Is muscle surgery or bone surgery better for young children with cerebral palsy who have hip displacement? The Cerebral Palsy Hip Interventions Project (CP-HIP)
Dr Kate Willoughby
All children with cerebral palsy are at risk of developing hip displacement. For children who are non-ambulant the risk of developing significant and progressive hip displacement is much higher, with the majority of children requiring surgical intervention. Hip displacement refers to the femoral head (‘ball’) of the hip joint gradually moving out of the acetabulum (‘socket’). Hip displacement can be caused by a combination of muscle contracture and bony dysplasia. Without effective management, displacement can progress to dislocation of the hip with associated pain and negative impact on function and quality of life.
Surgery to lengthen hip adductor muscles is only successful in preventing further progression of hip displacement in the short-term. A significant proportion of children who undergo muscle lengthening procedures progress to requiring a second stage of bony reconstructive surgery. The advantages of adductor surgery include a less invasive surgical procedure, with a faster recovery. Disadvantages include the need for a period of immobilisation in a plaster cast and a high risk of needing further intervention. Currently, adductor surgery is used as a temporising measure to delay bony surgery until children are older, however this approach requires both the child and family to endure two surgeries to manage hip displacement.
Advantages of bony surgery include more complete correction of hip displacement, no need for cast immobilisation and an anticipated need for fewer additional procedures. This may lead to benefits for the child and parents/carers (fewer operations and hospital admissions) as well as potential economic benefits (reduced health care costs). This study will compare adductor release and bony reconstruction for young children (aged 3-10 years) who present with early hip displacement to investigate their impact on a range of outcomes: hip status, pain, gross motor function, carer burden during the post-operative period, and health-related quality of life.
- NH&MRC CP-CRE, Chief Investigators: Professor Dinah Reddihough, Professor H.Kerr Graham, Professor Christine Imms, Professor Nadia Badawi, Associate Professor Michael Coory, Professor Eve Blair, Professor Rob Carter.
- Canadian Institutes of Health Research: Professor Unni Narayanan, Dr Darcy Fehlings, Professor H. Kerr Graham, Dr R Hamdy, Dr Kishore Mulpuri.
- Shore BJ, Yu X, Desai S, Selber P, Wolfe R, Graham HK. Adductor surgery to prevent hip dislocation in children with cerebral palsy: the predictive role of the Gross Motor Function Classification System. J Bone Joint Surg [Am]. 2012;94:326-34.
- Wawrzuta J, Willoughby KL, Molesworth C, Ang SG, Shore BJ, Thomason P, Graham HK. Hip health at skeletal maturity: a population-based study of young adults with cerebral palsy. Dev Med Child Neurol 2016;58(12):1273-1280.
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