Children with cerebral palsy (CP) have a higher than normal chance of developing hip dysplasia or abnormal growth of the hip. This is related to the tightening of the muscles –
also called spasticity – that occurs with cerebral palsy.
In a normal hip, the ball of the thigh bone (femur) sits in the socket of the hip bone. For some kids with CP, as the hip develops, the ball starts to pull away from the socket. This can lead to a lot of pain if it’s not treated.
Because kids with cerebral palsy are likely to develop hip problems, and because these problems develop slowly, we keep an eye out for this condition on an ongoing basis. We have worked with other top hospitals to develop a hip surveillance program for children with CP. That means we have a schedule to regularly assess the hip using X-ray. You may also hear this referred to as hip screening.
CP hip develops over time. It’s different from hip dysplasia that is present at birth. It occurs in 20 percent to 80 percent of children who have CP and is more common in kids who don’t walk. It develops less frequently in kids with CP who are able to walk.
Using the five-level Gross Motor Function Classification System (GMFCS), kids whose CP is classified at the higher levels (IV-V), have a higher chance of developing hip problems.
CP hip can occur any time in childhood. We’ve seen it from ages 2-18. CP hip can be found in one or both hips.
Signs and Symptoms
Oftentimes kids have no symptoms of a CP hip disorder. That is why we keep a close watch for it. Our goal is to find signs of a hip problem as soon as we can. When we diagnose CP hip early, we have more treatment options.
Sometimes a child will have one or more of the following symptoms of CP hip:
- Hip pain
- Less range of motion in the hip
- Trouble walking
But it’s also important to note that a child with hip dysplasia might walk just fine, or a child without dysplasia may not walk at all.
We use X-rays to diagnose cerebral palsy hip.
We typically begin our CP hip surveillance with an X-ray at age 1-2. X-rays are taken regularly afterward to see if hip dysplasia starts to develop.
Treatments depend on how severe the problem is. Treatments can include one or more of the following:
- Physical therapy. This is often used early on. Therapy can help maintain range of motion in the hip, movement and walking.
- Botox injections. These are sometimes used to help relieve muscle tightness. This can help relax the muscles and make movement easier.
- Bracing. Braces, or orthotic devices, may be used to limit the tightening of the muscles, help with movement and increase strength.
- Hip reconstruction surgery. If the hip’s cartilage is still intact, we often can reconstruct the hip. Through surgery, we re-seat the ball into the hip socket. It’s a major surgery with a long recovery, but it’s very successful. We perform this type of surgery often and have very good results with it.
- Guided growth. This treatment is an option if we catch the dysplasia very early on. With this technique, we use a device that allows your child’s growth to help the hips grow correctly into the socket. This is a less invasive procedure than hip reconstruction surgery. It involves a smaller incision, and we don’t need to manipulate the joint as much. We have had good success with this treatment.
Your child may start with physical therapy and move on to other options if the hip dysplasia worsens. Treatments may change over time. Your doctor will work with you to discuss the best treatments as your child grows.
Our Treatment Approach
At Cincinnati Children’s, our Hip Preservation Program is involved in many projects to make the care we provide even better. For treating CP hip, we have worked on improving both the quality and safety of our treatments. We offer unique ways of giving anesthesia that have made our surgeries more successful. We have also lowered infection rates after surgery. Our care is based on years of experience and the latest research.
Children who undergo surgery for CP hip do very well after recovery. One of our goals with surgery is “overcontainment,” which means we aim to seat the hip ball into the socket very deep. This approach has resulted in fewer recurrences of CP hip in the same child. It often reduces or eliminates the need for another surgery in the child’s future.