Hip displacement in cerebral palsy.
BACKGROUND
Hip displacement is considered to be common in children with cerebral palsy but the reported incidence and the proposed risk factors vary widely. Knowledge regarding its overall incidence and associated risk factors can facilitate treatment of these children.


METHODS
An inception cohort was generated from the Victorian Cerebral Palsy Register for the birth years 1990 through 1992, inclusive, and multiple data sources pertaining to the cohort were reviewed during 2004. Gross motor function was assessed for each child and was graded according to the Gross Motor Function Classification System (GMFCS), which is a valid, reliable, five-level ordinal grading system. Hip displacement, defined as a migration percentage of >30%, was measured on an anteroposterior radiograph of the pelvis with use of a reliable technique.


RESULTS
A full data set was obtained for 323 (86%) of 374 children in the Register for the birth years 1990 through 1992. The mean duration of follow-up was eleven years and eight months. The incidence of hip displacement for the entire birth cohort was 35%, and it showed a linear relationship with the level of gross motor function. The incidence of hip displacement was 0% for children with GMFCS level I and 90% for those with GMFCS level V. Compared with children with GMFCS level II, those with levels III, IV, and V had significantly higher relative risks of hip displacement (2.7, 4.6, and 5.9, respectively).


CONCLUSIONS
Hip displacement is common in children with cerebral palsy, with an overall incidence of 35% found in this study. The risk of hip displacement is directly related to gross motor function as graded with the Gross Motor Function Classification System. This information may be important when assessing the risk of hip displacement for an individual child who has cerebral palsy, for counseling parents, and in the design of screening programs and resource allocation.
Soo
Brendan
B
Department of Orthopaedic Surgery, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
Howard
Jason J
JJ
Boyd
Roslyn N
RN
Reid
Susan M
SM
Lanigan
Anna
A
Wolfe
Rory
R
Reddihough
Dinah
D
Graham
H Kerr
HK
D002547:Cerebral Palsy / Q000145:classification / Q000150:complications*; D002648:Child; D015331:Cohort Studies; D004421:Dystonia / Q000145:classification; D005500:Follow-Up Studies; D006429:Hemiplegia / Q000145:classification; D006617:Hip Dislocation / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008124:Locomotion / Q000502:physiology; D009069:Movement Disorders / Q000145:classification / Q000209:etiology; D009123:Muscle Hypotonia / Q000145:classification; D009128:Muscle Spasticity / Q000145:classification; D004856:Postural Balance / Q000502:physiology; D011782:Quadriplegia / Q000145:classification; D011859:Radiography; D012307:Risk Factors; D012420:Running / Q000502:physiology; D012656:Self-Help Devices; D016138:Walking / Q000502:physiology; D014910:Wheelchairs