Correction of hip joint instability in children with cerebral palsy — current state of the problem and prospects for its solution (literature REVIEW)

Authors

  • Oleg Sakalouski Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk. Belarus, Belarus
  • Mihail Herasimenka Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk. Belarus, Belarus
  • Roman Klimau Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk. Belarus, Belarus
  • Leanid Hlazkin Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk. Belarus, Belarus

DOI:

https://doi.org/10.15674/0030-59872021273-82

Keywords:

instability, Cerebral palsy, surgical correction, hip joint, orthopedic correction, dysplasia

Abstract

Hip instability in children with cerebral palsy (CP) is a serious unresolved problem in modern orthopedics. Objective. To analyze the state of the problem of the hip joint instability in children with cerebral palsy and determine the prospects for its solution. Me­thods. A thematic review of 68 studies was made. Results. The basis for the prevention of instability of the hip joint should be a systema­tic X-ray screening at least once a year.  The instability of the hip joint is based on neurological disorders, if the index of migration of the femoral head (MP) is less than 30 %, the application of selective dorsal rhizotomy or baclofen pump is promising and justified. If MP > 30–100 % dorsal rhizotomy can be used after surgical correction of abnormalities in the hip joint to reduce the recurrence rate. The existing surgeries on the pelvic and femur is sufficient to restore the stability of this joint, even in the most severe cases, but the result is not always possible to maintain due to the recurrence of the deformity. The requirement for hip intervention in a patient with cerebral palsy is a preventive focus, by which we mean not only the achievement of joint stability, but also the creation of conditions for its preservation. Temporary blockage of the medial portion of the femoral head growth area is a minimally invasive procedure and may be recommended for use alone or as an adjunct to hip soft tissue release or for hip and bone surgery. However, it is still unclear at what age it is better to block the growth plate of the femoral head, whether and how often to change the clamps and so on. A prerequisite for the treatment of patients with this pathology is an individual approach, taking into account the degree of displacement of the femoral head, the presence of pathology of adjacent joints, the age of the child and the severity of the disease.  Correction of existing deviations should be performed in one step at many levels.

Author Biographies

Oleg Sakalouski, Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk. Belarus

MD, Prof. in Traumatology and Orthopaedics

Mihail Herasimenka, Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk. Belarus

MD, Prof. in Traumatology and Orthopaedics

Roman Klimau, Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk. Belarus

MD

Leanid Hlazkin, Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk. Belarus

MD

References

  1. Portinaro, N., Turati, M., Cometto, M., Bigoni, M., Davids, J. R., & Panou, A. (2019). Guided growth of the proximal femur for the management of hip dysplasia in children with cerebral palsy. Journal of Pediatric Orthopaedics, 39(8), e622-e628. https://doi.org/10.1097/bpo.0000000000001069
  2. Dohin, B. (2019). The spastic hip in children and adolescents. Orthopaedics & Traumatology: Surgery & Research, 105(1), S133-S141. https://doi.org/10.1016/j.otsr.2018.03.018
  3. Aicardi, J. (2013). Diseases of the Nervous System in Children. T. 1, M.: Binom. [in Russian]
  4. Yeargin-Allsopp, M., Van Naarden Braun, K., Doernberg, N. S., Benedict, R. E., Kirby, R. S., & Durkin, M. S. (2008). Prevalence of cerebral palsy in 8-Year-Old children in three areas of the United States in 2002: A multisite collaboration. PEDIATRICS, 121(3), 547-554. https://doi.org/10.1542/peds.2007-1270
  5. Prikhodko, I. S., Bukach, M. I., & Vlasova, S. V. (2007). Rehabilitation of disabled children with cerebral palsy at school age. Medical and social examination and rehabilitation. Ministry of Health. Rep. Belarus, State Institution "Republican Scientific and Practical Center for Medical Examination and Rehabilitation". Minsk. [in Russian]
  6. Lundy, D. W., Ganey, T. M., Ogden, J. A., & Guidera, K. J. (1998). Pathologic morphology of the dislocated proximal femur in children with cerebral palsy. Journal of Pediatric Orthopaedics, 18(4), 528-534. https://doi.org/10.1097/01241398-199807000-00025
  7. Sauser, D., Hewes, R., & Root, L. (1986). Hip changes in spastic cerebral palsy. American Journal of Roentgenology, 146(6), 1219-1222. https://doi.org/10.2214/ajr.146.6.1219
  8. Chang, C. H., Wang, Y. C., Ho, P. C., Hwang, A. W., Kao, H. K., Lee, W. C., Yang, W. E., & Kuo, K. N. (2015). Determinants of hip displacement in children with cerebral palsy. Clinical Orthopaedics & Related Research, 473(11), 3675-3681. https://doi.org/10.1007/s11999-015-4515-3
  9. Chung, M. K., Zulkarnain, A., Lee, J. B., Cho, B. C., Chung, C. Y., Lee, K. M., Sung, K. H., & Park, M. S. (2017). Functional status and amount of hip displacement independently affect acetabular dysplasia in cerebral palsy. Developmental Medicine & Child Neurology, 59(7), 743-749. https://doi.org/10.1111/dmcn.13437
  10. Graham, H. K. (2005). Classifying cerebral palsy. Journal of Pediatric Orthopaedics, 25(1), 127-128. https://doi.org/10.1097/01241398-200501000-00026
  11. Dobson, F., Boyd, R. N., Parrott, J., Nattrass, G. R., & Graham, H. K. (2002). Hip surveillance in children with cerebral palsy. The Journal of Bone and Joint Surgery. British volume, 84-B(5), 720-726. https://doi.org/10.1302/0301-620x.84b5.0840720
  12. Terjesen, T. (2012). The natural history of hip development in cerebral palsy. Developmental Medicine & Child Neurology, 54(10), 951-957. https://doi.org/10.1111/j.1469-8749.2012.04385.x
  13. Hägglund, G., Lauge-Pedersen, H., & Wagner, P. (2007). Characteristics of children with hip displacement in cerebral palsy. BMC Musculoskeletal Disorders, 8(1). https://doi.org/10.1186/1471-2474-8-101
  14. Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E., & Galuppi, B. (2008). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine & Child Neurology, 39(4), 214-223. https://doi.org/10.1111/j.1469-8749.1997.tb07414.x
  15. Abousamra, O., Er, M. S., Rogers, K. J., Nishnianidze, T., Dabney, K. W., & Miller, F. (2016). Hip reconstruction in children with unilateral cerebral palsy and hip dysplasia. Journal of Pediatric Orthopaedics, 36(8), 834-840. https://doi.org/10.1097/bpo.0000000000000563
  16. Soo, B. (2006). Hip displacement in cerebral palsy. The Journal of Bone and Joint Surgery (American), 88(1), 121. https://doi.org/10.2106/jbjs.e.00071
  17. Rutz, E., Passmore, E., Baker, R., & Graham, K. H. (2012). Multilevel surgery improves gait in spastic hemiplegia but does not resolve hip dysplasia. Clinical Orthopaedics & Related Research, 470(5), 1294-1302. https://doi.org/10.1007/s11999-011-2079-4
  18. DiFazio, R., Shore, B., Vessey, J. A., Miller, P. E., & Snyder, B. D. (2016). Effect of hip reconstructive surgery on health-related quality of life of non-ambulatory children with cerebral palsy. Journal of Bone and Joint Surgery, 98(14), 1190-1198. https://doi.org/10.2106/jbjs.15.01063
  19. Wynter, M., Gibson, N., Willoughby, K. L., Love, S., Kentish, M., Thomason, P., & Graham, H. K. (2015). Australian hip surveillance guidelines for children with cerebral palsy: 5-year review. Developmental Medicine & Child Neurology, 57(9), 808-820. https://doi.org/10.1111/dmcn.12754
  20. Hägglund, G., Alriksson-Schmidt, A., Lauge-Pedersen, H., Rodby-Bousquet, E., Wagner, P., & Westbom, L. (2014). Prevention of dislocation of the hip in children with cerebral palsy. The Bone & Joint Journal, 96-B(11), 1546-1552. https://doi.org/10.1302/0301-620x.96b11.34385
  21. Elkamil, A. I., Andersen, G. L., Hägglund, G., Lamvik, T., Skranes, J., & Vik, T. (2011). Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: A cross sectional study in Sweden and Norway. BMC Musculoskeletal Disorders, 12(1). https://doi.org/10.1186/1471-2474-12-284
  22. Portinaro, N., Panou, A., Gagliano, N., & Pelillo, F. (2009). D.D.S.H.: Developmental dysplasia of the spastic hip: Strategies of management in cerebral palsy. A new suggestive algorithm. HIP International, 19(6_suppl), 69-74. https://doi.org/10.1177/112070000901906s12
  23. Dohin, B., Garin, C., Vanhems, P., & Kohler, R. (2007). Botulinum toxin for postoperative careafter limb surgery in cerebral palsy children. Revue de Chirurgie Orthopedique et Reparatrice de l'appareil Moteur, 93(7), 674–681. https://doi.org/10.1016/s0035-1040(07)73252-x.
  24. Reimers, J. (1980). The stability of the hip in children: A radiological study of the results of muscle surgery in cerebral palsy. Acta Orthopaedica Scandinavica, 51(sup184), 1-100. https://doi.org/10.3109/ort.1980.51.suppl-184.01
  25. Miller, S. D., Juricic, M., Hesketh, K., Mclean, L., Magnuson, S., Gasior, S., Schaeffer, E., O'donnell, M., & Mulpuri, K. (2017). Prevention of hip displacement in children with cerebral palsy: A systematic review. Developmental Medicine & Child Neurology, 59(11), 1130-1138. https://doi.org/10.1111/dmcn.13480
  26. Gerszten, P. C., Albright, A. L., & Johnstone, G. F. (1998). Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with spastic cerebral palsy. Journal of Neurosurgery, 88(6), 1009-1013. https://doi.org/10.3171/jns.1998.88.6.1009
  27. Krach, L. E., Kriel, R. L., Gilmartin, R. C., Swift, D. M., Storrs, B. B., Abbott, R., ... & Nadell, J. M. (2004). Hip status in cerebral palsy after one year of continuous intrathecal baclofen infusion. Pediatric Neurology, 30(3), 163-168. https://doi.org/10.1016/j.pediatrneurol.2003.08.006
  28. Silva, S., Nowicki, P., Caird, M. S., Hurvitz, E. A., Ayyangar, R. N., Farley, F. A., ... & Craig, C. L. (2012). A comparison of hip dislocation rates and hip containment procedures after selective dorsal Rhizotomy versus intrathecal Baclofen pump insertion in Nonambulatory cerebral palsy patients. Journal of Pediatric Orthopaedics, 32(8), 853-856. https://doi.org/10.1097/bpo.0b013e31826ba7b2
  29. O'Sullivan, R., Walsh, M., Hewart, P., Jenkinson, A., Ross, L., & O'Brien, T. (2006). Factors associated with internal hip rotation gait in patients with cerebral palsy. Journal of Pediatric Orthopaedics, 26(4), 537-541. https://doi.org/10.1097/01.bpo.0000217727.93546.2b
  30. Cobeljic, G., Bajin, Z., Milickovic, S., Lesic, A., & Krajcinovic, O. (2005). Paraliticka dislokacija kuka kod cerebralne paralize - hirursko lecenje mekotkivnim postupcima. Acta chirurgica Iugoslavica, 52(2), 49-53. https://doi.org/10.2298/aci0502049c
  31. Abel, M. F, & Damiano, D. L. (2002). Cerebral Palsy. Orthopaedic Knowledge Update: Pediatrics 2. Rosemont : American Academy Orthopaedic Surgeons
  32. Presedo, A., Oh, C., Dabney, K. W., & Miller, F. (2005). Soft-tissue releases to treat spastic hip subluxation in children with cerebral palsy. The Journal of Bone & Joint Surgery, 87(4), 832-841. https://doi.org/10.2106/jbjs.c.01099
  33. Guglielmetti, L. G., Santos, R. M., Mendonça, R. G., Yamada, H. H., Assumpçao, R. M., & Fucs, P. M. (2010). Results of adductors muscle tenotomy in spastic cerebral palsy. Revista Brasileira de Ortopedia (English Edition), 45(4), 420-425. https://doi.org/10.1016/s2255-4971(15)30391-8
  34. Soo, B., Howard, J. J., Boyd, R. N., Reid, S. M., Lanigan, A., Wolfe, R., Reddihough, D., & Graham, H. K. (2006). Hip displacement in cerebral palsy. The Journal of Bone and Joint Surgery-American Volume, 88(1), 121-129. https://doi.org/10.2106/00004623-200601000-00015
  35. Terjesen, T., Lie, G. D., Hyldmo, Å. A., & Knaus, A. (2005). Adductor tenotomy in spastic cerebral palsy. Acta Orthopaedica, 76(1), 128-137. https://doi.org/10.1080/00016470510030454
  36. Knapp, D. R., & Cortes, H. (2002). Untreated hip dislocation in cerebral palsy. Journal of Pediatric Orthopaedics, 22(5), 668-671. https://doi.org/10.1097/01241398-200209000-00018
  37. Shore, B. J., Yu, X., Desai, S., Selber, P., Wolfe, R., & Graham, H. K. (2012). Adductor surgery to prevent hip displacement in children with cerebral palsy: The predictive role of the gross motor function classification system. Journal of Bone and Joint Surgery, 94(4), 326-334. https://doi.org/10.2106/jbjs.j.02003
  38. Dohin, B. (2019). The spastic hip in children and adolescents. Orthopaedics & Traumatology: Surgery & Research, 105(1), S133-S141. https://doi.org/10.1016/j.otsr.2018.03.018
  39. Chang, F. M., Ma, J., Pan, Z., Ingram, J. D., & Novais, E. N. (2016). Acetabular remodeling after a Varus Derotational osteotomy in children with cerebral palsy. Journal of Pediatric Orthopaedics, 36(2), 198-204. https://doi.org/10.1097/bpo.0000000000000418
  40. Huh, K., Rethlefsen, S. A., Wren, T. A., & Kay, R. M. (2011). Surgical management of hip subluxation and dislocation in children with cerebral palsy. Journal of Pediatric Orthopaedics, 31(8), 858-863. https://doi.org/10.1097/bpo.0b013e31822e0261
  41. Canavese, F., Emara, K., Sembrano, J. N., Bialik, V., Aiona, M. D., & Sussman, M. D. (2010). Varus Derotation osteotomy for the treatment of hip subluxation and dislocation in GMFCS level III to V patients with unilateral hip involvement. follow-up at skeletal maturity. Journal of Pediatric Orthopaedics, 30(4), 357-364. https://doi.org/10.1097/bpo.0b013e3181d8fbc1
  42. Shore, B. J., Shrader, M. W., Narayanan, U., Miller, F., Graham, H. K., & Mulpuri, K. (2017). Hip surveillance for children with cerebral palsy: A survey of the POSNA membership. Journal of Pediatric Orthopaedics, 37(7), e409-e414. https://doi.org/10.1097/bpo.0000000000001050
  43. Shukla, P. Y., Mann, S., Braun, S. V., & Gholve, P. A. (2013). Unilateral hip reconstruction in children with cerebral palsy. Journal of Pediatric Orthopaedics, 33(2), 175-181. https://doi.org/10.1097/bpo.0b013e31827d0b73
  44. Al-Ghadir, M., Masquijo, J. J., Guerra, L. A., & Willis, B. (2009). Combined femoral and pelvic osteotomies versus femoral osteotomy alone in the treatment of hip dysplasia in children with cerebral palsy. Journal of Pediatric Orthopaedics, 29(7), 779-783. https://doi.org/10.1097/bpo.0b013e3181b76968
  45. Davids, J. R. (2018). Management of neuromuscular hip dysplasia in children with cerebral palsy: Lessons and challenges. Journal of Pediatric Orthopaedics, 38(Suppl 1), S21-S27. https://doi.org/10.1097/bpo.0000000000001159
  46. Brunner, R., & Baumann, J. U. (1997). Long-term effects of Intertrochanteric Varus-derotation osteotomy on femur and acetabulum in spastic cerebral palsy: An 11- to 18-Year follow-up study. Journal of Pediatric Orthopaedics, 17(5), 585-591. https://doi.org/10.1097/00004694-199709000-00004
  47. Rutz, E., Vavken, P., Camathias, C., Haase, C., Jünemann, S., & Brunner, R. (2015). Long-term results and outcome predictors in one-stage hip reconstruction in children with cerebral palsy. Journal of Bone and Joint Surgery, 97(6), 500-506. https://doi.org/10.2106/jbjs.n.00676
  48. Graham, H. K., & Selber, P. (2003). Musculoskeletal aspects of cerebral palsy. The Journal of Bone and Joint Surgery. British volume, 85-B(2), 157-166. https://doi.org/10.1302/0301-620x.85b2.14066
  49. Dohin, B. (2019). The spastic hip in children and adolescents. Orthopaedics & Traumatology: Surgery & Research, 105(1), S133-S141. https://doi.org/10.1016/j.otsr.2018.03.018
  50. Refakis, C. A., Baldwin, K. D., Spiegel, D. A., & Sankar, W. N. (2018). Treatment of the dislocated hip in infants with spasticity. Journal of Pediatric Orthopaedics, 38(7), 345-349. https://doi.org/10.1097/bpo.0000000000000829
  51. Root, L., Laplaza, F. J., Brourman, S. N., & Angel, D. H. (1995). The severely unstable hip in cerebral palsy. Treatment with open reduction, pelvic osteotomy, and femoral osteotomy with shortening. The Journal of Bone & Joint Surgery, 77(5), 703-712. https://doi.org/10.2106/00004623-199505000-00006
  52. Hesketh, K., Leveille, L., & Mulpuri, K. (2016). The frequency of AVN following reconstructive hip surgery in children with cerebral palsy. Journal of Pediatric Orthopaedics, 36(2), e17-e24. https://doi.org/10.1097/bpo.0000000000000485
  53. Koch, A., Jozwiak, M., Idzior, M., Molinska-Glura, M., & Szulc, A. (2015). Avascular necrosis as a complication of the treatment of dislocation of the hip in children with cerebral palsy. The Bone & Joint Journal, 97-B(2), 270-276. https://doi.org/10.1302/0301-620x.97b2.34280
  54. Barakat, M. J., While, T., Pyman, J., Gargan, M., & Monsell, F. (2007). Bilateral hip reconstruction in severe whole-body cerebral palsy. The Journal of Bone and Joint Surgery. British volume, 89-B(10), 1363-1368. https://doi.org/10.1302/0301-620x.89b10.18446
  55. Norlin, R., & Tkaczuk, H. (1985). One-session surgery for correction of lower extremity deformities in children with cerebral palsy. Journal of Pediatric Orthopaedics, 5(2), 208-211. https://doi.org/10.1097/01241398-198505020-00016
  56. Godwin, E. M., Spero, C. R., Nof, L., Rosenthal, R. R., & Echternach, J. L. (2009). The gross motor function classification system for cerebral palsy and single-event multilevel surgery: Is there a relationship between level of function and intervention over time? Journal of Pediatric Orthopaedics, 29(8), 910-915. https://doi.org/10.1097/bpo.0b013e3181c0494f
  57. Thomason, P., Selber, P., & Graham, H. K. (2013). Single event multilevel surgery in children with bilateral spastic cerebral palsy: A 5 year prospective cohort study. Gait & Posture, 37(1), 23-28. https://doi.org/10.1016/j.gaitpost.2012.05.022
  58. Mcginley, J. L., Dobson, F., Ganeshalingam, R., Shore, B. J., Rutz, E., & Graham, H. K. (2011). Single-event multilevel surgery for children with cerebral palsy: A systematic review. Developmental Medicine & Child Neurology, 54(2), 117-128. https://doi.org/10.1111/j.1469-8749.2011.04143.x
  59. Umnov, V. V. (2014). Tactics of two-stage treatment of complex cases of instability of the hip joint in patients with cerebral palsy. Pediatric Traumatology, Orthopedics and Reconstructive Surgery, 2(2), 66–69. [in Russian]
  60. Widmann, R. F., Do, T. T., Doyle, S. M., Burke, S. W., & Root, L. (1999). Resection arthroplasty of the hip for patients with cerebral palsy: An outcome study. Journal of Pediatric Orthopaedics, 19(6), 805. https://doi.org/10.1097/01241398-199911000-00020
  61. Bayusentono, S., Choi, Y., Chung, C. Y., Kwon, S., Lee, K. M., & Park, M. S. (2014). Recurrence of hip instability after reconstructive surgery in patients with cerebral palsy. Journal of Bone and Joint Surgery, 96(18), 1527-1534. https://doi.org/10.2106/jbjs.m.01000
  62. Schmale, G. A., Eilert, R. E., Chang, F., & Seidel, K. (2006). High Reoperation rates after early treatment of the Subluxating hip in children with spastic cerebral palsy. Journal of Pediatric Orthopaedics, 26(5), 617-623. https://doi.org/10.1097/01.bpo.0000235391.26666.b0
  63. Portinaro, N., Turati, M., Cometto, M., Bigoni, M., Davids, J. R., & Panou, A. (2019). Guided growth of the proximal femur for the management of hip dysplasia in children with cerebral palsy. Journal of Pediatric Orthopaedics, 39(8), e622-e628. https://doi.org/10.1097/bpo.0000000000001069
  64. Torode, I. P., & Young, J. L. (2015). Caput valgum associated with developmental dysplasia of the hip: Management by transphyseal screw fixation. Journal of Children's Orthopaedics, 9(5), 371-379. https://doi.org/10.1007/s11832-015-0681-9
  65. Lee, W., Kao, H., Yang, W., Ho, P., & Chang, C. (2016). Guided growth of the proximal femur for hip displacement in children with cerebral palsy. Journal of Pediatric Orthopaedics, 36(5), 511-515. https://doi.org/10.1097/bpo.0000000000000480
  66. Hsieh, H., Wang, T., Kuo, K. N., Huang, S., & Wu, K. (2019). Guided growth improves coxa Valga and hip subluxation in children with cerebral palsy. Clinical Orthopaedics & Related Research, 477(11), 2568-2576. https://doi.org/10.1097/corr.0000000000000903
  67. Aversano, M. W., Sheikh Taha, A. M., Mundluru, S., & Otsuka, N. Y. (2017). What’s new in the orthopaedic treatment of cerebral palsy. Journal of Pediatric Orthopaedics, 37(3), 210-216. https://doi.org/10.1097/bpo.0000000000000675
  68. Miller, F., Dabney, K. W., & Rang, M. (1995). Complications in cerebral palsy treatment. Complications in pediatric orthopaedic surgery. Philadelphia : JB Lippincott Co

How to Cite

Sakalouski, O. ., Herasimenka, M. ., Klimau, R. ., & Hlazkin, L. . (2023). Correction of hip joint instability in children with cerebral palsy — current state of the problem and prospects for its solution (literature REVIEW). ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (2), 73–82. https://doi.org/10.15674/0030-59872021273-82

Issue

Section

DIGESTS AND REVIEWS