Management of Moderate to Severe Hip Displacement in Nonambulatory Children with Cerebral Palsy

* Spastic hip displacement is the second most common musculoskeletal deformity in children with cerebral palsy, after equinus of the ankle. * Population-based studies have shown that hip displacement affects approximately one-third of children with cerebral palsy and is directly related to limitations in gross motor function, as measured by the Gross Motor Function Classification System (GMFCS). * Children with cerebral palsy have both increased femoral-neck anteversion and neck-shaft angle, with nonambulatory children having the greatest increases from normal. * Isolated soft-tissue surgical procedures for the treatment of progressive hip displacement in nonambulatory children with cerebral palsy are unlikely to be successful as a definitive treatment. However, appropriate lengthening of the hip adductors and flexors can delay the timing of osseous reconstruction to a more appropriate age and stage in the child’s development, which may be advantageous. * An osseous reconstructive surgical procedure in nonambulatory children with cerebral palsy is often necessary; consider age, bilaterality, and combined femoral and pelvic procedures when planning operative intervention. * A morphologically well-developed hip is usually pain-free; facilitates comfortable sitting and transfers and ease of care for those who require assistance with personal hygiene; and contributes to higher levels of health-related quality of life.