Comparison of botulinum toxin type A injection and soft-tissue surgery to treat hip subluxation in children with cerebral palsy.
OBJECTIVE
To compare the effects of botulinum toxin type A (BTX-A) injection into the hip adductor muscles on hip displacement with soft-tissue surgery and assess the factors related to a favorable outcome after intervention in children with bilateral spastic cerebral palsy (CP).


METHODS
Retrospective chart review with regard to radiographic findings.


METHODS
University hospital.


METHODS
Children with CP (N=194).


METHODS
BTX-A injection and soft-tissue surgery into the hip adductor muscles.


METHODS
The Reimers hip migration percentage (MP).


RESULTS
Sixty-nine children did not receive any therapeutic intervention for hip displacement, whereas 60 children underwent soft-tissue surgery and 65 children took BTX-A injection for the spasticity of their hip muscles. MP was measured on each radiograph of the pelvis. The annual change of MP was improved in both the soft-tissue surgery and BTX-A groups, whereas it worsened in the nonintervention group. The annual improvement of MP in the BTX-A group did not differ significantly from that of the soft-tissue surgery group. The improvement in hip displacement after therapeutic intervention was greater in young children and high-functioning groups compared with older children and low-functioning groups. Hip displacement was progressive in the severely hip subluxated group despite therapeutic intervention.


CONCLUSIONS
Comparable effects of BTX-A injection to soft-tissue surgery in our study suggest that BTX-A injection, if timely reinjected, may replace soft-tissue surgery as a prophylactic procedure against progressive hip subluxation or dislocation in children. Age at intervention, functional level, and initial MP before therapeutic intervention were the factors affecting the outcomes.
Yang
Eun Joo
EJ
Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Rha
Dong-Wook
DW
Kim
Hyun Woo
HW
Park
Eun Sook
ES
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications / Q000534:rehabilitation*; D002675:Child, Preschool; D005260:Female; D006617:Hip Dislocation / Q000517:prevention & control*; D006621:Hip Joint; D006801:Humans; D007223:Infant; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D009128:Muscle Spasticity; D018482:Muscle, Skeletal / Q000601:surgery; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011859:Radiography; D012189:Retrospective Studies
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A