The hip in cerebral palsy

Abstract

Hip displacement in children with cerebral palsy (CP) is a complex problem and requires a multidisciplinary team approach. It is the most common orthopaedic problem in the non-ambulatory group of children and causes significant pain, which can be prevented or treated with appropriate management. Hip subluxation occurs due to asymmetrical muscle imbalance in the context of abnormal proximal femoral morphology. Work from CP registries has shown strong correlation between Gross Motor Function Classification System (GMFCS) level and rate of hip displacement. This has led to the development of preventative surveillance programmes. This review focuses particularly on non-ambulatory patients (GMFCS IV/V) and the options open to the paediatric orthopaedic surgeon in managing associated hip displacement. Surgical strategies can be broadly grouped into preventative, reconstructive and salvage options.