Abstract
BackgroundHip dislocation is a serious complication among children with cerebral palsy (CP). The aim of this study was to compare the prevalence of hip dislocation among children with CP in an area providing regular care with an area providing hip surveillance services.MethodsThis is a cross-sectional study in seven Norwegian counties providing regular care and one Swedish healthcare region where a hip surveillance programme was introduced in 1994. Data were provided by the Norwegian Cerebral Palsy Register and the CP Register in Southern Sweden. Children born 1996 - 2003 with moderate to severe CP, defined as Gross Motor Classification System (GMFCS) levels III - V, were included. In all, 119 Norwegian and 136 Swedish children fulfilled the criteria. In Norway, data on hip operations and radiographs of the hips were collected from medical records, while these data are collected routinely in the Swedish register. The hip migration percentage was measured on the recent radiographs. Hip dislocation was defined as a migration percent of 100%.ResultsThe proportion of children at GMFCS levels III - V was 34% in the Norwegian and 38% in the Swedish population. In the Norwegian population, hip dislocation was diagnosed in 18 children (15.1%; CI: 9.8 - 22.6) compared with only one child (0.7%; 95% CI: 0.01 - 4.0) in Southern Sweden (p = < 0.001). Hip surgery was performed in 53 (44.5%) of the Norwegian children and in 43 (32%) of the Swedish children (p = 0.03). The total number of hip operations was 65 in Norway and 63 in Sweden. Norwegian children were first operated at a mean age of 7.6 years (SD: 2.9) compared with 5.7 years (SD: 2.3) in Sweden (p = 0.001).ConclusionsThe surveillance programme reduced the number of hip dislocations and the proportion of children undergoing hip surgery was lower. However, with the surveillance programme the first operation was performed at a younger age. Our results strongly support the effectiveness of a specifically designed follow-up programme for the prevention of hip dislocation in children with CP.
Highlights
Hip dislocation is a serious complication among children with cerebral palsy (CP)
The aim of this study was, to compare the prevalence of hip dislocation in a Norwegian population receiving regular care with a group of children in Southern Sweden included in the hip surveillance programme, and to compare the number and type of hip operations performed in these areas
The proportion of children classified as dyskinetic CP was, higher in Sweden compared with Norway where the proportion with bilateral spastic subtype was higher (Table 1)
Summary
Hip dislocation is a serious complication among children with cerebral palsy (CP). The aim of this study was to compare the prevalence of hip dislocation among children with CP in an area providing regular care with an area providing hip surveillance services. Dislocation of the hip among children with cerebral palsy (CP) is a severe complication following insidious hip displacement. In Southern Sweden, a follow-up programme for CP was started in 1994 with a specific aim to identify patients at risk for hip dislocation and to prevent this complication. Together with increased awareness of the risk of hip displacement, these new treatment modalities might have resulted in reduction of hip displacement even in centres where the surveillance programme had not been implemented
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