Hip dislocation in cerebral palsy
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7544.772 (Published 30 March 2006) Cite this as: BMJ 2006;332:772
- Teresa Pountney, research physiotherapist (Terry.Pountney@southdowns.nhs.uk)1,
- Elizabeth M Green, consultant in paediatric rehabilitation1
- 1 Chailey Heritage Clinical Services, North Chailey, BN8 4JN
- Correspondence to: T Pountney
- Accepted 8 February 2006
The first report on treatment of hip contractures in cerebral palsy was published in 1880.1 Lateral migration of the hip (subluxation or partial dislocation) occurs in 30-60% of children with cerebral palsy who are not walking independently at 5 years.2–5 Its clinical course has been well documented, including its effect on function (such as pain affecting the ability to sit and hygiene).w1 We review the literature on current management of hip dislocation in cerebral palsy in terms of its clinical course, measurement, and treatments.
Age 3: early migration of right femoral head (left); age 5: progression to dislocation despite right hip adductor releases (right)
Methods
We searched the major databases including PubMed, AMED, Embase, CINAHL, and the Cochrane Library and focused on the prevalence of hip dislocation, its clinical course, measurement of the condition, and treatment options. Keywords used were: “cerebral palsy”, “children”, “hip subluxation or hip dislocation”, “windswept deformity”, “migration percentage”, “surgery”, “postural management”, “botulinum toxin”, and “pain”. The search found little high quality evidence. Studies were largely cohort or population studies. We found no systematic reviews and only two randomised controlled trials and one evidence report (by the American Academy of Cerebral Palsy and Developmental Medicine).6–8
Clinical course of hip dislocation
In children with cerebral palsy the hip is normal at birth but the effects of delayed motor development lead to dysplasia. Asymmetrical activity of the muscles surrounding the hip and lack of load bearing affect bone development and are the main causes of subluxation and dislocation (figs 1 and 2).w2-w5
Derotational femoral osteotomy to relocate the femoral head
Two large studies (93 and 234 participants) investigated pain in adolescents and adults with cerebral palsy by interview and standardised questionnaires to identify sites and duration of pain. Thirty nine per cent and 47% of …
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