Surveillance measures of the hips of children with bilateral cerebral palsy
- aNeurosciences Unit, Institute of Child Health, London, bNewcomen Centre, Guy’s Hospital, London
- David Scrutton, Newcomen Centre, Guy’s Hospital, St Thomas’ Street, London SE1 9RT.
Bilateral cerebral palsy
Gradually developing deformity can be an insidious complication of bilateral cerebral palsy and it is one which can all too easily be overlooked by the paediatrician already coping with the many other developmental, social, and educational problems presented by these children and their families. Although the orthopaedic management of some deformity can be deferred, this is not so for all deformities. Hip and spinal deformities can benefit from early intervention.
Gradually developing hip instability
In the past, gradual hip subluxation, often leading to dislocation, has often been referred to as ‘developmental dislocation’, but this term has become associated with congenital dislocation of the hip and it is confusing to continue its use in cerebral palsy and similar situations where there is no primary abnormality of the hip joint. The medium to long term consequences of increasing hip deformity are subluxation/dislocation of the hip. Subsequently, loss of hip flexion causes kyphotic sitting with an increased risk of spinal deformity and, in a significant number of children and young adults, nursing/daily living problems increase, often accompanied by hip pain.1 Asymmetrical deformity will cause pelvic obliquity with a greatly increased risk of scoliosis.2 The hip of a child with hemiplegic cerebral palsy appears to avoid this complication, although a child diagnosed as having ‘hemiplegia’, but in reality having a markedly asymmetrical bilateral disorder, can be affected.
From our review of the children who had attended one tertiary referral orthopaedic clinic over a period of 17 years and of the publications relating to hip problems in cerebral palsy, it was obvious that certain basic information from a prospective population based study of this complication was lacking and so the incidence and natural history were not known, although the severity of cerebral palsy and the age of pulling to stand were useful indicators of risk.3
Reasons for surveillance and early management