Prevalence and morbidity of hip excentration in cerebral palsy: review of the literature

Purpose of the study Excentration of the hip is one of the main orthopedic complications of ante and perinatal cerebral palsy. Excentration can progress to dislocation eve n if tenotomy is performed. What is the prevalence and morbidity of hip exc entration? Methods We reviewed the pertinent literature on the prevalence and morbidity of hip excentration in patients with cerebral palsy based on the Medline and Reed oc databases. Results Data presented in the literature vary greatly. Populations are representati ve of the referral network of the teams reporting the study rather than the cerebral palsy population in general. Signs reported were pain, difficult nursing procedures, difficult sitting position, pressure sores and fracture s, but only one sign can be taken fully into account: 50 p. cent of the dis located hip joints were painful. Discussion No one study gives a precise assessment of the prevalence of hip excentrati on and displacement and its consequences in patients with cerebral palsy. I n a population of quadriplegic patients who do not walk, the question is wh ether complementary tenotomy should be performed, knowking the difficult op erative and postoperative situation of such procedures. In this population, walking is an exceptional goal of bone surgery, pain relief and patient co mfort are more common goals. Data in this literature (50 p. 100 of the disl ocated hips are painful) suggest a prudent approach. However, there is no k nown marker which can be used to distinguish hips which will become painful from those which will remain pain free. In addition, irreversible cartilag e degeneration can cause pain contraindicating reconstructive surgery.