Hip health at skeletal maturity: a population-based study of young adults with cerebral palsy.
OBJECTIVE
We studied 'hip health' in a population-based cohort of adolescents and young adults with cerebral palsy to investigate associations between hip morphology, pain, and gross motor function.


METHODS
Ninety-eight young adults (65 males, 33 females) from the birth cohort were identified as having developed hip displacement (migration percentage >30) and were reviewed at a mean age of 18 years 10 months (range 15-24y). Hip morphology was classified using the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS). Severity and frequency of pain were recorded using Likert scales. Gross motor function was classified by the Gross Motor Function Classification System (GMFCS).


RESULTS
Hip pain was reported in 72% of participants. Associations were found between pain scores and both hip morphology and GMFCS. Median pain severity score for MCPHCS grades 1 to 4 was 2 (interquartile range [IQR] 1.0-3.0) compared to 7 (IQR 6.0-8.0) for grades 5 and 6 (severe subluxation or dislocation). Hip surveillance and access to surgery were associated with improved hip morphology and less pain.


CONCLUSIONS
Poor hip morphology at skeletal maturity was associated with high levels of pain. Limited hip surveillance and access to surgery, rather than GMFCS, was associated with poor hip morphology. The majority of young adults who had access to hip surveillance, and preventive and reconstructive surgery, had satisfactory hip morphology at skeletal maturity and less pain.
Orthopaedic Department, The Royal Children's Hospital, Parkville, Vic., Australia.|Department of Paediatrics, University of Melbourne, Carlton, Vic., Australia.
Joanna
J
Wawrzuta
Orthopaedic Department, The Royal Children's Hospital, Parkville, Vic., Australia.|Centre of Research Excellence in Cerebral Palsy, Murdoch Childrens Research Institute, Parkville, Vic., Australia.
Kate L
KL
Willoughby
Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Vic., Australia.
Charlotte
C
Molesworth
Orthopaedic Department, The Royal Children's Hospital, Parkville, Vic., Australia.
Soon Ghee
SG
Ang
Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.
Benjamin J
BJ
Shore
Centre of Research Excellence in Cerebral Palsy, Murdoch Childrens Research Institute, Parkville, Vic., Australia.|Hugh Williamson Gait Laboratory, The Royal Children's Hospital, Parkville, Vic., Australia.
Pam
P
Thomason
Orthopaedic Department, The Royal Children's Hospital, Parkville, Vic., Australia.|Department of Paediatrics, University of Melbourne, Carlton, Vic., Australia.|Centre of Research Excellence in Cerebral Palsy, Murdoch Childrens Research Institute, Parkville, Vic., Australia.|Hugh Williamson Gait Laboratory, The Royal Children's Hospital, Parkville, Vic., Australia.
H Kerr
HK
Graham
D000293:Adolescent; D000328:Adult; D018771:Arthralgia / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D002547:Cerebral Palsy / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D006615:Hip / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006617:Hip Dislocation / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D012042:Registries; D012720:Severity of Illness Index; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult