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Radiographic threshold values for hip screening in cerebral palsy

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

To analyse the consequences of using different radiographic measurements and different threshold values for hip screening in children with cerebral palsy (CP).

Methods

In a total sample of children with CP a standardised radiological follow-up of the hips was carried out as a part of a hip prevention programme. Acetabular index (AI) and migration percentage (MP) were measured on all radiographs. In this study, 1,067 radiographs of 272 children born 1992–1998 were analysed.

Results

Lateral displacement of the femoral head was common without acetabular dysplasia, and acetabular dysplasia occurred at a later stage than femoral head lateralisation. Hip dysplasia without lateral displacement of the femoral head was rare. In 16 of the 56 hips (29%) with AI ≥ 27° and in 23 of the 71 (32%) hips with MP ≥ 33% the values decreased below the threshold value without operative treatment. In hips with AI ≥ 30° only 2 of 31 hips (6%) and in hips with MP ≥ 40% only 5 of 44 hips (11%) decreased below the threshold values without operative treatment.

Conclusions

Radiographic follow-up with only measurement of the MP seems sufficient in screening for dislocation in children with CP. MP ≥ 33% is recommended as threshold for reaction or intensified observation. In children with MP ≥ 40%, the lateral displacement increased over time in most hips, thus indicating the need for operative intervention. In children with MP 33–40%, treatment should be based on other clinical signs and the progression of MP over time.

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References

  1. Dobson F, Boyd RN, Parrott J, Nattrass GR, Graham HK (2002) Hip surveillance in children with cerebral palsy. J Bone Joint Surg Br 84-B:720–726

    Article  Google Scholar 

  2. Hägglund G, Andersson S, Düppe H, Lauge Pedersen H, Nordmark E, Westbom L (2005) Prevention of dislocation of the hip in children with cerebral palsy. First ten years experience of a population based prevention program. J Bone Joint Surg Br 87-B:95–101

    Google Scholar 

  3. Rang M, Silver R, de la Garza J (1986) Cerebral palsy. In: Lovell WW, Winter RB (eds) Pediatric orthopaedics, 2nd edn. JB Lippincott Co., Philadelphia, pp 345–396

    Google Scholar 

  4. Reimers J (1980) The stability of the hip in children: a radiological study of results of muscle surgery in cerebral palsy. Acta Orthop Scand 184:1–100

    Article  CAS  Google Scholar 

  5. Hilgenreiner H (1925) Zur Frühdiagnose und Frühbehandlung der angeborenen Hüftgelenkverrenkung. Medizinische Klinik 21:1385–13425

    Google Scholar 

  6. Onimus M, Allamel G, Manzone P, Laurain JM (1991) Prevention of hip dislocation in cerebral palsy by early psoas and adductors tenotomies. J Pediatr Orthop 11:432–435

    Article  CAS  Google Scholar 

  7. Cooke PH, Cole WG, Carey RPL (1989) Dislocation of the hip in cerebral palsy. Natural history and predictability. J Bone Joint Surg Br 71-B:441–446

    Google Scholar 

  8. Nordmark E, Hägglund G, Lagergren J (2001) Cerebral palsy in southern Sweden. I. Prevalence and clinical features. Acta Paediatr 90:1271–1276

    Article  CAS  Google Scholar 

  9. Hägglund G, Andersson S, Düppe H, Lauge Pedersen H, Nordmark E, Westbom L (2005) Prevention of severe contractures might replace multilevel surgery in cerebral palsy: results of a population-based health care programme and new techniques to reduce spasticity. J Pediatr Orthop 14:268–272

    Google Scholar 

  10. Nordmark E, Hägglund G, Lagergren J (2001) Cerebral palsy in southern Sweden. II. Gross motor function and disabilities. Acta Paediatr 90:1277–1282

    Article  CAS  Google Scholar 

  11. Hagberg B, Hagberg G, Olow I (1975) The changing panorama of cerebral palsy in Sweden 1954–1970. Acta Paediatr Scand 64:187–192

    Article  CAS  Google Scholar 

  12. Palisano R, Rosenbaum P, Walter S, Russel D, Wood E, Galuppi B (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39:214–223

    Article  CAS  Google Scholar 

  13. Parrott J, Boyd RN, Dobson F, Lancaster A, Love S, Oates J, Wolfe R, Nattrass GR, Graham HK (2002) Hip displacement in spastic cerebral palsy: Repeatability of radiologic measurement. J Pediatr Orthop 22:660–667

    Google Scholar 

  14. Faraj S, Atherton WG, Stott NS (2004) Inter- and intra-measurer error in the measurement of Reimer’s hip migration percentage. J Bone Joint Surg Br 86:434–437

    Article  CAS  Google Scholar 

  15. Vidal J, Deguillaume P, Vidal M (1985) The anatomy of the dysplastic hip in cerebral palsy related to prognosis and treatment. Int Orthop 9:105–110

    Article  CAS  Google Scholar 

  16. Weeler ME, Weinstein SL (1984) Adductor tenotomy-obturator neurectomy. J Pediatr Orthop 4:48–51

    Article  Google Scholar 

  17. Cornell MS, Hatrick NC, Boyd R, Baird G, Spencer JD (1997) The hip in children with cerebral palsy. Clin Orthop 340:165–171

    Article  Google Scholar 

  18. Silver RI, Rang M, Chan J, de la Garza J (1985) Adductor release in nonambulant children with cerebral palsy. J Pediatr Orthop 5:672–677

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The study was supported by the Medical faculty, Lund University and Linnéa and Josef Carlssons stiftelse.

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Authors and Affiliations

  1. Department of Orthopaedics, Lund University Hospital, 221 85, Lund, Sweden

    Gunnar Hägglund, Henrik Lauge-Pedersen & Måns Persson

Authors
  1. Gunnar Hägglund
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  2. Henrik Lauge-Pedersen
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  3. Måns Persson
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Corresponding author

Correspondence to Gunnar Hägglund.

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Hägglund, G., Lauge-Pedersen, H. & Persson, M. Radiographic threshold values for hip screening in cerebral palsy. J Child Orthop 1, 43–47 (2007). https://doi.org/10.1007/s11832-007-0012-x

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  • DOI: https://doi.org/10.1007/s11832-007-0012-x

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