Article

Pain is a serious complication associated with hip dislocation in
cerebral palsy (CP), limiting patient independence and quality of life. This
study aimed to determine the frequency of pain in severe CP patients with hip
dislocation and to reveal factors associated with the hip pain. METHODS:
Seventy-three consecutive new-intervention CP patients admitted to authors'
institution with spastic quadriplegia, mean age 10.8 years (range 4.0-18.0 years)
were enrolled: 31 females and 42 males, totally 99 dislocated hips. All patients
were assessed level IV or V according to the Gross Motor Function Classification
Scale (GMFCS) and had poor communication skills. Pain severity was evaluated
according to the Numeric Rating Scale (NRS-11). Data concerning previously
applied physiotherapy was collected to divide the patients into subgroups: A - no
abduction therapy (n = 24), B - abduction therapy (n = 35) and C - abduction
therapy and horse-back riding (n = 13). On the pelvic antero-posterior
radiographs head migration percentage was measured to reveal hip dislocation.
Femoral head cartilage degenerative lesions were evaluated for size and location
in 45 hips undergoing surgical treatment. RESULTS: Overall pain prevalence was
56%. The appearance of pain was associated with the patient age (p = 0.048),
previous abduction physiotherapy (p < 0.00001), previous horse-back riding
therapy (p < 0.00001) and anterior location of degenerative changes of the
femoral head (p = 0.03). Pain intensity was related to the size of the
degenerative cartilage lesions (p = 0.004) and to the degree of femoral anteversion (p < 0.0001). CONCLUSIONS: Extensive abduction exercises,
hippotherapy and presence of degenerative cartilage lesions on the anterior part
of femoral head may be considered risk factors for hip pain appearance in the
dislocated hip of a child with severe spastic CP. Other associated factors are
abduction exercise intensity, age, excessive femoral anteversion and size of
degenerative cartilage lesions.

Langue : ANGLAIS