Hip displacement in children with post-neonatal cerebral palsy and acquired brain injury: a systematic review

ABSTRACT

Aim

To systematically review the prevalence, risk factors and timing of onset of hip displacement in children with a post-neonatal (PNN) brain injury with regards to hip surveillance recommendations.

Method

A search of PubMed, MEDLINE, Embase, CINAHL and Web of Science was conducted on 22^nd February 2022. Studies were included if they reported presence of, and risk factors for, hip displacement in children with PNN brain injury. Data was extracted on patient characteristics, and analyzed in terms of risk factors of interest and timing of development of hip displacement.

Results

Six studies met the inclusion criteria (n = 408 participants). All were cohort studies: five retrospective and one prospective. Rates of hip displacement ranged from 1% to 100%, and were higher in children with diffuse brain injury at an early age, who were non-ambulant and had spastic quadriplegia. Hip displacement and hip dislocation were first identified at one and three months respectively following PNN brain injury.

Interpretation

Evidence on hip displacement in children with PNN brain injury is sparse and low quality. Children who remain non-ambulant after diffuse PNN brain injury before five years of age appear most at risk of developing progressive hip displacement and earlier hip surveillance is recommended.

What this paper adds

• As for children with cerebral palsy (CP), children with a post-neonatal (PNN) brain injury who are non-ambulant are most at risk of progressive hip displacement.

• Children with a diffuse brain injury before five years of age appear to be at greater risk.

• Hip displacement can occur very early and progress rapidly following PNN brain injury.

KEYWORDS:

• Hip surveillance
• pediatric brain injury
• orthopedic

Abbreviations

ABI	=	Acquired brain injury
CNS	=	Central nervous system
CP	=	Cerebral Palsy
GMFCS	=	Gross Motor Function Classification System
HIE	=	Hypoxic-ischemic encephalopathy
MP	=	Migration percentage
NAI	=	Non-accidental injury
PNN	=	Post-neonatal
TBI	=	Traumatic brain injury

Acknowledgments

We are thankful to David Honeyman, research librarian, for assisting us with the database search strategies. We thank Miah Okamoto for her assistance with translation, and Dr. Yukihiro Kitai for sharing his study data for this review.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02699052.2024.2350049.

Additional information

Funding

This work was supported by the Parker Paediatric Physiotherapy Research Fund, Department of Physiotherapy, Perth Children’s Hospital, Perth, Western Australia [EB, grant number PPPRF 2021/06].