Hägglund, J Bone Joint Surg Br 2005 - Prevention of Dislocation of the Hip in Children with Cerebral Palsy. The First Ten Years of a Population-Based Prevention Programme
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Prevention of Dislocation of the Hip in Children with Cerebral Palsy. The First Ten Years of a Population-Based Prevention Programme
Hägglund, Westbom, et al.·J Bone Joint Surg Br·2005·279 citations·Prospective cohort
Hägglund and colleagues tested whether a population‑based register and surveillance program could prevent hip dislocation in children with cerebral palsy.
Population‑based register cohort in southern Sweden: 206 children with CP born 1992 to 1997 in the program vs 103 controls born 1990 to 1991, census January 1, 2003.
Methods
Design
Population‑based register study with a historical control group
Data source
Southern Sweden CP register and prevention program, started 1994
Patients
206 children with CP born 1992 to 1997 in the program
48 children who moved into the area
103 controls with CP born 1990 to 1991
Exposure
Screening with early intervention once lateral femoral head displacement was detected
Follow-up
Census date January 1, 2003
Controls living in the area 1994 to 2002
Outcomes
Hip dislocation
Migration percentage (MP)
Acetabular index
Key Findings
No child followed by the program from diagnosis developed a hip dislocation (0 of 206), vs 8 of 103 controls (p < 0.001).
All 8 control dislocations were unilateral and occurred between ages 3 and 6.
Only 2 of the 251 children aged 5 to 11 at the 2003 census had a dislocated hip: a boy who arrived at age 9 already dislocated, and a girl whose parents declined the program and who dislocated both hips.
A boy judged too frail for preventive surgery developed a painful dislocation at age 5 and died 3 years later.
The authors suggested that MP alone could serve as the screening measurement, because lateral displacement appeared to precede acetabular dysplasia.
The authors estimated the natural risk of hip dislocation across a whole CP population at 15% to 20%.
Board pearl
In this cohort, no hip with a migration percentage above 42% returned to normal without surgery.
Authors' conclusion
Dislocation of the hip in cerebral palsy remains a serious problem, and prevention is important. Our screening programme and early intervention when lateral displacement of the femoral head was detected appear to be successful.
Hägglund and colleagues tested whether a population‑based register and surveillance program could prevent hip dislocation in children with cerebral palsy.
Population‑based register cohort in southern Sweden: 206 children with CP born 1992 to 1997 in the program vs 103 controls born 1990 to 1991, census January 1, 2003.
Methods
Design
Population‑based register study with a historical control group
Data source
Southern Sweden CP register and prevention program, started 1994
Patients
206 children with CP born 1992 to 1997 in the program
48 children who moved into the area
103 controls with CP born 1990 to 1991
Exposure
Screening with early intervention once lateral femoral head displacement was detected
Follow-up
Census date January 1, 2003
Controls living in the area 1994 to 2002
Outcomes
Hip dislocation
Migration percentage (MP)
Acetabular index
Key Findings
No child followed by the program from diagnosis developed a hip dislocation (0 of 206), vs 8 of 103 controls (p < 0.001).
All 8 control dislocations were unilateral and occurred between ages 3 and 6.
Only 2 of the 251 children aged 5 to 11 at the 2003 census had a dislocated hip: a boy who arrived at age 9 already dislocated, and a girl whose parents declined the program and who dislocated both hips.
A boy judged too frail for preventive surgery developed a painful dislocation at age 5 and died 3 years later.
The authors suggested that MP alone could serve as the screening measurement, because lateral displacement appeared to precede acetabular dysplasia.
The authors estimated the natural risk of hip dislocation across a whole CP population at 15% to 20%.
Board pearl
In this cohort, no hip with a migration percentage above 42% returned to normal without surgery.
Authors' conclusion
Dislocation of the hip in cerebral palsy remains a serious problem, and prevention is important. Our screening programme and early intervention when lateral displacement of the femoral head was detected appear to be successful.