Outcomes of Hip Interventions for Children with Cerebral Palsy – An International, Multi-Centre Prospective, Comparative Cohort Study
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. Without effective management, displacement can progress to dislocation of the hip with associated pain and negative impact on function and quality of life. Non-surgical interventions, such as botulinum toxin to the adductor muscles, have a very limited effect on hip displacement. For the majority of children, surgery to lengthen hip adductor muscles is also only successful in preventing further progression of hip displacement in the short-term. A significant proportion of children require further bony reconstructive surgery.
This international, multi-centre, prospective longitudinal cohort study will compare the range of interventions that are currently used for non-ambulant children with CP, aged 3 to 18 years, with the aim of addressing hip displacement. Children enrolled in the study are followed prospectively in one of 5 study cohorts:
- A.“Watchful Waiting” - monitoring through outpatient follow-up and routine hip x-rays
- B.Botulinum toxin injections +/- a hip abduction brace
- C.Soft tissue release of the hip adductor muscles
- D.Bony reconstructive surgery of the hip, or
- E.Salvage surgery - palliative procedures for dislocated hips when bony reconstruction is not possible
The study will investigate the effectiveness of these interventions to prevent or relieve the symptoms associated with hip displacement. The Royal Children’s Hospital sub-site will focus enrolment to the study on cohorts C and D, with limited enrolment anticipated to study cohorts B and E.
- 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.
- Willoughby KL, Jachno K, Ang SG, Thomason P, Graham HK. The impact of complementary and alternative medicines on hip development in children with cerebral palsy. Dev Med Child Neurol 2013;55:472-479.
- Willoughby KL, Ang SG, Thomason P, Graham HK. The impact of botulinum toxin A and abduction bracing on long-term hip development in children with cerebral palsy. Dev Med Child Neurol 2012;54:743–747.
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