Natural History and Surveillance of Hip Dysplasia in Cerebral Palsy

Abstract

Children with cerebral palsy (CP) very commonly develop subluxation or dislocation of the hip joint. This dislocation leads to difficulty sitting, problems with custodial care, and hip pain. The hip in the child with CP is normal at birth, and because of the abnormal muscle pull and growth, it slowly becomes displaced moving lateral and posterior superior. This process typically begins around age 2 and has the highest risk between 3 and 5 years old. The subluxation is measured with anteriorposterior supine pelvic radiographs, and the amount of subluxation is approximately one degree a month which means radiographs are required annually from age 2 to 8 years old and then every 2 years till completion of growth. The high-risk group of children are those who cannot walk or need to use assistive devices like walkers or crutches (GMFCS III–V). For children who can walk (GMFCS I–II), there needs to be only one radiograph in early childhood 2–4 years old; if it is normal (<25% MP), no further radiographs are needed.When the MP reaches 25%, there should be an increase in attention with increased radiograph every 6months, and consideration of surgical invention occurs with subluxation between 25 and 40%. For MP greater than 40 percent, surgical invention should be considered. Based on the experience from Sweden, almost all children with CP can reach adulthood with located hip joints.