title: Head-shaft angle is a risk factor for hip displacement in children with cerebral palsy.
abstract: OBJECTIVE
  Hip dislocation in children with cerebral palsy (CP) is a common and severe problem. The Swedish follow-up program for CP (CPUP) includes standardized monitoring of the hips. Migration percentage (MP) is a widely accepted measure of hip displacement. Coxa valga and valgus of the femoral head in relation to the femoral neck can be measured as the head-shaft angle (HSA). We assessed HSA as a risk factor for hip displacement in CP.
  
  
  METHODS
  We analyzed radiographs of children within CPUP from selected regions of Sweden. Inclusion criteria were children with Gross Motor Function Classification System (GMFCS) levels III-V, MP of < 40% in both hips at the first radiograph, and a follow-up period of 5 years or until development of MP > 40% of either hip within 5 years. Risk ratio between children who differed in HSA by 1 degree was calculated and corrected for age, MP, and GMFCS level using multiple Poisson regression.
  
  
  RESULTS
  145 children (73 boys) with a mean age of 3.5 (0.6-9.7) years at the initial radiograph were included. 51 children developed hip displacement whereas 94 children maintained a MP of < 40%. The risk ratio for hip displacement was 1.05 (p < 0.001; 95% CI 1.02-1.08). When comparing 2 children of the same age, GMFCS level, and MP, a 10-degree difference in HSA results in a 1.6-times higher risk of hip displacement in the child with the higher HSA.
  
  
  CONCLUSIONS
  A high HSA appears to be a risk factor for hip displacement in children with CP.
authors.affiliation: Department of Clinical Science, Orthopedic Surgery, Skåne University Hospital, Lund.
authors.forename: Maria
authors.initials: M
authors.lastname: Hermanson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Hägglund
authors.forename: Jacques
authors.initials: J
authors.lastname: Riad
authors.forename: Philippe
authors.initials: P
authors.lastname: Wagner
mesh_terms: D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005270:Femur Head / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D005272:Femur Neck / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D006617:Hip Dislocation / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography; D012307:Risk Factors; D013548:Sweden