Skip to main content

Advertisement

SpringerLink
Log in

Imaging Parameters of Hip Dysplasia in Cerebral Palsy: A Systematic Review

  • Review Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Cerebral Palsy is the leading cause of childhood physical disability globally. The motor disorders of CP are often associated with musculoskeletal anomalies, of which hip displacement is the second most common abnormality after abnormalities of foot and ankle. Various radiological parameters have been described in the literature which detects and quantifies hip dysplasia, with MP being the current gold standard. This study aims to review these radiological indicators of hip dysplasia in children with cerebral palsy from the published literature.

Methods

A literature search using PubMed, Embase, and Google Scholar was done on 15th June 2021 focusing on surveillance of hip dysplasia in cerebral palsy. The studies to be included were to have used anyone or more radiological parameter for detection of hip dysplasia with the use of any of the radiological methods.

Results

The initial search yielded 1184 results. After the screening of the abstracts and full texts, a final of 30 studies was included for this systematic review. The majority of the studies were graded as Level 3 evidence (16/30), followed by Level 2 studies (14/30). X-ray was the most common modality of detection of dysplasia followed by CT scan, ultrasonography, and arthrogram. The reproducibility of the various parameters shows good to excellent intraclass coefficients.

Conclusions

Parameters other than MP can be used to screen hips in CP. This would be useful in patients in whom either the lateral acetabular edge is not discernible on a plain anteroposterior radiograph or there are issues in the positioning of the patient. Additional views and structures can be visualized which can lead to improved screening and planning. Further investigations are required to appreciate the full potential of these parameters and how they can be better utilized.

Graphical abstract

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
Fig2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Hallman-Cooper, J. L., & Rocha Cabrero, F. (2021). Cerebral palsy. StatPearls Treasure Island. StatPearls Publishing.

    Google Scholar 

  2. Sadowska, M., Sarecka-Hujar, B., & Kopyta, I. (2020). Cerebral palsy: Current opinions on definition, epidemiology, risk factors, classification and treatment options. Neuropsychiatric Disease and Treatment, 16, 1505–1518.

    PubMed  PubMed Central  Google Scholar 

  3. Incidence of Cerebral Palsy Remains Constant in India. (2010). https://www.medindia.net/news/incidence-of-cerebral-palsy-remains-constant-in-india-74912-1.htm. Published October 4, 2010. Accessed 19 Jan 2022.

  4. Galea, C., Mcintyre, S., Smithers-Sheedy, H., Reid, S. M., Gibson, C., Delacy, M., et al. (2019). Cerebral palsy trends in Australia (1995–2009): A population-based observational study. Developmental Medicine and Child Neurology, 61(2), 186–193.

    PubMed  Google Scholar 

  5. Alexandra Hospital, A. E. (2016). Hip dislocation in cerebral palsy: Treatment options. Orthopedic Research and Physiotherapy, 2(2), 1–6.

    Google Scholar 

  6. Lonstein, J. E., & Beck, K. (1986). Hip dislocation and subluxation in cerebral palsy. Journal of Pediatric Orthopedics, 6(5), 521–526.

    CAS  PubMed  Google Scholar 

  7. Chang, C. H., Wang, Y. C., Ho, P. C., Hwang, A. W., Kao, H. K., Lee, W. C., et al. (2015). Determinants of hip displacement in children with cerebral palsy. Clinical Orthopaedics and Related Research, 473(11), 3675–3681.

    PubMed  PubMed Central  Google Scholar 

  8. Chang, C. H., Kuo, K. N., Wang, C. J., Chen, Y. Y., Cheng, H. Y., & Kao, H. K. (2011). Acetabular deficiency in spastic hip subluxation. Journal of Pediatric Orthopaedics, 31(6), 648–654.

    PubMed  Google Scholar 

  9. Gose, S., Sakai, T., Murase, T., & Sugamoto, K. (2010). Morphometric analysis of the femur in cerebral palsy: 3-dimensional CT Study. Journal of Pediatric Orthopaedics, 30(6), 7.

    Google Scholar 

  10. Gose, S., Sakai, T., Shibata, T., Murase, T., Yoshikawa, H., & Sugamoto, K. (2009). Morphometric analysis of acetabular dysplasia in cerebral palsy: Three-dimensional CT study. Journal of Pediatric Orthopaedics, 29(8), 896–902.

    PubMed  Google Scholar 

  11. Abel, M. F., Wenger, D. R., Mubarak, S. J., & Sutherland, D. H. (1994). Quantitative analysis of hip dysplasia in cerebral palsy: a study of radiographs and 3-D reformatted images. Journal of Pediatric Orthopedics, 14(3), 283–289.

    CAS  PubMed  Google Scholar 

  12. Buckley, S. L., Sponseller, P. D., & Magid, D. (1991). The acetabulum in congenital and neuromuscular hip instability. Journal of Pediatric Orthopedics, 11(4), 498–501.

    CAS  PubMed  Google Scholar 

  13. Kay, R. H., Noble, J. J., Johnston, L., Keevil, S. F., Kokkinakis, M., Reed, D., et al. (2020). 3D ultrasound to quantify lateral hip displacement in children with cerebral palsy: A validation study. Developmental Medicine and Child Neurology, 62(12), 1389–1395.

    PubMed  Google Scholar 

  14. Šmigovec, I., Đapić, T., & Trkulja, V. (2014). Ultrasound screening for decentered hips in children with severe cerebral palsy: A preliminary evaluation. Pediatric Radiology, 44(9), 1101–1109.

    PubMed  Google Scholar 

  15. Heinrich, S. D., MacEwen, G. D., & Zembo, M. M. (1991). Hip dysplasia, subluxation, and dislocation in cerebral palsy: An arthrographic analysis. Journal of Pediatric Orthopedics, 11(4), 488–493.

    CAS  PubMed  Google Scholar 

  16. Sauser, D. D., Hewes, R. C., & Root, L. (1986). Hip changes in spastic cerebral palsy. AJR American Journal of Roentgenology, 146(6), 1219–1222.

    CAS  PubMed  Google Scholar 

  17. Miller, F., & Bagg, M. R. (1995). Age and migration percentage as risk factors for progression in spastic hip disease. Developmental Medicine and Child Neurology, 37(5), 449–455.

    CAS  PubMed  Google Scholar 

  18. Kentish, M., Wynter, M., Snape, N., & Boyd, R. (2011). Five-year outcome of state-wide hip surveillance of children and adolescents with cerebral palsy. Journal of Pediatric Rehabilitation Medicine, 4(3), 205–217.

    CAS  PubMed  Google Scholar 

  19. Terjesen, T. (2012). The natural history of hip development in cerebral palsy: Hip Development in CP. Developmental Medicine and Child Neurology, 54(10), 951–957.

    PubMed  Google Scholar 

  20. Terjesen, T. (2006). Development of the hip joints in unoperated children with cerebral palsy: a radiographic study of 76 patients. Acta Orthopaedica, 77(1), 125–131.

    PubMed  Google Scholar 

  21. Poirot, I., Laudy, V., Rabilloud, M., Roche, S., Iwaz, J., Kassaï, B., et al. (2019). Patterns of hip migration in non-ambulant children with cerebral palsy: A prospective cohort study. Annals of Physical and Rehabilitation Medicine, 63, 400–407.

    PubMed  Google Scholar 

  22. Park, J. Y., Choi, Y., Cho, B. C., Moon, S. Y., Chung, C. Y., Lee, K. M., et al. (2016). Progression of hip displacement during radiographic surveillance in patients with cerebral palsy. Journal of Korean Medical Science, 31(7), 1143.

    PubMed  PubMed Central  Google Scholar 

  23. Wek, C., Chowdhury, P., Smith, C., & Kokkinakis, M. (2020). Is the Gothic Arch a reliable radiographic landmark for migration percentage in children with cerebral palsy? Journal of Children’s Orthopaedics, 14(5), 397–404.

    PubMed  PubMed Central  Google Scholar 

  24. Hägglund, G., Goldring, M., Hermanson, M., & Rodby-Bousquet, E. (2018). Pelvic obliquity and measurement of hip displacement in children with cerebral palsy. Acta Orthopaedica, 89(6), 652–655.

    PubMed  PubMed Central  Google Scholar 

  25. Lim, S.-J., & ParK, Y.-S. (2015). Plain radiography of the hip: A review of radiographic techniques and image features. Hip and Pelvis, 27(3), 125. https://doi.org/10.5371/hp.2015.27.3.125

    Article  PubMed  PubMed Central  Google Scholar 

  26. Southwick, W. O. (1967). Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. The Journal of Bone and Joint Surgery American, 49(5), 807–835.

    CAS  Google Scholar 

  27. Van der List, J. P., Witbreuk, M. M., Buizer, A. I., & van der Sluijs, A. J. (2015). The head–shaft angle of the hip in early childhood: a comparison of reference values for children with cerebral palsy and normally developing hips. The Bone and Joint Journal, 97-B(9), 1291–1295.

    PubMed  Google Scholar 

  28. Finlayson, L., Czuba, T., Gaston, M. S., Hägglund, G., & Robb, J. E. (2018). The head shaft angle is associated with hip displacement in children at GMFCS levels III-V - a population based study. BMC Musculoskeletal Disorders, 19(1), 356.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Hermanson, M., Hägglund, G., Riad, J., & Wagner, P. (2015). Head-shaft angle is a risk factor for hip displacement in children with cerebral palsy. Acta Orthopaedica, 86(2), 229–232.

    PubMed  PubMed Central  Google Scholar 

  30. Hermanson, M., Hägglund, G., Riad, J., Rodby-Bousquet, E., & Wagner, P. (2015). Prediction of hip displacement in children with cerebral palsy: development of the CPUP hip score. The Bone and Joint Journal, 97-B(10), 1441–1444.

    CAS  PubMed  Google Scholar 

  31. Craven, A., Pym, A., & Boyd, R. N. (2014). Reliability of radiologic measures of hip displacement in a cohort of preschool-aged children with cerebral palsy. Journal of Pediatric Orthopaedics, 34(6), 597–602.

    PubMed  Google Scholar 

  32. Chougule, S., Dabis, J., Petrie, A., Daly, K., & Gelfer, Y. (2016). Is head–shaft angle a valuable continuous risk factor for hip migration in cerebral palsy? Journal of Children’s Orthopaedics, 10(6), 651–656.

    PubMed  PubMed Central  Google Scholar 

  33. Ha, M., Okamoto, T., Fukuta, T., Tsuboi, Y., Shirai, Y., Hattori, K., et al. (2018). Preoperative radiologic predictors of successful soft tissue release surgery for hip subluxation among cerebral palsy patients: A STROBE compliant study. Medicine, 97(33), e11847.

    PubMed  PubMed Central  Google Scholar 

  34. Scrutton, D., Baird, G., & Smeeton, N. (2001). Hip dysplasia in bilateral cerebral palsy: incidence and natural history in children aged 18 months to 5 years. Developmental Medicine and Child Neurology, 43(9), 586–600.

    CAS  PubMed  Google Scholar 

  35. Heidt, C., Hollander, K., Wawrzuta, J., Molesworth, C., Willoughby, K., Thomason, P., et al. (2015). The radiological assessment of pelvic obliquity in cerebral palsy and the impact on hip development. The Bone and Joint Journal, 97-B(10), 1435–1440.

    CAS  PubMed  Google Scholar 

  36. Hägglund, G. (2020). Association between pelvic obliquity and scoliosis, hip displacement and asymmetric hip abduction in children with cerebral palsy: A cross-sectional registry study. BMC Musculoskeletal Disorders, 21(1), 464.

    PubMed  PubMed Central  Google Scholar 

  37. Porter, D., Michael, S., & Kirkwood, C. (2007). Patterns of postural deformity in non-ambulant people with cerebral palsy: What is the relationship between the direction of scoliosis, direction of pelvic obliquity, direction of windswept hip deformity and side of hip dislocation? Clinical Rehabilitation, 21(12), 1087–1096.

    PubMed  Google Scholar 

  38. Suh, D.-H., Hong, J.-Y., Suh, S.-W., Park, J.-W., & Lee, S.-H. (2014). Analysis of hip dysplasia and spinopelvic alignment in cerebral palsy. The Spine Journal, 14(11), 2716–2723.

    PubMed  Google Scholar 

  39. Karim, T., Al Imam, M. H., Golland, P., Khan, A. I., Hossain, I., Smithers-Sheedy, H., et al. (2019). Hip dysplasia among children with spastic cerebral palsy in rural Bangladesh. BMC Musculoskeletal Disorders, 20(1), 494.

    PubMed  PubMed Central  Google Scholar 

  40. Robb, J. E., & Hägglund, G. (2013). Hip surveillance and management of the displaced hip in cerebral palsy. Journal of Children’s Orthopaedics, 7(5), 407–413.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Marcström, A., Hägglund, G., & Alriksson-Schmidt, A. I. (2019). Hip pain in children with cerebral palsy: A population-based registry study of risk factors. BMC Musculoskeletal Disorders, 20(1), 62.

    PubMed  PubMed Central  Google Scholar 

  42. Shore, B., Spence, D., & Graham, H. (2012). The role for hip surveillance in children with cerebral palsy. Current Reviews in Musculoskeletal Medicine, 5(2), 126–134.

    PubMed  PubMed Central  Google Scholar 

  43. Das, S. P., Sahoo, P., Sahu, M. M., & Chitapure, T. (2017). Radiological evaluation of hip in cerebral palsy: A randomized cross-sectional study. Indian Journal of Physical Medicine and Rehabilitation, 28(3), 95–99.

    Google Scholar 

Download references

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, Deoghar, Jharkhand, India

    Sitanshu Barik

  2. Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

    Aakash Jain, Hawaibam Nongdamba, Sunny Chaudhary, Rama Priya Yasam & Vivek Singh

  3. Department of Orthopaedics, All India Institute of Medical Sciences, Bhatinda, Punjab, India

    Tarun Goyal

Authors
  1. Sitanshu Barik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aakash Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hawaibam Nongdamba
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sunny Chaudhary
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rama Priya Yasam
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tarun Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vivek Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

S.B., H.N., S.C., R.P.Y contributed to planning of study, and writing and revising the manuscript. A.J. was involved in analysis, data management, and preparation of the manuscript. V.S. performed planning of study and manuscript preparation. T.G. contributed to literature search, writing the manuscript, and data analysis.

Corresponding author

Correspondence to Aakash Jain.

Ethics declarations

Conflict of Interest

All the authors declare that they do not have any competing interest, concerning this research, authorship, and/or publication of this article.

Ethical Standard Statement

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Ethical Approval

Not applicable.

Informed Consent

For this type of study informed consent is not required.

Consent to Participate

Not applicable.

Additional information

Publisher's Note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barik, S., Jain, A., Nongdamba, H. et al. Imaging Parameters of Hip Dysplasia in Cerebral Palsy: A Systematic Review. JOIO 56, 939–951 (2022). https://doi.org/10.1007/s43465-022-00610-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-022-00610-x

Keywords

Search

Navigation