Abstract
Aim
To assess the risk of hip dislocations in children with cerebral palsy (CP) attending special schools, and the effects of preventative soft tissue surgery (psoas and adductor tenotomy).
Method
110 children were reviewed from 1985-2000. Severity of CP was graded according to the Gross Motor Function Classification System (GMFCS). Hemiplegics - grade 1, Diplegics grades 2 & 3, Quadriplegics grades 4 & 5. Patients were grouped into age groups 5, 10 and 15 years and the number of hip dislocations in each group were noted. Numbers of patients who had preventative soft tissue surgery was also noted. Indication for surgery, >35% femoral head uncovering.
Results
Percentage of dislocations increased with CP severity. At 15 years, no dislocations in GMFCS 2, 6% GMFCS 3, 19% GMFCS 4 and 40% in GMFCS 5. The number of patients with at least 1 hip dislocation increased with age at all age groups. GMFCS 4 (age 5 yrs 9%, age 10 yrs 20% and 15 yrs 30%). GMFCS 5 (age5 yrs 22%, age 10 yrs 48% and age 15 yrs 50%).
By 15 years, 54 hips in GMFCS 2 & 3 (diplegics), preventative soft tissue surgery had not reduced chances of hip dislocation; only 1 dislocated (2%). In GMFCS 4 & 5 (quadriplegics), dislocations reduced from 40% in those without surgery to 26% in those who had preventive soft tissue surgery. This was particularly so in GMFCS 5 where there was a reduction from 83% dislocation without surgery to 33% with soft tissue preventive surgery.
Conclusions
Preventive soft tissue surgery was effective in reducing the rate of hip dislocation in quadriplegic CP especially GMFCS 5.
