Joanna Wawrzuta1,2, Kate L Willoughby1,3, Charlotte Molesworth4, Soon Ghee Ang1, Benjamin J Shore5, Pam Thomason3,6, H Kerr Graham1,2,3,6. 1. Orthopaedic Department, The Royal Children's Hospital, Parkville, Vic., Australia. 2. Department of Paediatrics, University of Melbourne, Carlton, Vic., Australia. 3. Centre of Research Excellence in Cerebral Palsy, Murdoch Childrens Research Institute, Parkville, Vic., Australia. 4. Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Vic., Australia. 5. Harvard Medical School, Boston Children's Hospital, Boston, MA, USA. 6. Hugh Williamson Gait Laboratory, The Royal Children's Hospital, Parkville, Vic., Australia.
Abstract
AIM: We studied 'hip health' in a population-based cohort of adolescents and young adults with cerebral palsy to investigate associations between hip morphology, pain, and gross motor function. METHOD: Ninety-eight young adults (65 males, 33 females) from the birth cohort were identified as having developed hip displacement (migration percentage >30) and were reviewed at a mean age of 18 years 10 months (range 15-24y). Hip morphology was classified using the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS). Severity and frequency of pain were recorded using Likert scales. Gross motor function was classified by the Gross Motor Function Classification System (GMFCS). RESULTS: Hip pain was reported in 72% of participants. Associations were found between pain scores and both hip morphology and GMFCS. Median pain severity score for MCPHCS grades 1 to 4 was 2 (interquartile range [IQR] 1.0-3.0) compared to 7 (IQR 6.0-8.0) for grades 5 and 6 (severe subluxation or dislocation). Hip surveillance and access to surgery were associated with improved hip morphology and less pain. INTERPRETATION: Poor hip morphology at skeletal maturity was associated with high levels of pain. Limited hip surveillance and access to surgery, rather than GMFCS, was associated with poor hip morphology. The majority of young adults who had access to hip surveillance, and preventive and reconstructive surgery, had satisfactory hip morphology at skeletal maturity and less pain.
AIM: We studied 'hip health' in a population-based cohort of adolescents and young adults with cerebral palsy to investigate associations between hip morphology, pain, and gross motor function. METHOD: Ninety-eight young adults (65 males, 33 females) from the birth cohort were identified as having developed hip displacement (migration percentage >30) and were reviewed at a mean age of 18 years 10 months (range 15-24y). Hip morphology was classified using the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS). Severity and frequency of pain were recorded using Likert scales. Gross motor function was classified by the Gross Motor Function Classification System (GMFCS). RESULTS:Hip pain was reported in 72% of participants. Associations were found between pain scores and both hip morphology and GMFCS. Median pain severity score for MCPHCS grades 1 to 4 was 2 (interquartile range [IQR] 1.0-3.0) compared to 7 (IQR 6.0-8.0) for grades 5 and 6 (severe subluxation or dislocation). Hip surveillance and access to surgery were associated with improved hip morphology and less pain. INTERPRETATION: Poor hip morphology at skeletal maturity was associated with high levels of pain. Limited hip surveillance and access to surgery, rather than GMFCS, was associated with poor hip morphology. The majority of young adults who had access to hip surveillance, and preventive and reconstructive surgery, had satisfactory hip morphology at skeletal maturity and less pain.
Authors: Kate L Willoughby; Soon Ghee Ang; Pam Thomason; Erich Rutz; Benjamin Shore; Aaron J Buckland; Michael B Johnson; H Kerr Graham Journal: J Paediatr Child Health Date: 2021-08-28 Impact factor: 1.929
Authors: Armagan Can Ulusaloglu; Ali Asma; Kenneth J Rogers; Michael Wade Shrader; H Kerr Graham; Jason J Howard Journal: J Child Orthop Date: 2022-04-30 Impact factor: 1.917