title: Progression of Hip Displacement during Radiographic Surveillance in Patients with Cerebral Palsy.
abstract: Progression of hip displacement is common in patients with cerebral palsy (CP). We aimed to investigate the rate of progression of hip displacement in patients with CP by assessing changes in radiographic indices according to Gross Motor Function Classification System (GMFCS) level during hip surveillance. We analyzed the medical records of patients with CP aged < 20 years who underwent at least 6 months interval of serial hip radiographs before any surgical hip intervention, including reconstructive surgery. After panel consensus and reliability testing, radiographic measurements of migration percentage (MP), neck-shaft angle (NSA), acetabular index (AI), and pelvic obliquity (PO) were obtained during hip surveillance. For each GMFCS level, annual changes in radiographic indices were analyzed and adjusted for affecting factors, such as sex, laterality, and type of CP. A total of 197 patients were included in this study, and 1,097 radiographs were evaluated. GMFCS classifications were as follows: 100 patients were level I-III, 48 were level IV, and 49 were level V. MP increased significantly over the duration of hip surveillance in patients with GMFCS levels I-III, IV, and V by 0.3%/year (P < 0.001), 1.9%/year (P < 0.001), and 6.2%/year (P < 0.001), respectively. In patients with GMFCS level IV, NSA increased significantly by 3.4°/year (P < 0.001). Our results suggest that periodic monitoring and radiographic hip surveillance is warranted for patients with CP, especially those with GMFCS level IV or V. Furthermore, physicians can predict and inform parents or caregivers regarding the progression of hip displacement in patients with CP.
authors.affiliation: Department of Orthopaedic Surgery, 21th Century Hospital, Wonju, Korea .
authors.forename: Jae Young
authors.identifier: 0000-0002-6159-0003
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea .
authors.forename: Young
authors.identifier: 0000-0002-6816-2693
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea .
authors.forename: Byung Chae
authors.identifier: 0000-0002-9395-8896
authors.initials: BC
authors.lastname: Cho
authors.affiliation: Yeollin Orthopedic Clinic, Suwon, Korea .
authors.forename: Sang Young
authors.identifier: 0000-0001-6936-9234
authors.initials: SY
authors.lastname: Moon
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea .
authors.forename: Chin Youb
authors.identifier: 0000-0002-0658-4532
authors.initials: CY
authors.lastname: Chung
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea .
authors.forename: Kyoung Min
authors.identifier: 0000-0002-2372-7339
authors.initials: KM
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea .
authors.forename: Ki Hyuk
authors.identifier: 0000-0002-5007-2403
authors.initials: KH
authors.lastname: Sung
authors.affiliation: Department of Mathematics, College of Natural Science, Ajou University, Suwon, Korea .
authors.forename: Soon-Sun
authors.identifier: 0000-0002-3344-1609
authors.initials: SS
authors.lastname: Kwon
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea .
authors.forename: Moon Seok
authors.identifier: 0000-0002-2856-7522
authors.initials: MS
authors.lastname: Park
mesh_terms: D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000473:pathology*; D002648:Child; D018450:Disease Progression; D005260:Female; D006617:Hip Dislocation; D006801:Humans; D016014:Linear Models; D008297:Male; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors
keywords: Cerebral Palsy; Hip Displacement; Hip Surveillance; Progression