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Koch A, Kasprzyk M, Musielak B, Jóźwiak M. Long-term outcomes of reconstructive treatment for painful dislocations in patients with cerebral palsy. J Child Orthop 2024; 18:315-321. [PMID: 38831856 PMCID: PMC11144373 DOI: 10.1177/18632521241233165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/31/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose This report presents the long-term results of the hip joint reconstruction in patients with spastic hip disease through open reduction, proximal femur varus derotation osteotomy, and Dega transiliac osteotomy. Methods We analyzed retrospectively patients diagnosed with a spastic form of bilateral cerebral palsy with painful hip subluxation or dislocation. All patients underwent the same surgical procedure. The minimum follow-up time was 15 years. The study group comprised 15 patients (22 hips), classified with the Gross Motor Function Classification System as levels IV and V. The hip joint range of motion and anteroposterior X-ray examination at the final follow-up visit were compared with pre-operative data. The pain level was evaluated using the Visual Analogue Scale (VAS), and the femoral head shape was assessed using the Rutz classification. The patients' caregivers answered questions regarding pain during sitting, personal hygiene activities, and at rest. The caregivers' satisfaction with the treatment was also assessed with the Caregiver Priorities and Child Health Index of Life with Disabilities questionnaire. Results We observed a significant reduction of the hip joint pain and improvement in both radiological hip stability parameters and range of motion at the final follow-up visit. Based on the Rutz classification, one hip remained type B, while the other joints became type A. Reduced pain was reported in all three positions, with the most pronounced improvement during sitting and personal hygiene activities. Interestingly, patients with unilateral hip reconstruction were more prone to pain after reconstruction than those operated bilaterally. Conclusion Primary reconstruction of the painful hip joint neurogenic dislocation results in a stable joint reduction, pain decrease, and improved quality of life in patients with cerebral palsy. Level of evidence IV case series.
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Affiliation(s)
| | - Maciej Kasprzyk
- Maciej Kasprzyk, Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, ul. 28 Czerwca 1956r. nr 135/147, 61-545 Poznań, Poland.
| | - Bartosz Musielak
- Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznań, Poland
| | - Marek Jóźwiak
- Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznań, Poland
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2
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Iwasaka-Neder J, Bedoya MA, Connors J, Warfield S, Bixby SD. Morphometric and clinical comparison of MRI-based synthetic CT to conventional CT of the hip in children. Pediatr Radiol 2024; 54:743-757. [PMID: 38421417 DOI: 10.1007/s00247-024-05888-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/03/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND MRI-based synthetic CT (sCT) generates CT-like images from MRI data. OBJECTIVE To evaluate equivalence, inter- and intraobserver reliability, and image quality of sCT compared to conventional (cCT) for assessing hip morphology and maturity in pediatric patients. MATERIALS AND METHODS We prospectively enrolled patients <21 years old with cCT and 3T MRI of the hips/pelvis. A dual-echo gradient-echo sequence was used to generate sCT via a commercially available post-processing software (BoneMRI v1.5 research version, MRIguidance BV, Utrecht, NL). Two pediatric musculoskeletal radiologists measured seven morphologic hip parameters. 3D surface distances between cCT and sCT were computed. Physeal status was established at seven locations with cCT as reference standard. Images were qualitatively scored on a 5-point Likert scale regarding diagnostic quality, signal-to-noise ratio, clarity of bony margin, corticomedullary differentiation, and presence and severity of artifacts. Quantitative evaluation of Hounsfield units (HU) was performed in bone, muscle, and fat tissue. Inter- and intraobserver reliability were measured by intraclass correlation coefficients. The cCT-to-sCT intermodal agreement was assessed via Bland-Altman analysis. The equivalence between modalities was tested using paired two one-sided tests. The quality parameter scores of each imaging modality were compared via Wilcoxon signed-rank test. For tissue-specific HU measurements, mean absolute error and mean percentage error values were calculated using the cCT as the reference standard. RESULTS Thirty-eight hips in 19 patients were included (16.6 ± 3 years, range 9.9-20.9; male = 5). cCT- and sCT-based morphologic measurements demonstrated good to excellent inter- and intraobserver correlation (0.77 CONCLUSION sCT is equivalent to cCT for the assessment of hip morphology, physeal status, and radiodensity assessment in pediatric patients.
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Affiliation(s)
- Jade Iwasaka-Neder
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - M Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - James Connors
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Simon Warfield
- Computational Radiology Laboratory, Boston Children's Hospital, 401 Park Drive, Boston, MA, 02215, USA
| | - Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
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Hidalgo Robles Á, Paleg GS, Livingstone RW. Identifying and Evaluating Young Children with Developmental Central Hypotonia: An Overview of Systematic Reviews and Tools. Healthcare (Basel) 2024; 12:493. [PMID: 38391868 PMCID: PMC10887882 DOI: 10.3390/healthcare12040493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
Children with developmental central hypotonia have reduced muscle tone secondary to non-progressive damage to the brain or brainstem. Children may have transient delays, mild or global functional impairments, and the lack of a clear understanding of this diagnosis makes evaluating appropriate interventions challenging. This overview aimed to systematically describe the best available evidence for tools to identify and evaluate children with developmental central hypotonia aged 2 months to 6 years. A systematic review of systematic reviews or syntheses was conducted with electronic searches in PubMed, Medline, CINAHL, Scopus, Cochrane Database of Systematic Reviews, Google Scholar, and PEDro and supplemented with hand-searching. Methodological quality and risk-of-bias were evaluated, and included reviews and tools were compared and contrasted. Three systematic reviews, an evidence-based clinical assessment algorithm, three measurement protocols, and two additional measurement tools were identified. For children aged 2 months to 2 years, the Hammersmith Infant Neurological Examination has the strongest measurement properties and contains a subset of items that may be useful for quantifying the severity of hypotonia. For children aged 2-6 years, a clinical algorithm and individual tools provide guidance. Further research is required to develop and validate all evaluative tools for children with developmental central hypotonia.
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Affiliation(s)
| | - Ginny S Paleg
- Physical Therapist, Montgomery County Infants and Toddlers Program, Rockville, MD 20825, USA
| | - Roslyn W Livingstone
- Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada
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Sadur A, Martinez C, Dance S, Travers R, Gonzalez A, Tabaie SA. From Hip Screening to Hip Surveillance: Transforming Care for Patients With Cerebral Palsy: An Analysis of a Single Institution. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202312000-00009. [PMID: 38063442 PMCID: PMC10697633 DOI: 10.5435/jaaosglobal-d-23-00236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Surveillance programs aimed at monitoring hip displacement in patients with cerebral palsy have been demonstrated to decrease the incidence of hip dislocations and properly time surgical intervention, ultimately improving patient outcomes. The objective of this study was to determine whether the implementation of a hip screening to surveillance program at a tertiary academic teaching hospital in 2017 increased the frequency of radiographic evaluations and changed the timing of surgical intervention. METHODS A total of 592 patients with cerebral palsy were identified, and 468 of these patients had initial radiograph date data available. In this analysis, 246 patients with initial radiograph dates after 2012 were included. The study population was divided into two groups based on the initial radiograph date, 2012 to 2016 versus 2017 to 2022. One hundred sixty patients (65%) were in the 2012 to 2016 group, and 86 (35%) were in the 2017 to 2022 group. Statistical analysis was conducted using various techniques, such as two-sample Student t-test, Mann-Whitney U test, chi square/Fisher exact test, and multivariable linear regression analysis. RESULTS The average number of radiographs per year in the 2017 to 2022 group was 0.11 (95% CI: 0.02, 0.20, P = 0.017) higher than the 2012 to 2016 group. After adjusting for confounders using multivariable linear regression analysis, this difference was even larger (difference 0.16, 95% CI: 0.06, 0.25, P = 0.001). The surgical intervention rate was significantly lower in the 2017 to 2022 group compared with the 2012 to 2016 group (12.9% versus 40.6%, P < 0.001). DISCUSSION The results of this study suggest that the implementation of a hip screening to surveillance program results in more frequent radiographic evaluations and possibly a reduced need for surgical intervention from 2017 to 2022. In the 2012 to 2016 group, more surgical interventions were performed likely because of the lack of any hip surveillance or screening program in place.
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Affiliation(s)
- Alana Sadur
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Curt Martinez
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Sarah Dance
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Ryan Travers
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Ariana Gonzalez
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Sean A. Tabaie
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
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Miller SD, Juricic M, Bone JN, Steinbok P, Mulpuri K. The Effect of Selective Dorsal Rhizotomy on Hip Displacement in Children With Cerebral Palsy: A Long-term Follow-up Study. J Pediatr Orthop 2023; 43:e701-e706. [PMID: 37493022 PMCID: PMC10481910 DOI: 10.1097/bpo.0000000000002473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND Hip displacement is common in children with cerebral palsy (CP). Spasticity in the hip adductor muscles, hip flexors, and medial hamstrings has been identified as a possible cause of progressive hip displacement. Selective dorsal rhizotomy (SDR) aims to reduce lower extremity spasticity in children with CP. Here, we investigate the influence of SDR on hip displacement in children with CP at long-term follow-up, a minimum of 5 years post-SDR. METHODS A retrospective review of children undergoing SDR at a Canadian pediatric hospital was completed. Migration percentage (MP) was measured on pelvis radiographs taken in the 6 months before SDR and minimum 5 years post-SDR or before hip surgery. The number of hips with displacement, defined as MP >30%, and the number of children with at least 1 hip displaced were determined. A linear mixed-effects model was used to assess potential risk factors for poor outcome post-SDR, defined as having MP >40% or surgical intervention for hip displacement. RESULTS Ninety children [50 males, 40 females, Gross Motor Function Classification System (GMFCS) levels I to V: 1/13/24/43/9] with a mean follow-up of 8.5 years (SD 5.1) were included. The mean age at SDR was 4.9 years (SD 1.5); more than half of children (52%) had hip displacement at the time of SDR. Post-SDR, MP exceeded 30% in 0 (0%) of children at GMFCS level I, 1 (8%) at II, 11 (46%) at III, 31 (72%) at IV, and 7 (78%) at V. A poor outcome was associated with preoperative MP, age, and GMFCS level. CONCLUSIONS The incidence of hip displacement post-SDR was consistent with population-based studies when evaluated by GMFCS. Our findings suggest that SDR has neither a positive nor negative effect on hip displacement when assessed at least 5 years postintervention. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Stacey D. Miller
- Department of Physical Therapy, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Maria Juricic
- Department of Physical Therapy, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey N. Bone
- Biostatistics, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Paul Steinbok
- Division of Pediatric Neurosurgery, Department of Surgery, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kishore Mulpuri
- Department of Orthopaedics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
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Cooper MS, Imms C. Editorial Highlights from the Comorbidities and Complications of Cerebral Palsy Special Issue. J Clin Med 2023; 12:5329. [PMID: 37629371 PMCID: PMC10455945 DOI: 10.3390/jcm12165329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Cerebral palsy is a life-long condition and the most common cause of physical disability in childhood [...].
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Affiliation(s)
- Monica S Cooper
- Department of Neurodevelopment & Disability, Royal Children’s Hospital, 50 Flemington Road, Melbourne, VIC 3052, Australia
- Neurodisability and Rehabilitation, Clinical Sciences, Murdoch Children’s Research Institute, 50 Flemington Road, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, 50 Flemington Road, Melbourne, VIC 3052, Australia
| | - Christine Imms
- Department of Neurodevelopment & Disability, Royal Children’s Hospital, 50 Flemington Road, Melbourne, VIC 3052, Australia
- Neurodisability and Rehabilitation, Clinical Sciences, Murdoch Children’s Research Institute, 50 Flemington Road, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, 50 Flemington Road, Melbourne, VIC 3052, Australia
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Benvenuto S, Barbi E, Boaretto S, Landolfo M, Rispoli F, Cozzi G, Carbone M. Study Confirms Safety and Effectiveness of Intra-Articular Glucocorticoids for Painful Hip Dislocation in Children and Young Adults with Neurologic Impairment. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1353. [PMID: 37628352 PMCID: PMC10453576 DOI: 10.3390/children10081353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Hip dislocation is a common source of pain in children with neurologic impairment. When medical interventions fail, orthopedic surgery does not guarantee a definitive result as the displacement may continue postoperatively and a second operation is often required. METHODS Retrospective analysis of data regarding the safety and effectiveness of an intra-articular corticosteroid injection (IACI) in 11 patients, aged 15 ± 5 years old, collected through a telephonic questionnaire administered to parents. RESULTS 21 IACIs were performed, a mean number of 1.9 ± 1.5 times for each patient, at a mean age (of the first IACI) of 13.5 ± 5 years. According to the parents, the IACI significantly lowered the number of participants experiencing pain (82% reduction) and using analgesics (60% reduction). There was also a significant improvement in the children's hip mobility (63% reduction in patients experiencing stiffness), decubitus (90% reduction in obligated positioning), behavior (80% reduction in lamenting or crying patients), sleep quality (87.5% reduction in patients awakening every night), and caregivers' quality of life (91% reduction in worried parents). The mean reported duration of the IACIs' benefit was 5.4 ± 2.4 months (range 1-9), with a positive correlation with the number of IACIs (r = 0.48; p-value = 0.04) and a negative correlation with the age at the first injection (r = -0.71; p-value = 0.02). The only reported adverse event was mild local swelling in one child. CONCLUSIONS the IACI could represent a safe and effective intervention for painful hip dislocation, both before and after surgery, with a long-lasting benefit which seems to increase as multiple IACIs are performed.
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Affiliation(s)
- Simone Benvenuto
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, 34127 Trieste, Italy
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Silvia Boaretto
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Matteo Landolfo
- Medical Clinic, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, 34149 Trieste, Italy
| | - Francesco Rispoli
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Marco Carbone
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy
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Graham K, Rutz E, Thomason P, Willoughby K. Reducing spasticity does not prevent hip displacement in cerebral palsy. Dev Med Child Neurol 2023; 65:1123. [PMID: 37208916 DOI: 10.1111/dmcn.15613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 05/21/2023]
Abstract
This letter to the editor is on the commentary by Gormley on pages 1003–1004 of this issue.
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Affiliation(s)
- Kerr Graham
- Royal Children's Hospital - Orthopaedics, Parkville, Victoria, Australia
| | - Erich Rutz
- Royal Children's Hospital - Orthopaedics, Parkville, Victoria, Australia
- Royal Children's Hospital - Hugh Williamson Gait Laboratory, Parkville, Victoria, Australia
| | - Pam Thomason
- Royal Children's Hospital - Hugh Williamson Gait Laboratory, Parkville, Victoria, Australia
| | - Kate Willoughby
- Royal Children's Hospital - Orthopaedics, Parkville, Victoria, Australia
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Al-Rumaih MH, Camp MW, Narayanan UG. Current Concept and Management of Spastic Hip in Children: A Narrative Review. Cureus 2023; 15:e43347. [PMID: 37577278 PMCID: PMC10421643 DOI: 10.7759/cureus.43347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 08/15/2023] Open
Abstract
Cerebral palsy (CP) is a non-progressive motor condition that hinders the development of movement and posture. One of the common problems faced in CP is spastic hips, which can cause discomfort, deformity, and functional restrictions. This review article seeks to offer a thorough summary of the most recent methods for treating spastic hips in cerebral palsy patients. Additionally, it describes the success and potential risks of various conservative and surgical procedures. It also looks at new treatments and potential avenues for managing this complicated ailment.
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Affiliation(s)
- Mohammed H Al-Rumaih
- Department of Orthopaedic Surgery, Prince Sultan Military Medical City, Riyadh, SAU
- Scientific Research Center (SRC), Prince Sultan Military Medical City, Riyadh, SAU
| | - Mark W Camp
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, CAN
- Department of Surgery, University of Toronto, Toronto, CAN
| | - Unni G Narayanan
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, CAN
- Department of Surgery, University of Toronto, Toronto, CAN
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, CAN
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, CAN
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Howard JJ, Shrader MW. Intrathecal baclofen therapy does not prevent hip displacement in children with cerebral palsy. Dev Med Child Neurol 2023; 65:1124. [PMID: 37208917 DOI: 10.1111/dmcn.15641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/21/2023]
Abstract
This letter to the editor is on the commentary by Gormley on pages 1003–1004 of this issue.
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