Developmental dysplasia of spastic hip (DDSH) in
cerebral palsy often causes severe sufferings including pain [1],
reduced range of hip motion with associated sitting, standing and
walking problems, if not detected early [2]. The incidence of spastic
hip displacement in cerebral palsy is reported to vary from 1% to 75%
[3,4]. This study was planned to find out DDSH in cerebral palsy, as
there is a lack of Indian data on this aspect.
This descriptive study was conducted between May 2014
and January 2015 in children presenting with clinical features
suggestive of cerebral palsy at a tertiary care teaching hospital. A
total of 118 children with cerebral palsy between 2 to 12 years of age
belonging to Gross motor function classification system (GMFCS) grade
III-V were enrolled. History and clinical examination using
systematically designed forms were taken. Radiograph of pelvis and hip
joint with hip abducted in supine position was taken. The degree of hip
displacement was measured by Reimer’s Migration Percentage (MP) [1]. Hip
migration between 33-80% was labeled subluxation, and over 80% as
dislocation. Gross motor function in cerebral palsy was assessed
according to GMFCS a five level ordinal scale [5]. This study was
approved by the Institutional ethical committee of our institute.
DDSH was found in 15 (12.71%) children (hip
subluxation 14, hip dislocation 1). All these children had spastic
cerebral palsy. Sublaxation was seen in children (6.2%) with GMFCS grade
III, 6 children (16.6%) with GMFCS grade IV and 6 children (12.0%) with
GMFCS grade V. One child (2%) with GMFCS grade V had hip dislocation. No
hip subluxation or dysplasia was found in dyskinetic cerebral palsy. One
child (7.1%) with spastic hemiplegia and 2 children (14.2%) with spastic
diplegia had subluxation. Eleven (12.2%) of the 90 children with spastic
quadriplegia had subluxation. One child with spastic quadriplegia had
hip dislocation.
Hip dysplasia in cerebral palsy is due to
asymmetrical activity of the muscles surrounding the hip joint [6].
Previous studies described hip subluxation in 30-60% of children with
cerebral palsy which is much higher then in our study [3,7]. The
probable reason for less number of DDSH in current study is probably due
to the positioning of younger kids on their mothers waist with hips
widely abducted.
Soo, et al. [8], demonstrated a linear
relationship between the rate of hip displacement and a child’s GMFCS
level, with hip displacement seen in 90% of GMFCS V children. They also
reported more hip dysplasia in spastic quadriplegia than diplegia [8].
Our study showed similar results.
Limitations of the present study are a descriptive
study, and not analyzing serial pelvis X-ray changes. Our hip
dysplasia treatment protocol involves abduction brace, Botulinum toxin,
abductor tenotomy and/or varus osteotomy based on severity of hip
displacement. Early detection and surgical intervention for spastic hip
displacement can prevent hip dislocation and need for more invasive
surgery.
Acknowledgement: Dr Giriyanna Gowda and Dr
Chandana Krishna from the Department of community medicine, Kempegowda
Institute of Medical Sciences, Bangalore for valuable inputs regarding
data analysis.
Contributors: VR: Revised the manuscript for
important intellectual content and guarantor of the paper; VM:
Conceptualization of the study, collection, analysis of the data,
writing the manuscript; RR: Designed the study, conducted laboratory
tests and analyzed the data; PR: Supervision of the work and revision of
manuscript.
Funding: None; Competing interests: None
stated.
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