The application of the German hip surveillance protocol in children with bilateral spastic cerebral palsy – a single centre cohort study

C Jansen; AS Schröder; K Hinterstoißer; K Huß; F Heinen; S Berweck

doi:10.1055/s-0031-1274010

Neuropediatrics, Inhaltsverzeichnis

The application of the German hip surveillance protocol in children with bilateral spastic cerebral palsy – a single centre cohort study

C Jansen ¹, AS Schröder ¹, K Hinterstoißer ¹, K Huß ¹, F Heinen ¹, S Berweck ²

¹Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Pädiatrische Neurologie, Entwicklungsneurologie und Sozialpädiatrie, München, Germany
²Schön Klinik Vogtareuth, Neuropädiatrie und Neurologische Rehabilitation, Epilepsiezentrum für Kinder und Jugendliche, Tagesklinik für Neuropädiatrie, Vogtareuth, Germany

Abstract

Introduction: a progressive subluxation (Migration percentage of Reimers, MI) is a typical musculoskeletal complication in children with cerebral palsy. To determine the risk of progressive subluxation a German hip surveillance protocol using a „hip signal light“ was established (www.cp-netz.de). Aim of this study was to correlate the MI percentage with potential risk factors such as age and severity of groß motor functioning (GMFCS) in children with bilateral spastic CP (BSCP) by using the criteria of this new surveillance tool.

Method: single centre descriptive cohort study. Evaluation of the first hip x-rays of 61 patients with BSCP treated in the time from 01/2004–12/2009. Categorisation of hips according to the patients GMFCS level (I-V) and age (0–2;>2–4;>4–6;>6–12;>12 years of age). Calculation of Spearmans correlation coefficient for MI versus age and MI versus GMFCS.

Results: 122 hips could be analysed. Hip signal was green in 22% (27), yellow in 66% (81) and red in 12% (14). Distribution according to GMFCS levels revealed: I: green 65%, yellow 35%, red 0%; II: 42%, 54%, 4%; III: 0%, 97%, 3%; IV: 8%, 75%, 17%; V: 6%, 44%, 50%. Distribution of age groups revealed: 0–2 y: green 8%, yellow 92%, red 0%; >2–4 y: 32%, 59%, 9%; >4–6 y: 25%, 64%, 11%; >6–12 y.: 11%, 67%, 22%; >12J.: 0%, 80%, 20%. The risk of progressive MI showed a significant correlation (0,579) with GMFCS level of the patients, there was no correlation between MI and age of the patients.

Conclusion: the correlation of high MI percentage and GMFCS level in children with BSCP is in accordance with previously published literature (Soo et al. 2006). Two out of three children with BSCP showed a „hip at risk“ constellation according to the criteria of the German hip surveillance protocol. Integrative and early evaluation of the hips in children with BSCP by paediatric neurologists and paediatric orthopaedics is necessary to treat progressive subluxation.