Wednesday, December 21, 2016

The Necessity of Hip Surveillance in Children with Cerebral Palsy

The Necessity of Hip Surveillance in Children with Cerebral Palsy

At least every week, I see children with cerebral palsy with advanced hip diseases requiring major reconstructive surgery that may have been easily prevented by proper   screening and preventive procedures. This post describes the necessity of hip surveillance in all children with cerebral palsy.

The hip is the second most common involved joint (after ankle)in children with cerebral palsy. The hip is a ball and socket joint and for its proper function and painless movement, the ball (femoral head) should be located inside the socket (acetabulum). The hip joint is under higher pressure due to tight muscles in children with cerebral palsy. These high pressures could gradually displace the ball out of socket resulting in early arthritis and painful hips. The displaced painful hips are usually debilitating both in the group of children that walk using assistive devices and in children who use wheelchairs for mobility.
Early stages of the hip disease in children with cerebral palsy could easily be overlooked since the child does not complain of any pain. If the treatment is not started in time, this could rapidly progress resulting in a painful displaced hip which could affect the ambulation and the quality of life. By the time to child starts complaining of pain, the hip is usually displaced out of the socket and the treatment options at that stage are very limited.
It is very important that all children with cerebral palsy be evaluated and screened for hip problems during the course of their growth and development. This is usually done by complete physical examination in addition to x-rays of the hipX-rays of the hip are required every 6-12 months depending on the level of the spasticity and functional ambulation of the child.
Early stages of hip displacement could be treated by procedures on the muscles of the hip. Advanced stages of hip involvement may require extensive reconstructive procedures involving the hip and the pelvis.
By routine and timely screening of all children with cerebral palsy for hip problems, this debilitating problem can be avoided in most cases.

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