Review Article

Hip displacement in children with cerebral palsy: surveillance to surgery – a current concepts review

¹ Department of Orthopedic Surgery, Nemours Children’s Hospital, 1600 Rockland Road, Wilmington, Delaware 19803, USA
² Department of Orthopaedic Surgery, Royal Children’s Hospital, 50, Flemington Road, Parkville, Victoria 3052, Australia
³ Department of Paediatric Orthopaedics, Children’s Orthopaedic Centre, 298, Lady Jamshedji Road, Mahim West, Mumbai 400016, Maharashtra, India
⁴ Division of Orthopaedic Surgery, The Hospital for Sick Children & University of Toronto, 555 University Avenue, Toronto M5P 3E1, Ontario, Canada
⁵ Orthos Orthopaedic Solutions Inc., 452 E Columbia St., New Westminster, British Columbia V3L 3X5, Canada
⁶ Department of Pediatric Orthopedics, Robert Debré University Hospital, 48 Blvd Sérurier, Paris 75019, France
⁷ Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, 300, Longwood Avenue, Boston MA 02115, MA, USA
⁸ Department of Paediatric Orthopaedics, Sabara Children’s Hospital, Ave. Angélica, 1987 Consolação, São Paulo, SP 01227-200, Brazil
⁹ Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai 400012, Maharashtra, India

^* Corresponding author: aaroojis@gmail.com

Received: 4 April 2024
Accepted: 14 June 2024

Abstract

This review brings together a multidisciplinary, multinational team of experts to discuss the current state of knowledge in the detection and treatment of hip displacement in cerebral palsy (CP), a global public health problem with a high disease burden. Though common themes are pervasive, different views are also represented, reflecting the confluence of traditional thinking regarding the aetiology and treatment of hip displacement in CP with emerging research that challenges these tried-and-true principles. The development of hip displacement is most closely related to gross motor function, with radiographic surveillance programs based on the Gross Motor Function Classification System (GMFCS), the goal being early detection and timely treatment. These treatments may include non-operative methods such as abduction bracing and Botulinum Neurotoxin A (BoNT-A), but outcomes research in this area has been variable in quality. This has contributed to conflicting opinions and limited consensus. Soft tissue lengthening of the hip adductors and flexors has traditionally been employed for younger patients, but population-based studies have shown decreased survivorship for this treatment when performed in isolation. Concerns with the identification of hip displacement in very young children are raised, noting that early reconstructive surgery has a high recurrence rate. This has prompted consideration of viable minimally invasive alternatives that may have better success rates in very young children with CP, or may at least delay the need for osteotomies. Recent reports have implicated the role of abnormal proximal femoral growth and secondary acetabular dysplasia as a primary cause of hip displacement, related to ambulatory status and abductor function. As such, guided growth of the proximal femur has emerged as a possible treatment that addresses this purported aetiology, with promising early results.