Literature DB >> 23798769

Author's reply in response to letter to editor Indian J Orthop 2012;46:602 titled "Utility of combined abduction angle for hip surveillance in children with cerebral palsy".

Akshay Divecha1, Atul Bhaskar.   

Abstract

Entities:  

Year:  2013        PMID: 23798769      PMCID: PMC3687915     

Source DB:  PubMed          Journal:  Indian J Orthop        ISSN: 0019-5413            Impact factor:   1.251


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Sir, We thank Meena et al. for his keen interest shown in our article1 and critically analysing it.2 We do appreciate the fallacy of goniometric measurement, but in our study we used a standard protocol and the therapist was trained of taking measurement. In the clinical setting, an average of five readings would probably give us a good estimate of the hip abduction. We also agree that the false negative rate of 13.9% (CHAA angle was more than 40° in 14 children, but the migration was more than 33%) may be high and this is reflected in the sensitivity of the CHAA test. Perhaps, a large study can answer the efficacy of this test. We hope that all children are followed up regularly as certainly the hip abduction will decrease with further migration. A large review study in 2006 revealed that 60% of all children with cerebral palsy who had not walked by 5 years have had hip subluxation or dislocation.3 This has been our experience as well. Hence, we recommend that the functional ambulators and non-ambulators (GMFCS V and IV) be followed closely.4 Both clinical examination and X-rays are important. No single reading will be reliable, but regular followup of these children showing stiffening in range of motion should alert the person to seek further confirmation. Both clinical examination and radiographs are complementary. The last sentence is very relevant. Very often, children are seen by a therapist who does not order X-rays directly but refers the child to an orthopedic surgeon. To our dismay, even our orthopedic colleagues not dealing with CP children usually treat the child symptomatically without asking for xrays and even checking for range of motion of the hip. A recent Scandinavian study on CP children showed a high proportion of hip dislocation in children who never had any formal screening.4 Hence, it may be a good idea to have routine X-rays, but we did not address this issue in our study.
  4 in total

Review 1.  A systematic review of the evidence for hip surveillance in children with cerebral palsy.

Authors:  G S Gordon; D E Simkiss
Journal:  J Bone Joint Surg Br       Date:  2006-11

2.  Utility of combined hip abduction angle for hip surveillance in children with cerebral palsy.

Authors:  Sanjay Meena; Ratnav Ratan; Lalit Lohia; Rishi Raj
Journal:  Indian J Orthop       Date:  2012-09       Impact factor: 1.251

3.  Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: a cross sectional study in Sweden and Norway.

Authors:  Areej I Elkamil; Guro L Andersen; Gunnar Hägglund; Torarin Lamvik; Jon Skranes; Torstein Vik
Journal:  BMC Musculoskelet Disord       Date:  2011-12-16       Impact factor: 2.362

4.  Utility of combined hip abduction angle for hip surveillance in children with cerebral palsy.

Authors:  Akshay Divecha; Atul Bhaskar
Journal:  Indian J Orthop       Date:  2011-11       Impact factor: 1.251

  4 in total

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