislocated hip becomes painful in adulthood or develops an adduction contracture interfering with perineal care, a proximal femoral resection can be performed with reliably good success.

Untreated hip dislocation in cerebral palsy

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Untreated hip dislocation in cerebral palsy