Skip to main content
SpringerLink
Log in

Musculoskeletal injections for palliative treatment of neuromuscular hip dysplasia patients: how I do it

  • How I do it
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

This review describes our institution’s standardized technique as well as potential pitfalls for therapeutic steroid injections in children with symptomatic neuromuscular hip dysplasia. Symptomatic, painful neuromuscular hip dysplasia can dramatically affect quality of life. Steroid injections are used to identify the source of perceived pain, temporarily treat pain while awaiting surgical intervention, or for therapeutic management for nonoperative hip joints.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

Data availability

The data supporting this study are included in this article and its supplementary material.

References

  1. Maenner MJ, Blumberg SJ, Kogan MD et al (2016) Prevalence of cerebral palsy and intellectual disability among children identified in two U.S. National Surveys, 2011–2013. Ann Epidemiol 26:222–226. https://doi.org/10.1016/j.annepidem.2016.01.001

    Article  PubMed  PubMed Central  Google Scholar 

  2. Pruszczynski B, Sees J, Miller F (2016) Risk factors for hip displacement in children with cerebral palsy: systematic review. J Pediatr Orthop 36:829–833. https://doi.org/10.1097/BPO.0000000000000577

    Article  PubMed  Google Scholar 

  3. Lins LAB, Watkins CJ, Shore BJ (2019) Natural history of spastic hip disease. J Pediatr Orthop 39:S33–S37. https://doi.org/10.1097/BPO.0000000000001347

    Article  PubMed  Google Scholar 

  4. Larsen SM, Ramstad K, Terjesen T (2021) Hip pain in adolescents with cerebral palsy: a population-based longitudinal study. Dev Med Child Neurol 63:601–607. https://doi.org/10.1111/dmcn.14782

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ramstad K, Terjesen T (2016) Hip pain is more frequent in severe hip displacement: a population-based study of 77 children with cerebral palsy. J Pediatr Orthop B 25:217–221. https://doi.org/10.1097/BPB.0000000000000282

    Article  PubMed  Google Scholar 

  6. Koch A, Krasny J, Dziurda M et al (2021) Parents and caregivers satisfaction after palliative treatment of spastic hip dislocation in cerebral palsy. Front Neurol 12:635894. https://doi.org/10.3389/fneur.2021.635894

    Article  PubMed  PubMed Central  Google Scholar 

  7. Shrader MW, Wimberly L, Thompson R (2019) Hip surveillance in children with cerebral palsy. J Am Acad Orthop Surg 27:760–768. https://doi.org/10.5435/JAAOS-D-18-00184

    Article  PubMed  Google Scholar 

  8. Davids JR (2018) Management of neuromuscular hip dysplasia in children with cerebral palsy: lessons and challenges. J Pediatr Orthop 38(Suppl 1):S21–S27. https://doi.org/10.1097/BPO.0000000000001159

    Article  PubMed  Google Scholar 

  9. Robb JE, Brunner R (2006) A Dega-type osteotomy after closure of the triradiate cartilage in non-walking patients with severe cerebral palsy. J Bone Joint Surg Br 88:933–937. https://doi.org/10.1302/0301-620X.88B7.17506

    Article  CAS  PubMed  Google Scholar 

  10. Ayub A, Graff C, Horvat LM, Maizen C (2023) Hip reconstruction in cerebral palsy: lessons from a single center and 137 hips. J Child Orthop 17:469–480. https://doi.org/10.1177/18632521231196846

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rastogi AK, Davis KW, Ross A, Rosas HG (2016) Fundamentals of joint injection. Am J Roentgenol 207:484–494. https://doi.org/10.2214/AJR.16.16243

    Article  Google Scholar 

  12. Kolman SE, Ruzbarsky JJ, Spiegel DA, Baldwin KD (2016) Salvage options in the cerebral palsy hip: a systematic review. Journal of Pediatric Orthopaedics 36:645. https://doi.org/10.1097/BPO.0000000000000501

    Article  PubMed  Google Scholar 

  13. Spruit M, Van Goethem CJ, Kooijman MA, Pavlov PW (1997) Diagnostic infiltration of the hip joint with bupivacain in adult acetabular dysplasia. Acta Orthop Belg 63:274–277

    CAS  PubMed  Google Scholar 

  14. Zielinski JM, Garner MJ, Band PR et al (2009) Health outcomes of low-dose ionizing radiation exposure among medical workers: a cohort study of the Canadian national dose registry of radiation workers. Int J Occup Med Environ Health 22:149–156. https://doi.org/10.2478/v10001-009-0010-y

    Article  PubMed  Google Scholar 

  15. Cole BJ, Schumacher HR (2005) Injectable corticosteroids in modern practice. J Am Acad Orthop Surg 13:37–46. https://doi.org/10.5435/00124635-200501000-00006

    Article  PubMed  Google Scholar 

  16. Pyne D, Ioannou Y, Mootoo R, Bhanji A (2004) Intra-articular steroids in knee osteoarthritis: a comparative study of triamcinolone hexacetonide and methylprednisolone acetate. Clin Rheumatol 23:116–120. https://doi.org/10.1007/s10067-003-0841-z

    Article  PubMed  Google Scholar 

  17. Sukharomana M, Charuvanij S (2023) Outcomes of intraarticular triamcinolone acetonide injection in children with non-systemic juvenile idiopathic arthritis. Clin Rheumatol 42:1665–1674. https://doi.org/10.1007/s10067-023-06569-w

    Article  PubMed  Google Scholar 

  18. Paskins Z, Bromley K, Lewis M et al (2022) Clinical effectiveness of one ultrasound guided intra-articular corticosteroid and local anaesthetic injection in addition to advice and education for hip osteoarthritis (HIT trial): single blind, parallel group, three arm, randomised controlled trial. BMJ e068446. https://doi.org/10.1136/bmj-2021-068446

  19. Eberhard BA, Ilowite NT, Sison C (2012) A dose schedule for intraarticular steroids in juvenile arthritis. J Rheumatol 39:374–376. https://doi.org/10.3899/jrheum.110125

    Article  CAS  PubMed  Google Scholar 

  20. Eberhard BA, Sison MC, Gottlieb BS, Ilowite NT (2004) Comparison of the intraarticular effectiveness of triamcinolone hexacetonide and triamcinolone acetonide in treatment of juvenile rheumatoid arthritis. J Rheumatol 31:2507–2512

    CAS  PubMed  Google Scholar 

  21. Lemos SE (2022) Editorial commentary: periarticular and intra-articular injections may do the right thing for patients’ pain but may be the wrong thing for their articular cartilage: be careful. Arthroscopy 38:1996–1998. https://doi.org/10.1016/j.arthro.2022.03.003

    Article  PubMed  Google Scholar 

  22. Piper SL, Kramer JD, Kim HT, Feeley BT (2011) Effects of local anesthetics on articular cartilage. Am J Sports Med 39:2245–2253. https://doi.org/10.1177/0363546511402780

    Article  PubMed  Google Scholar 

  23. Breu A, Rosenmeier K, Kujat R et al (2013) The cytotoxicity of bupivacaine, ropivacaine, and mepivacaine on human chondrocytes and cartilage. Anesth Analg 117:514. https://doi.org/10.1213/ANE.0b013e31829481ed

    Article  CAS  PubMed  Google Scholar 

  24. Piper SL, Kim HT (2008) Comparison of ropivacaine and bupivacaine toxicity in human articular chondrocytes. J Bone Joint Surg Am 90:986–991. https://doi.org/10.2106/JBJS.G.01033

    Article  PubMed  Google Scholar 

  25. Wallen M, Gillies D (2006) Intra-articular steroids and splints/rest for children with juvenile idiopathic arthritis and adults with rheumatoid arthritis. Cochrane Database Syst Rev 2006:CD002824. https://doi.org/10.1002/14651858.CD002824.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kompel AJ, Roemer FW, Murakami AM et al (2019) Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought? Radiology 293:656–663. https://doi.org/10.1148/radiol.2019190341

    Article  PubMed  Google Scholar 

  27. Vitrikas K, Dalton H, Breish D (2020) Cerebral palsy: an overview. Am Fam Physician 101:213–220

    PubMed  Google Scholar 

  28. Novak I (2014) Evidence-based diagnosis, health care, and rehabilitation for children with cerebral palsy. J Child Neurol 29:1141–1156. https://doi.org/10.1177/0883073814535503

    Article  PubMed  Google Scholar 

  29. Wright PB, Ruder J, Birnbaum MA et al (2013) Outcomes after salvage procedures for the painful dislocated hip in cerebral palsy. J Pediatr Orthop 33:505–510. https://doi.org/10.1097/BPO.0b013e3182924677

    Article  PubMed  Google Scholar 

  30. Patel NK, Sabharwal S, Gooding CR et al (2015) Proximal femoral excision with interposition myoplasty for cerebral palsy patients with painful chronic hip dislocation. J Child Orthop 9:263–271. https://doi.org/10.1007/s11832-015-0662-z

    Article  PubMed  PubMed Central  Google Scholar 

  31. Silverio AL, Nguyen SV, Schlechter JA, Rosenfeld SR (2016) Proximal femur prosthetic interposition arthroplasty for painful dislocated hips in children with cerebral palsy. J Child Orthop 10:657–664. https://doi.org/10.1007/s11832-016-0775-z

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank Alissa Kan for preparing the illustration in Fig. 5.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Jason Zarahi Amaral, Rebecca J. Schultz & Scott B. Rosenfeld

  2. Department of Orthopedic Surgery, Wayne State University, Detroit, MI, USA

    Rebecca J. Schultz

  3. Department of Radiology, Texas Children’s Hospital, Baylor College of Medicine, 6621 Fannin Street, Houston, TX, 77030, USA

    J. Herman Kan

Authors
  1. Jason Zarahi Amaral
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rebecca J. Schultz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott B. Rosenfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Herman Kan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors substantially contributed to the conception, design, execution, and writing of this manuscript. J.Z.A. drafted, conceived, edited for revisions, interpreted images, and supported the study. R.J.S. drafted the initial manuscript, edited for revisions, and supported the study. S.B.R. conceived, drafted, substantially edited the manuscript for critical concepts, and supported the study. J.H.K. conceived, supervised, interpreted images, substantially edited the manuscript for critical concepts, and supported the study. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to J. Herman Kan.

Ethics declarations

Conflicts of interest

None

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 92 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Amaral, J.Z., Schultz, R.J., Rosenfeld, S.B. et al. Musculoskeletal injections for palliative treatment of neuromuscular hip dysplasia patients: how I do it. Pediatr Radiol 54, 693–701 (2024). https://doi.org/10.1007/s00247-024-05858-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-024-05858-z

Keywords

Search

Navigation