The Journal of Bone and Joint Surgery (American). 2006;88:121-129.
doi:10.2106/JBJS.E.00071
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Hip Displacement in Cerebral Palsy

Brendan Soo, MBBS1, Jason J. Howard, MD, FRCS(C)1, Roslyn N. Boyd, PhD, MSc(Physiotherapy)1, Susan M. Reid, MClinEpi1, Anna Lanigan, RN1, Rory Wolfe, PhD2, Dinah Reddihough, MD, FRACP, FAFRM1 and H. Kerr Graham, MD, FRCS(Ed), FRACS1

1 Departments of Orthopaedic Surgery (B.S., J.J.H., R.N.B., and H.K.G.) and Child Development and Rehabilitation (S.M.R., A.L., and D.R.), Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia. E-mail address for H.K. Graham: kerr.graham{at}rch.org.au
2 Monash University, Alfred Hospital, Commercial Road, Prahran, Victoria 3004, Australia

Investigation performed at the Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Parkville, Victoria, Australia

In support of their research for or preparation of this manuscript, one or more of the authors received a Murdoch Children's Research Institute Theme Grant. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Hip displacement is considered to be common in children with cerebral palsy but the reported incidence and the proposed risk factors vary widely. Knowledge regarding its overall incidence and associated risk factors can facilitate treatment of these children.

Methods: An inception cohort was generated from the Victorian Cerebral Palsy Register for the birth years 1990 through 1992, inclusive, and multiple data sources pertaining to the cohort were reviewed during 2004. Gross motor function was assessed for each child and was graded according to the Gross Motor Function Classification System (GMFCS), which is a valid, reliable, five-level ordinal grading system. Hip displacement, defined as a migration percentage of >30%, was measured on an anteroposterior radiograph of the pelvis with use of a reliable technique.

Results: A full data set was obtained for 323 (86%) of 374 children in the Register for the birth years 1990 through 1992. The mean duration of follow-up was eleven years and eight months. The incidence of hip displacement for the entire birth cohort was 35%, and it showed a linear relationship with the level of gross motor function. The incidence of hip displacement was 0% for children with GMFCS level I and 90% for those with GMFCS level V. Compared with children with GMFCS level II, those with levels III, IV, and V had significantly higher relative risks of hip displacement (2.7, 4.6, and 5.9, respectively).

Conclusions: Hip displacement is common in children with cerebral palsy, with an overall incidence of 35% found in this study. The risk of hip displacement is directly related to gross motor function as graded with the Gross Motor Function Classification System. This information may be important when assessing the risk of hip displacement for an individual child who has cerebral palsy, for counseling parents, and in the design of screening programs and resource allocation.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


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