title: The impact of complementary and alternative medicine on hip development in children with cerebral palsy.
abstract: OBJECTIVE
  This study aimed to evaluate the effect of complementary and alternative medicine (CAM) approaches on long-term surgical requirements, and clinical and radiographic outcomes for children with cerebral palsy and hip displacement.
  
  
  METHODS
  Twenty-three children with cerebral palsy and early hip displacement who were offered preventive hip surgery and whose parents declined in favour of CAM approaches were followed (13 males, 10 females; mean age 13 y 9 mo [SD 3 y 1 mo]; mean length of follow-up 10 y 2 mo [SD 2 y 11 mo]; 17 with spastic quadriplegia, two with spastic triplegia, and four with spastic diplegia; three with gross motor function classified at Gross Motor Function Classification System [GMFCS] level II, four at level III, six at level IV, and 10 at level V). Principal outcome measures were progression of hip displacement (measured by migration percentage: the percentage of the femoral head sitting outside of the acetabulum), eventual need for reconstructive or salvage surgery, and long-term hip morphology (classified by the Melbourne Cerebral Palsy Hip Classification Scale). The results were compared with a previously reported cohort of 46 children who had surgery when recommended (31 males, 15 females; mean age 13 y 11 mo [SD 1 y 6 mo]; mean length of follow-up 10 y 10 mo; 10 with diplegia and 36 with quadriplegia; three at GMFCS level II, 11 at level III, 20 at level IV, and 12 at level V).
  
  
  RESULTS
  Outcomes for 23 children who had pursued CAM were analysed (mean length of follow-up 10 y 2 mo). Hip displacement progressed in one or both hips in all non-ambulant children (GMFCS level IV or V). Of the 20 children with documented progressive hip displacement, eight developed pain and deformity requiring salvage surgery. An additional 11 children with progressive hip displacement had late reconstructive surgery when symptoms first started. There was strong evidence of a relationship between GMFCS and both progressive hip displacement (χ(2) =17.78; p=0.001) and final Melbourne Cerebral Palsy Hip Classification Scale grade (odds ratio 12.5; p=0.012; 95% confidence interval 1.7-90.4). There was also evidence of those children who pursued CAM requiring more complex surgery than the group who had surgery when recommended (odds ratio 2.5; p=0.002; 95% confidence interval 1.4-4.5).
  
  
  CONCLUSIONS
  CAM therapy did not appear to influence the progression of hip displacement in children with cerebral palsy. Most children required major reconstructive surgery or salvage surgery despite pursuing CAM.
authors: Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia.
authors: Kate
authors: K
authors: Willoughby
authors: Kim
authors: K
authors: Jachno
authors: Soon Ghee
authors: SG
authors: Ang
authors: Pam
authors: P
authors: Thomason
authors: H Kerr
authors: HK
authors: Graham
mesh_terms: D000293:Adolescent; D001178:Arthroplasty / Q000379:methods; D002547:Cerebral Palsy / Q000150:complications*; D016009:Chi-Square Distribution; D002648:Child; D000529:Complementary Therapies / Q000009:adverse effects*; D005260:Female; D006617:Hip Dislocation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011859:Radiography; D019651:Plastic Surgery Procedures; D016879:Salvage Therapy; D012720:Severity of Illness Index