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Nosrati R, Zhang D, Callahan MJ, Shore BJ, Tsai A. Hip Imaging in Children With Cerebral Palsy: Estimation and Intrapatient Comparison of Patient-Specific Radiation Doses of Low-Dose CT and Radiography. Invest Radiol 2023; 58:190-198. [PMID: 36070536 DOI: 10.1097/rli.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Hip displacement is the second most common orthopedic problem affecting children with cerebral palsy (CP). Routine radiographic hip surveillance typically involves an anteroposterior (AP) pelvis radiograph. Unfortunately, this imaging protocol is limited by its projectional technique and the positioning challenges in children with CP. Alternatively, hip low-dose computed tomography (LDCT) has been advocated as a more accurate strategy for imaging surveillance as it provides biofidelic details of the hip that is independent of patient positioning. However, the tradeoff is the (presumed) higher radiation dose to the patient. The goal of this study is to estimate patient-specific radiation doses of hip LDCTs and AP pelvis radiographs in CP patients, and perform an intrapatient dose comparison. MATERIALS AND METHODS A search of our imaging database was performed to identify children with CP who underwent hip LDCT and AP pelvis radiograph within 6 months of each other. The LDCTs were performed using weight-adjusted kVp and tube current modulation, whereas the radiographs were obtained with age-/size-adjusted kVp/mAs. The patient-specific organ and effective doses for LDCT were estimated by matching the patients to a nonreference pediatric phantom library from the National Cancer Institute Dosimetry System for Computed Tomography database with Monte Carlo-based dosimetry. The patient-specific organ and effective doses for radiograph were estimated using the National Cancer Institute Dosimetry System for Radiography and Fluoroscopy with Monte Carlo-based dose calculation. Dose conversion k-factors of dose area product for radiography and dose length product for LDCT were adapted, and the estimation results were compared with patient-specific dosimetry. RESULTS Our study cohort consisted of 70 paired imaging studies from 67 children (age, 9.1 ± 3.3 years). The patient-specific and dose length product-based effective doses for LDCT were 0.42 ± 0.21 mSv and 0.59 ± 0.28 mSv, respectively. The patient-specific and dose area product-based effective doses for radiography were 0.14 ± 0.09 mSv and 0.08 ± 0.06 mSv, respectively. CONCLUSIONS The radiation dose for a hip LDCT is ~4 times higher than pelvis radiograph, but it is still very low and poses minimal risk to the patient.
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Affiliation(s)
| | - Da Zhang
- From the Departments of Radiology
| | | | - Benjamin J Shore
- Orthopedics, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Aroojis A, Mantri N, Johari AN. Hip Displacement in Cerebral Palsy: The Role of Surveillance. Indian J Orthop 2021; 55:5-19. [PMID: 33569095 PMCID: PMC7851306 DOI: 10.1007/s43465-020-00162-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/29/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Hip displacement is common in cerebral palsy (CP) and is related to the severity of neurological and functional impairment. It is a silent, but progressive disease, and can result in significant morbidity and decreased quality of life, if left untreated. The pathophysiology of hip displacement in CP is a combination of hip flexor-adductor muscle spasticity, abductor muscle weakness, and delayed weight-bearing, resulting in proximal femoral deformities and progressive acetabular dysplasia. Due to a lack of symptoms in the early stages of hip displacement, the diagnosis is easily missed. Awareness of this condition and regular surveillance by clinical examination and serial radiographs of the hips are the key to early diagnosis and treatment. HIP SURVEILLANCE PROGRAMMES Several population-based studies from around the world have demonstrated that universal hip surveillance in children with CP allows early detection of hip displacement and appropriate early intervention, with a resultant decrease in painful dislocations. Global hip surveillance models are based upon the patients' age, functional level determined by the Gross Motor Function Classification system (GMFCS), gait classification, standardized clinical exam, and radiographic indices such as the migration percentage (MP), as critical indicators of progressive hip displacement. CONCLUSION Despite 25 years of evidence showing the efficacy of established hip surveillance programmes, there is poor awareness among healthcare professionals in India about the importance of regular hip surveillance in children with CP. There is a need for professional organizations to develop evidence-based guidelines for hip surveillance which are relevant to the Indian context.
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Affiliation(s)
- Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, Maharashtra 400012 India
| | - Nihit Mantri
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, Maharashtra 400012 India
| | - Ashok N. Johari
- Paediatric Orthopaedics, Balabhai Nanavati Super Speciality Hospital, Mumbai, India
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Abstract
Hip dysplasia is common in children with cerebral palsy (CP), especially in those children with notable functional impairment. Severity of hip dysplasia has been shown to correlate with higher Gross Motor Function Classification System levels. Migration percentage measured on AP pelvis radiographs is the key radiographic measure quantifying hip displacement in CP. Hip surveillance programs for children with CP exist in Europe, Australia, and parts of Canada and have been adopted as standard of care. These programs have demonstrated improved detection of hip subluxation and appropriate early intervention with a resultant decrease in the number of painful dislocations. Hip surveillance programs provide healthcare providers with guidance for a schedule of obtaining hip radiographs based on patients' age, Gross Motor Function Classification System level, and migration percentage. Although systematic surveillance programs have yet to be adopted in the United States, several centers and organizations are currently investigating the potential and efficacy of hip screening in CP.
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Shore BJ, Graham HK. Management of Moderate to Severe Hip Displacement in Nonambulatory Children with Cerebral Palsy. JBJS Rev 2019; 5:e4. [PMID: 29256976 DOI: 10.2106/jbjs.rvw.17.00027] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - H Kerr Graham
- Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Abstract
BACKGROUND Currently, hip surveillance programs for children with cerebral palsy exist in Europe, Australasia, and parts of Canada, but a neuromuscular hip surveillance program has yet to be adopted in the United States. The purpose of this study was to report the current orthopaedic practice of hip surveillance in children with cerebral palsy, identify areas of practice variation, and suggest steps moving forward to generate guidelines for national neuromuscular hip surveillance. METHODS The entire membership of the Pediatric Orthopaedic Society of North America (POSNA) was surveyed in 2016 for information regarding their practice for hip surveillance in children with cerebral palsy. Detailed information regarding timing, frequency, and practice of hip surveillance was obtained in answers to 26 different questions. RESULTS A survey response rate of 27% was obtained (350/1300 members) during the study period. The majority of respondents treated pediatric patients exclusively (97%), worked in an academic practice (70%), and was affiliated with a university (76%). In total, 18% (69/350) of respondents followed a regular cerebral palsy hip surveillance program, about half of whom (44%, 30/69) had adopted the Australian guidelines. Respondents agreed that a dislocated hip in a child with cerebral palsy was painful (90% agreement) and should be prevented by hip surveillance (93% agreement). Furthermore, 93% of respondents indicated they would follow a national surveillance program if one was in place. Age (79%), Gross Motor Function Classification System (81%), and migration percentage (MP) (78%) were all identified as critical elements to a hip surveillance program. The majority of respondents felt that a hip "at risk" for hip displacement had a MP between 20% and 30% (57% of respondents), whereas surgery should be utilized once the MP exceeded 40% (50% of respondents). CONCLUSIONS Results from this survey demonstrate 90% of respondents agree that a dislocated hip could be painful and 93% would follow a national surveillance program if available. At a societal level, we have the ability to standardize cerebral palsy hip surveillance, thereby decreasing practice variation and improving quality of care delivery. LEVELS OF EVIDENCE Level V.
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Boyd RN, Davies PSW, Ziviani J, Trost S, Barber L, Ware R, Rose S, Whittingham K, Sakzewski L, Bell K, Carty C, Obst S, Benfer K, Reedman S, Edwards P, Kentish M, Copeland L, Weir K, Davenport C, Brooks D, Coulthard A, Pelekanos R, Guzzetta A, Fiori S, Wynter M, Finn C, Burgess A, Morris K, Walsh J, Lloyd O, Whitty JA, Scuffham PA. PREDICT-CP: study protocol of implementation of comprehensive surveillance to predict outcomes for school-aged children with cerebral palsy. BMJ Open 2017; 7:e014950. [PMID: 28706091 PMCID: PMC5734266 DOI: 10.1136/bmjopen-2016-014950] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cerebral palsy (CP) remains the world's most common childhood physical disability with total annual costs of care and lost well-being of $A3.87b. The PREDICT-CP (NHMRC 1077257 Partnership Project: Comprehensive surveillance to PREDICT outcomes for school age children with CP) study will investigate the influence of brain structure, body composition, dietary intake, oropharyngeal function, habitual physical activity, musculoskeletal development (hip status, bone health) and muscle performance on motor attainment, cognition, executive function, communication, participation, quality of life and related health resource use costs. The PREDICT-CP cohort provides further follow-up at 8-12 years of two overlapping preschool-age cohorts examined from 1.5 to 5 years (NHMRC 465128 motor and brain development; NHMRC 569605 growth, nutrition and physical activity). METHODS AND ANALYSES This population-based cohort study undertakes state-wide surveillance of 245 children with CP born in Queensland (birth years 2006-2009). Children will be classified for Gross Motor Function Classification System; Manual Ability Classification System, Communication Function Classification System and Eating and Drinking Ability Classification System. Outcomes include gross motor function, musculoskeletal development (hip displacement, spasticity, muscle contracture), upper limb function, communication difficulties, oropharyngeal dysphagia, dietary intake and body composition, participation, parent-reported and child-reported quality of life and medical and allied health resource use. These detailed phenotypical data will be compared with brain macrostructure and microstructure using 3 Tesla MRI (3T MRI). Relationships between brain lesion severity and outcomes will be analysed using multilevel mixed-effects models. ETHICS AND DISSEMINATION The PREDICT-CP protocol is a prospectively registered and ethically accepted study protocol. The study combines data at 1.5-5 then 8-12 years of direct clinical assessment to enable prediction of outcomes and healthcare needs essential for tailoring interventions (eg, rehabilitation, orthopaedic surgery and nutritional supplements) and the projected healthcare utilisation. TRIAL REGISTRATION NUMBER ACTRN: 12616001488493.
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Affiliation(s)
- Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Peter SW Davies
- Children's Nutrition Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Ziviani
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Stewart Trost
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lee Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Robert Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Stephen Rose
- CSIRO Australian e-Health Research Centre, Canberra, Australia
- Medical Imaging, Diagnostic and Interventional Neuroradiology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Kristie Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Christopher Carty
- Queensland Children's Motion Analysis Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Steven Obst
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Priya Edwards
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Megan Kentish
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Lisa Copeland
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Kelly Weir
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Clinical Governance, Education and Research, Gold Coast Health, Brisbane, Queensland, Australia
| | - Camilla Davenport
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
- Children's Nutrition Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Denise Brooks
- Children's Nutrition Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Alan Coulthard
- Medical Imaging, Diagnostic and Interventional Neuroradiology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Rebecca Pelekanos
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, Instituto Di Ricovero E Cura A Carattere Scientifico (IRCCS), Pisa, Italy
| | - Simona Fiori
- Department of Developmental Neuroscience, Instituto Di Ricovero E Cura A Carattere Scientifico (IRCCS), Pisa, Italy
| | - Meredith Wynter
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Christine Finn
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea Burgess
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Kym Morris
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - John Walsh
- Medical Imaging, Diagnostic and Interventional Neuroradiology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Queensland Children's Motion Analysis Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
- Department of Paediatric Orthopaedics, The Mater Health Services, Brisbane, Queensland, Australia
| | - Owen Lloyd
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Jennifer A Whitty
- Norwich Medical School, University of East Anglia, Norwich, UK
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Braatz F, Staude D, Klotz MC, Wolf SI, Dreher T, Lakemeier S. Hip-joint congruity after Dega osteotomy in patients with cerebral palsy: long-term results. INTERNATIONAL ORTHOPAEDICS 2015; 40:1663-1668. [PMID: 26454662 DOI: 10.1007/s00264-015-3013-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/25/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Neurogenic hip dislocation is quite common in children with cerebral palsy (CP). The purpose of this study was to evaluate the long-term outcome of single-event multilevel surgery (SEMLS) in combination with hip reconstruction by using a periacetabular osteotomy as described by Dega concerning post-operative remodeling and plasticity of the femoral head post-operatively. METHODS A total of 72 patients with CP as the primary disease and in whom a complex surgical hip reconstruction was performed during SEMLS between 1998 and 2004 were included in the study. There were 45 men and 27 women, with a median age of 7.6 (4.7-16.3) years at the time SEMLS was performed. The mean follow-up time was 7.7 years (4.9-11.8). X-rays were taken before and after surgery, and Rippstein 1 and 2 were used for follow-up. As the most reliable value for decentration, migration percentage (MP) as described by Reimers was used. To measure hip-joint cover at follow-up, the centre-edge angle was used. The hip was divided into four different categories according to sphericity and congruity. Using this approach, we could evaluate joint remodeling. RESULTS Pre-operatively, the mean MP measured by X-ray was 68 %. Directly after surgery, this value decreased on average by 12 % and at the long-term follow-up was 16.0 % on average. A high rate of incongruence was observed on X-rays taken directly after surgery: 66 hip joints were classified as incongruent. The number of aspherical and incongruent joints decreased to 54 at the follow-up examination. CONCLUSION Data of our study with high plasticity of the hip joint suggest that even if the femoral head is deformed and a persistent incongruency after surgery is expected, hip reconstruction can be recommended.
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Affiliation(s)
- Frank Braatz
- Department of Orthopedic and Trauma Surgery, University Hospital Heidelberg, Heidelberg, Germany. .,Department of Trauma Surgery and Orthopedics, University Medical centre Göttingen, Göttingen, Germany.
| | - Daniel Staude
- Juraklinik Scheßlitz, Fachabteilung Chirurgie, Scheßlitz, Germany
| | - Matthias C Klotz
- Department of Orthopedic and Trauma Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian I Wolf
- Department of Orthopedic and Trauma Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Dreher
- Department of Orthopedic and Trauma Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Lakemeier
- Department of Trauma Surgery and Orthopedics, University Medical centre Göttingen, Göttingen, Germany
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Boyd RN, Jordan R, Pareezer L, Moodie A, Finn C, Luther B, Arnfield E, Pym A, Craven A, Beall P, Weir K, Kentish M, Wynter M, Ware R, Fahey M, Rawicki B, McKinlay L, Guzzetta A. Australian Cerebral Palsy Child Study: protocol of a prospective population based study of motor and brain development of preschool aged children with cerebral palsy. BMC Neurol 2013; 13:57. [PMID: 23758951 PMCID: PMC3686628 DOI: 10.1186/1471-2377-13-57] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 05/31/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) results from a static brain lesion during pregnancy or early life and remains the most common cause of physical disability in children (1 in 500). While the brain lesion is static, the physical manifestations and medical issues may progress resulting in altered motor patterns. To date, there are no prospective longitudinal studies of CP that follow a birth cohort to track early gross and fine motor development and use Magnetic Resonance Imaging (MRI) to determine the anatomical pattern and likely timing of the brain lesion. Existing studies do not consider treatment costs and outcomes. This study aims to determine the pathway(s) to motor outcome from diagnosis at 18 months corrected age (c.a.) to outcome at 5 years in relation to the nature of the brain lesion (using structural MRI). METHODS This prospective cohort study aims to recruit a total of 240 children diagnosed with CP born in Victoria (birth years 2004 and 2005) and Queensland (birth years 2006-2009). Children can enter the study at any time between 18 months to 5 years of age and will be assessed at 18, 24, 30, 36, 48 and 60 months c.a. Outcomes include gross motor function (GMFM-66 & GMFM-88), Gross Motor Function Classification System (GMFCS); musculoskeletal development (hip displacement, spasticity, muscle contracture), upper limb function (Manual Ability Classification System), communication difficulties using Communication and Symbolic Behaviour Scales-Developmental Profile (CSBS-DP), participation using the Paediatric Evaluation of Disability Inventory (PEDI), parent reported quality of life and classification of medical and allied health resource use and determination of the aetiology of CP using clinical evaluation combined with MRI. The relationship between the pathways to motor outcome and the nature of the brain lesion will be analysed using multiple methods including non-linear modelling, multilevel mixed-effects models and generalised estimating equations. DISCUSSION This protocol describes a large population-based study of early motor development and brain structure in a representative sample of preschool aged children with CP, using direct clinical assessment. The results of this study will be published in peer reviewed journals and presented at relevant international conferences. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ACTRN1261200169820).
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Affiliation(s)
- Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health Sciences, The University of Queensland, Brisbane, Australia
- Department of Rehabilitation, Queensland Cerebral Palsy Health Service, Royal Children’s Hospital, Brisbane, Herston, Australia
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Royal Brisbane and Women’s Hospital, Level 7, Block 6, Herston, QLD, 4029, Australia
| | - Rachel Jordan
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health Sciences, The University of Queensland, Brisbane, Australia
| | - Laura Pareezer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health Sciences, The University of Queensland, Brisbane, Australia
| | - Anne Moodie
- Department of Rehabilitation, The Royal Children’s Hospital, Melbourne, Australia
| | - Christine Finn
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health Sciences, The University of Queensland, Brisbane, Australia
| | - Belinda Luther
- Department of Rehabilitation, The Royal Children’s Hospital, Melbourne, Australia
| | - Evyn Arnfield
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health Sciences, The University of Queensland, Brisbane, Australia
| | - Aaron Pym
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health Sciences, The University of Queensland, Brisbane, Australia
| | - Alex Craven
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health Sciences, The University of Queensland, Brisbane, Australia
| | - Paula Beall
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health Sciences, The University of Queensland, Brisbane, Australia
| | - Kelly Weir
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health Sciences, The University of Queensland, Brisbane, Australia
| | - Megan Kentish
- Department of Rehabilitation, Queensland Cerebral Palsy Health Service, Royal Children’s Hospital, Brisbane, Herston, Australia
| | - Meredith Wynter
- Department of Rehabilitation, Queensland Cerebral Palsy Health Service, Royal Children’s Hospital, Brisbane, Herston, Australia
| | - Robert Ware
- Queensland Children’s Medical Research Institute, The University of Queensland, Queensland, Australia
- School of Population Health, The University of Queensland, Queensland, Australia
| | - Michael Fahey
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Barry Rawicki
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Lynne McKinlay
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health Sciences, The University of Queensland, Brisbane, Australia
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
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Abstract
Spastic hip displacement is the second most common deformity seen in children with cerebral palsy (CP), and the long-term effects can be debilitating. Progressive hip displacement leading to dislocation can result in severe pain as well as impaired function and quality of life. Recent population-based studies have demonstrated that a child's Gross Motor Functional Classification System (GMFCS) level is most predictive for identifying hips "at-risk" for progressive lateral displacement. As a result, in many developed countries, hip surveillance has now been adopted as an integral piece of the comprehensive care puzzle for the management of children with spastic hip displacement. This paper reviews the spectrum of treatments available for progressive hip displacement, examines the current literature on the success of hip surveillance, and illustrates an example of a current hip surveillance program stratified by the GMFCS level.
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