The Femoral Head-Shaft Angle Is Not a Predictor of Hip Displacement in Children Under 5 Years With Cerebral Palsy: A Population-based Study of Children at GMFCS Levels III-V

BACKGROUNDThe aim of this study was to evaluate whether the femoral head-shaft angle (HSA) is a predictor of hip displacement in children with cerebral palsy (CP). METHODSThe patients were recruited from a population-based hip surveillance program. Inclusion criteria were age under 5 years, bilatera...

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Published in:Journal of pediatric orthopaedics 2021-09, Vol.41 (8), p.e659-e663
Main Authors: Terjesen, Terje, Horn, Joachim
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Language:English
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Cerebral Palsy
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Horn, Joachim
description BACKGROUNDThe aim of this study was to evaluate whether the femoral head-shaft angle (HSA) is a predictor of hip displacement in children with cerebral palsy (CP). METHODSThe patients were recruited from a population-based hip surveillance program. Inclusion criteria were age under 5 years, bilateral CP, Gross Motor Function Classification System (GMFCS) levels III-V, and migration percentage (MP) of both hips
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METHODSThe patients were recruited from a population-based hip surveillance program. Inclusion criteria were age under 5 years, bilateral CP, Gross Motor Function Classification System (GMFCS) levels III-V, and migration percentage (MP) of both hips &lt;40% at the primary radiograph. With these criteria, 101 children (61 boys) were included. GMFCS was level III in 26 patients, level IV in 23, and level V in 52. An anteroposterior radiograph of the pelvis was taken at diagnosis and at the last follow-up. Only the worst hip of each patient (the hip with the largest MP) was used for the analyses. RESULTSThe mean age at the primary radiograph was 2.4 years (range, 0.8 to 4.9 y). The mean primary HSA was 171.0 degrees (range, 152 to 190 degrees). The mean follow-up time was 4.3 years (range, 0.9 to 11.8 y). The mean MP at the primary radiograph was 17.5% (range, 0% to 39%) and at the last follow-up 41.9% (range, 0% to 100%). At that point, MP was &lt;40% in 54 hips and ≥40% in 47 hips. There was no significant difference in primary HSA between patients with final MP&lt;40% and those with final MP≥40% (170.8 and 171.3 degrees, respectively; P=0.761). At the last follow-up, the mean HSA was significantly larger in hips with final MP≥40% than in hips with final MP&lt;40% (171.1 vs. 167.4 degrees; P=0.029). CONCLUSIONSThere was a markedly increased valgus position of the proximal femur in nonambulatory children with CP. However, the primary HSA in children below 5 years of age was not a predictor of later hip displacement, defined as MP≥40%. CLINICAL RELEVANCEMeasurement of HSA is not necessary in routine hip surveillance in children below 5 years. LEVEL OF EVIDENCELevel I-investigating a diagnostic test.</description><identifier>ISSN: 0271-6798</identifier><identifier>EISSN: 1539-2570</identifier><identifier>DOI: 10.1097/BPO.0000000000001875</identifier><identifier>PMID: 34101699</identifier><language>eng</language><publisher>Lippincott Williams &amp; Wilkins</publisher><subject>Cerebral Palsy</subject><ispartof>Journal of pediatric orthopaedics, 2021-09, Vol.41 (8), p.e659-e663</ispartof><rights>Lippincott Williams &amp; Wilkins</rights><rights>info:eu-repo/semantics/openAccess</rights><rights>Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4542-b2fd982c336620ee1de039dc05e4df5072ef2ca4ad736c3c710582728e7a477a3</citedby><cites>FETCH-LOGICAL-c4542-b2fd982c336620ee1de039dc05e4df5072ef2ca4ad736c3c710582728e7a477a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,780,885,26567</link.rule.ids><linktorsrc>$$Uhttp://hdl.handle.net/10852/93195$$EView_record_in_NORA$$FView_record_in_$$GNORA$$Hfree_for_read</linktorsrc></links><search><creatorcontrib>Terjesen, Terje</creatorcontrib><creatorcontrib>Horn, Joachim</creatorcontrib><title>The Femoral Head-Shaft Angle Is Not a Predictor of Hip Displacement in Children Under 5 Years With Cerebral Palsy: A Population-based Study of Children at GMFCS Levels III-V</title><title>Journal of pediatric orthopaedics</title><description>BACKGROUNDThe aim of this study was to evaluate whether the femoral head-shaft angle (HSA) is a predictor of hip displacement in children with cerebral palsy (CP). METHODSThe patients were recruited from a population-based hip surveillance program. Inclusion criteria were age under 5 years, bilateral CP, Gross Motor Function Classification System (GMFCS) levels III-V, and migration percentage (MP) of both hips &lt;40% at the primary radiograph. With these criteria, 101 children (61 boys) were included. GMFCS was level III in 26 patients, level IV in 23, and level V in 52. An anteroposterior radiograph of the pelvis was taken at diagnosis and at the last follow-up. Only the worst hip of each patient (the hip with the largest MP) was used for the analyses. RESULTSThe mean age at the primary radiograph was 2.4 years (range, 0.8 to 4.9 y). The mean primary HSA was 171.0 degrees (range, 152 to 190 degrees). The mean follow-up time was 4.3 years (range, 0.9 to 11.8 y). The mean MP at the primary radiograph was 17.5% (range, 0% to 39%) and at the last follow-up 41.9% (range, 0% to 100%). At that point, MP was &lt;40% in 54 hips and ≥40% in 47 hips. There was no significant difference in primary HSA between patients with final MP&lt;40% and those with final MP≥40% (170.8 and 171.3 degrees, respectively; P=0.761). At the last follow-up, the mean HSA was significantly larger in hips with final MP≥40% than in hips with final MP&lt;40% (171.1 vs. 167.4 degrees; P=0.029). CONCLUSIONSThere was a markedly increased valgus position of the proximal femur in nonambulatory children with CP. However, the primary HSA in children below 5 years of age was not a predictor of later hip displacement, defined as MP≥40%. CLINICAL RELEVANCEMeasurement of HSA is not necessary in routine hip surveillance in children below 5 years. 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METHODSThe patients were recruited from a population-based hip surveillance program. Inclusion criteria were age under 5 years, bilateral CP, Gross Motor Function Classification System (GMFCS) levels III-V, and migration percentage (MP) of both hips &lt;40% at the primary radiograph. With these criteria, 101 children (61 boys) were included. GMFCS was level III in 26 patients, level IV in 23, and level V in 52. An anteroposterior radiograph of the pelvis was taken at diagnosis and at the last follow-up. Only the worst hip of each patient (the hip with the largest MP) was used for the analyses. RESULTSThe mean age at the primary radiograph was 2.4 years (range, 0.8 to 4.9 y). The mean primary HSA was 171.0 degrees (range, 152 to 190 degrees). The mean follow-up time was 4.3 years (range, 0.9 to 11.8 y). The mean MP at the primary radiograph was 17.5% (range, 0% to 39%) and at the last follow-up 41.9% (range, 0% to 100%). At that point, MP was &lt;40% in 54 hips and ≥40% in 47 hips. There was no significant difference in primary HSA between patients with final MP&lt;40% and those with final MP≥40% (170.8 and 171.3 degrees, respectively; P=0.761). At the last follow-up, the mean HSA was significantly larger in hips with final MP≥40% than in hips with final MP&lt;40% (171.1 vs. 167.4 degrees; P=0.029). CONCLUSIONSThere was a markedly increased valgus position of the proximal femur in nonambulatory children with CP. However, the primary HSA in children below 5 years of age was not a predictor of later hip displacement, defined as MP≥40%. CLINICAL RELEVANCEMeasurement of HSA is not necessary in routine hip surveillance in children below 5 years. LEVEL OF EVIDENCELevel I-investigating a diagnostic test.</abstract><pub>Lippincott Williams &amp; Wilkins</pub><pmid>34101699</pmid><doi>10.1097/BPO.0000000000001875</doi><oa>free_for_read</oa></addata></record>
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title The Femoral Head-Shaft Angle Is Not a Predictor of Hip Displacement in Children Under 5 Years With Cerebral Palsy: A Population-based Study of Children at GMFCS Levels III-V
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