Influence of gait analysis on decision-marketing for lower extremity surgery

Dislocated hip joint pain in children with severe cerebral palsy

M JOZWIAK, P HARASYMCZUK, A KOCH

  1. 1. Department of Pediatric Orthopedics and Traumatology, University of Medical Sciences, Poznan, Poland

Objective: Pain is a serious complication associated with hip dislocation in paediatric cerebral palsy (CP), which limits patient independence and quality of life. This study aimed to determine the frequency of joint pain in patients with hip dislocation and to correlate pain intensity and hip joint treatment.

Design: Prospective cohort study.

Method: Seventy-three patients with spastic quadriplegic CP were enrolled (31 females, 42 males) with spastic hip joint dislocation (92 hips). Mean age was 10 years 7 months (range 4-18y). All patients were assessed as Levels IV or V in the Gross Motor Function Classification System and had poor communication skills. Each patient underwent clinical and radiological hip evaluation. Pain severity was evaluated according to an 11-point numeric rating scale. Hip instability was assessed according to migration percentage. Surgery was performed on 45 hips and cartilage degenerative lesions were evaluated.

Results: Overall pain incidence was 56%. Pain was related to patient age (p=0.048) and associated with horseback riding therapy (p<0.0001) and abduction treatment (p<0.0001). Statistically significant correlations were found between the anterior location of femoral head lesion  and pain appearance (p=0.03) and between lesion size and pain intensity (p=0.004). A positive correlation between femoral antetorsion and pain magnitude was observed (p=0.0001).

Conclusions: Risk factors for pain in the totally dislocated hip of a child with spastic CP are abduction exercises, horseback riding therapy, and presence of anterior degenerative cartilage lesions. Other contributing factors are abduction exercise intensity, age, extensive femoral antetorsion, and size of degenerative cartilage lesions

 
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