Assessment of X-ray follow-up for hip displacement in patients with cerebral palsy at the Pereira Rossell Hospital

Authors

DOI:

https://doi.org/10.29193/RMU.35.4.4

Keywords:

CEREBRAL PALSY, HIP DISLOCATION, RADIOGRAPHY, CHILD

Abstract

Introduction: hip luxation is a severe complication in patients with cerebral palsy (CP), especially in gross motor functional classification system (GMFCS) III-V patients. Pelvic x-rays are necessary to identify this condition.
Objectives: to assess the x-ray follow-up in these patients and the early detection of this complication in  our hospital.
Method: the medical records and x-rays of 17 GMFCS III-V patients who were between 2 and 8 years old at the time of index pelvic x-ray were reviewed, measurement of the hip migration percentage according to Reimer´s index, the cervical-diaphyseal angle and calculation of the CPUP hip score for each hip. We assessed the follow-up x-ray a year later or later than that date, and in the even this had not happened, we would call the patients in for a control x-ray to identify the hips with an increase migration risk.
Results: 3 (18%) out of 17 patients assessed underwent a new pelvic x-ray a year later. 6 patients (35%) underwent one later than one year after and prior to the control visit planned, 7 (41%) patients were never controlled and they were called for a new x-ray in 2018. One patient (6%) was lost during follow-up. One patient had an increased risk hip (CPUP Score 50-60%), the rest had normal migration percentages.
Conclusions: few patients with PC GMFCS III-V underwent annual follow-up. Those monitored did not evidence progression of this condition. This study and the relevant literature back up the introduction of a surveillance program in our hospital. 

References

(1) Graham HK, Rosenbaum P, Paneth N, Dan B, Lin JP, Damiano DL, et al. Cerebral palsy. Nat Rev Dis Primers 2016; 2:15082.

(2) Hägglund G, Andersson S, Düppe H, Lauge-Pedersen H, Nordmark E, Westbom L. Prevention of hip dislocation in children with cerebral palsy. The first ten years experiences of a population-based prevention programme. J Bone Joint Surg Br 2005; 87(1):95-101.

(3) Pruszczynski B, Sees J, Miller F. Risk factors for hip displacement in children with cerebral palsy: systematic review. J Pediatr Orthop 2016; 36(8):829-33.

(4) Reimers J. The stability of the hip in children. A radiological study of the results of muscle surgery in cerebral palsy. Acta Orthop Scandin Suppl 1980; 184:1-100.

(5) Hermanson M, Hägglund G, Riad J, Rodby-Bousquet E, Wagner P. Prediction of hip displacement in children with cerebral palsy. Bone Joint J 2015; 97-B(10):1441-4.

(6) Hermanson M, Hägglund G, Riad J, Wagner P. Head-shaft angle is a risk factor for hip displacement in children with cerebral palsy. Acta Orthop 2015; 86(2):229-32.

(7) Givon U. Management of the spactic hip in cerebral palsy. Curr Opin Pediatr 2017; 29(1):65-9.

(8) Hägglund G, Alriksson-Schmidt A, Lauge-Pedersen H, Rodby-Bousquet E, Wagner P, Wastbom L. Prevention of dislocation of the hip in children with cerebral palsy: 20-year results of a population-based prevention programme. Bone Joint J 2014; 96-B(11):1546-52.

(9) Elkamil Al, Andersen GL, Hägglund G, Lamvik T, Skranes J, Vik T. Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: a cross sectional study in Sweden and Norway. BMC Musculoskel Dis 2011; 12:284.

(10) Kentish M, Wybter M, Snape N, Boyd R. Five-year outcome of state-wide hip surveillance of children and adolescents with cerebral palsy. J Pediatr Rehabil Med 2011; 4(3):205- 17.

(11) Hägglund G. Radiographic follow-up in CPUP to prevent hip dislocation. 2013. Disponible en: http://cpup.se/wp-content/uploads/2013/07/CPUPprevent_hip_dislocation20130210.pdf. Consulta: 24 setiembre 2018.

(12) Rehbein I. Análisis de los procedimientos quirúrgicos ortopédicos realizados en niños con parálisis cerebral en relación con la edad y función motora gruesa. Monografía Postgrado Montevideo: Traumatología y Ortopedia, Facultad de Medicina-UdelaR, 2018.

(13) Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39(4):214-23.

(14) Gainsborough M, Surman G, Maestri G, Colver A, Cans C. Validity and reliability of the guidelines of the surveillance of cerebral palsy in Europe for the classification of cerebral palsy. Dev Med Child Neurol 2008; 50(11):828-31.

(15) Hägglund G, Lauge-Pedersen H, Wagner P. Characteristics of children with hip displacement in cerebral palsy. BMC Musculoskeletal Disord 2007; 8:101.

(16) Hägglund G, Lauge-Pedersen H, Persson M. Radiographic threshold values for hip screening in cerebral palsy. J Child Orthop 2007(1):43-7.

(17) AppInConf AB. CPUP Hip Score APP. Lund, Suecia: AppInConf AB, 2019. Disponible para IPhone y Android.

(18) Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am 1967; 49(5):807-35.

(19) Hermanson M, Hägglund G, Riad J, Rodby-Bousquet E. Inter-and intra-rater reliability of the head-shaft angle in children with cerebral palsy. J Child Orthop 2017; 11(4):256-62.

(20) Craven A, Pym A, Boyd RN. Reliability of radiologic measures of hip displacement in a cohort of preschool- aged children with cerebral palsy. J Pediatr Orthop 2014; 34(6): 597-602.

(21) Faraj S, Atherton WG, Stott NS. Inter- and intra-measurer error in the measurement of Reimer’s hip migration percentage. J Bone Joint Surg Br 2004; 86(3):434-7.

(22) Gordon GS, Simkiss DE. A systematic review of the evidence for hip surveillance in children with cerebral palsy. J Bone Joint Surg Br 2006; 88(11):1492-6.

(23) Wynter M, Gibson N, Kentish M, Love S, Thomason P, Kerr Graham H. The consensus statement on hip surveillance for children with cerebral palsy: australian standards of care. J Pediatr Rehabil Med 2011; 4(3):183-95.

Published

2019-11-04

How to Cite

1.
Rehbein I, Teske V, von Heideken J. Assessment of X-ray follow-up for hip displacement in patients with cerebral palsy at the Pereira Rossell Hospital. Rev. Méd. Urug. [Internet]. 2019 Nov. 4 [cited 2024 Nov. 22];35(4):281-8. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/306