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To what extent can soft-tissue releases improve hip displacement in cerebral palsy?

ABSTRACT: Background and purpose - Hip displacement is frequent in nonambulatory children with cerebral palsy (CP) and treatment is controversial. This prospective study assesses the effectiveness of soft-tissue releases to treat hip subluxation, analyses prognostic factors for outcome, and identifies time to failure in hips with poor outcome. Patients and methods - 37 children (16 girls) with hip subluxation were recruited from the population-based screening program for children with CP in Norway. They had consecutively undergone soft-tissue releases (bilateral tenotomies of adductors and iliopsoas) at a mean age of 5.0 (2.8-7.2) years. Functional classification was Gross Motor Function Classification System (GMFCS) level III in 9 children, level IV in 10, and level V in 18 children. The outcome was termed good if the patient had not undergone further hip surgery and if the migration percentage (MP) of the worst hip at the latest follow-up was <50%. The mean follow-up time was 7.3 (5.1-9.8) years. Results - The outcome was good in all the ambulatory children and in 17 of 28 of the nonambulatory children. The only independent preoperative risk factor for poor outcome was MP ?50%. The mean time to failure was 2.2 (1-5) years postoperatively and the reasons for failure were insufficient initial correction and later deterioration of displacement. Interpretation - Bilateral soft-tissue release is recommended in both ambulatory and nonambulatory children with hip sub-luxation. The operation should be performed before the hip displacement reaches 50%.

SUBMITTER: Terjesen T

PROVIDER: S-EPMC5694817 | biostudies-other | 2017 Dec

REPOSITORIES: biostudies-other

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To what extent can soft-tissue releases improve hip displacement in cerebral palsy?

Terjesen Terje T

Acta orthopaedica 20170816 6

Background and purpose - Hip displacement is frequent in nonambulatory children with cerebral palsy (CP) and treatment is controversial. This prospective study assesses the effectiveness of soft-tissue releases to treat hip subluxation, analyses prognostic factors for outcome, and identifies time to failure in hips with poor outcome. Patients and methods - 37 children (16 girls) with hip subluxation were recruited from the population-based screening program for children with CP in Norway. They h ...[more]

PMID: 28812397

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Project description:ImportanceThere is no consensus on interventions to slow the progress of hip displacement in patients with cerebral palsy.ObjectiveTo investigate the efficacy of a novel hip brace in preventing progressive hip displacement in patients with cerebral palsy.Design, setting, and participantsThis 2-group randomized clinical trial was conducted at 4 tertiary hospitals in South Korea from July 2019 to November 2021. Participants included children aged 1 to 10 years with nonambulatory cerebral palsy (Gross Motor Function Classification System level IV or V). Block randomization was used to assign an equal number of patients to the study and control groups via computerized random allocation sequences. Data were analyzed from November to December 2021.InterventionsThe intervention group wore the hip brace for at least 12 hours a day for the study duration (ie, 12 months). Follow-up evaluations were performed after 6 and 12 months of wearing the brace. Both groups proceeded with conventional rehabilitation therapy during the trial.Main outcomes and measuresThe primary outcome was the Reimers migration index (MI) on radiography, as assessed by 3 blinded investigators. Primary outcome variables were analyzed using linear mixed models. Secondary outcomes include change in the Caregiver Priorities & Child Health Index of Life with Disabilities, on which lower scores indicate better quality of life.ResultsA total of 66 patients were included, with 33 patients (mean [SD] age, 68.7 [31.6] months; 25 [75.8%] boys) randomized to the intervention group and 33 patients (mean [SD] age, 60.7 [24.9] months; 20 [60.6%] boys) randomized to the control group. The baseline mean (SD) MI was 37.4% (19.3%) in the intervention group and 30.6% (16.3%) in the control group. The mean difference of the MI between the intervention group and control group was -8.7 (95% CI, -10.2 to -7.1) percentage points at 6 months and -12.7 (95% CI, -14.7 to -10.7) percentage points at 12 months. The changes in the Caregiver Priorities & Child Health Index of Life with Disabilities were favorable in the study group and reached statistical significance at the 6-month follow-up compared with the control group (difference, -14.2; 95% CI, -25.2 to -3.3).Conclusions and relevanceIn this randomized clinical trial, the novel hip brace was significantly effective in preventing the progression of hip displacement, compared with the control group. It effectively improved quality of life in patients with nonambulatory cerebral palsy. Therefore, hip brace use could be a promising treatment method to delay hip surgery and improve the quality of life of patients with nonambulatory cerebral palsy.Trial registrationClinicalTrials.gov Identifier: NCT04033289.

Project description:PurposeThe acetabulum interacts with the femoral head in daily activities and may exhibit structural changes in the presence of hip disorders. This study aims to redefine hip disorders in children with cerebral palsy by structural characteristics of the acetabulum in relation to the degree of the migration percentage.MethodsThe clinical and radiographic data of 70 patients (36 males, 34 females; mean age 8.2 years) with spastic cerebral palsy were retrospectively analyzed. The acetabular structure was measured by the acetabular index on reconstructed three-dimensional computerized tomography for precision of measurement. Any significant change in acetabular index measured on the reconstructive computerized tomography related to every 10% increment of migration percentage was regarded as clinically significant in hip disorders.ResultsThe acetabular index measured on the reconstructive computerized tomography showed an increasing trend with the increment of migration percentage. The most significant acetabular index measured on the reconstructive computerized tomography change occurred between the 20%-29% and 30%-39% migration percentage groups (p < 0.001), suggesting that a migration percentage of 30% is the starting point of hip disorder. A significant increase in the posterolateral acetabular index measured on the reconstructive computerized tomography occurred in migration percentages >50%, indicating posterolateral acetabular dysplasia. Hips with migration percentages from 80% to 100% had consistent acetabular indexes measured on the reconstructive computerized tomography values, suggesting complete dislocation and no more contact and interaction between the femoral head and acetabular fossa.ConclusionStructural characteristics in the acetabulum reflect hip dysfunction and potentially classify hip disorders. Results suggest the migration percentage 30% as a starting point of hip disorder and 80% as a turning point of hip dislocation in children with cerebral palsy.Level of evidencelevel IV, diagnostic study.

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To what extent can soft-tissue releases improve hip displacement in cerebral palsy?

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To what extent can soft-tissue releases improve hip displacement in cerebral palsy?

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