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22-12-2011 | Surgery | Article

Hip surveillance reduces dislocation risk in CP patients


Free abstract

MedWire News: Children with cerebral palsy (CP) benefit from a surveillance program for hip dislocation, with study findings demonstrating that regular follow-up reduces the risk for this common complication and corrective surgery.

"Chronic increase in muscle tone, muscle power imbalance and fixed contractures around the hip joint, together with unbalanced posture contribute to the progressive displacement of the femoral head out of the acetabular socket," explain Areej Elkamil (Norwegian University of Science and Technology, Trondheim) and co-workers.

To determine whether hip surveillance could reduce the risk for hip dislocation and hip surgery, the team compared the outcome of 119 patients from seven Norwegian counties who received regular healthcare with those of 136 Swedish residents of a region that implemented a hip surveillance program in 1994.

A comparable proportion of Norwegian and Swedish children had moderate to severe CP, defined as Gross Motor Function Classification System (GMFCS) level III-V (34 vs 38%). Swedish children were more likely to have dyskinetic CP and Norwegian children more likely to have bilateral spastic CP.

Eighteen (15.1%) of Norwegian children were diagnosed with hip dislocation compared with just one (0.7%) Swedish child, a significant difference in prevalence.

There was also a trend towards a greater requirement for surgery in Norwegian than Swedish children (44.5 vs 32.0%) but the difference did not reach statistical significance, Eklamil et al write.

However, surgery was first performed at a significantly older age in Norwegian than Swedish children, at 7.6 versus 5.7 years.

Data available for 28 Norwegian children and the Swedish cohort suggested that Swedish children received a greater number of plain anterioposterior X-rays than Norwegian children (9 vs 5), but Norwegian children were more likely to undergo pelvic computed tomography (CT; 4 versus 0).

Although the increased X-ray number may be considered a negative factor, the researchers comment: "Our limited information suggested that the higher number of X-rays per child in the surveillance area partly was outweighed by an apparent need for a pelvic CT scan in a few patients in the regular care area."

The team concludes: "Our results suggest that systematic follow up, including regular radiographic examinations of the pelvis from an early age, followed by early surgery is essential in preventing hip dislocation among children with severe CP."

By Lynda Williams

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