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Topic:

Cerebral Palsy

Issue:

Hip

Category:

Neuromuscular

Title:

Hip Displacement After Triradiate Closure in Ambulatory Cerebral Palsy: Who Needs Continued Surveillance?

Author:

Lindgren, Amelia M. MD; Asma, Ali MD; Rogers, Kenneth J. PhD, ATC; Miller, Freeman MD; Shrader, M. Wade MD; Howard, Jason J. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

November/December 2024

Reference:

44(10): p 601-607, DOI: 10.1097/BPO.0000000000002783

Level Of Evidence:

III

# of Patients:

76

Study Type:

Retrospective cohort study

Location:

Not specified (single-center study)

Summary:

This study investigates the prevalence and risk factors for progressive hip displacement after closure of the triradiate cartilage (TRC) in ambulatory children with cerebral palsy (CP). The research highlights the continued risk of hip displacement after skeletal maturity, with significant factors such as diplegia, epilepsy, and the initial migration percentage (MP) after TRC closure.

Methods:

Patients with ambulatory CP (Gross Motor Function Classification System I-III) who underwent regular hip surveillance were included. The study examined variables such as previous surgeries, topographic pattern, sex, scoliosis, and epilepsy, with a focus on the migration percentage (MP) after TRC closure.

Exclusions:

Patients with non-ambulatory CP or those without sufficient follow-up were excluded.

Results:

16 patients (21.1%) had an unsuccessful hip outcome, defined as MP ≥30%, MP progression ≥10%, or requiring reconstructive surgery. Diplegia and epilepsy were identified as risk factors for an unsuccessful hip. The initial MP after TRC closure was the strongest predictor of progression to an unsuccessful hip, with MP ≥28% identified as the threshold for risk.

Conclusions:

Annual hip surveillance should continue for ambulatory CP patients (GMFCS I-III) after TRC closure, especially those with MP ≥28%, bilateral CP, and epilepsy, as there is a relatively high risk of MP progression (21%) after skeletal maturity.

Relevance:

Limitations:

Perspective:

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