Hip Subluxation & Dislocation in Children with Cerebral Palsy
Hip subluxation is a common condition among patients with cerebral palsy (CP) and other neuromuscular disorders. Abnormal muscle force can cause the child’s muscles to pull the hip away from the socket, rather than keeping it in place. If this progresses, it can lead to complete dislocation of the hip.
Hip dislocation can occur in children without the presence of a neuromuscular disorder like cerebral palsy, due to conditions like developmental dysplasia of the hip or a sudden injury. However, treatments for CP patients with hip subluxation and dislocation may differ from treatments recommended for patients who are otherwise healthy. With CP patients, it is especially critical that hip problems be addressed before they lead to the development of early-onset arthritis, as these patients are typically not good candidates for joint replacement.
At Children’s Orthopaedic & Scoliosis Surgery Associates, Dr. Bland specializes in lower extremity treatment in patients with cerebral palsy, including hip subluxation and dislocation. Dr. Bland received fellowship training in pediatric orthopaedic surgery at Rady Children’s Hospital, training under world-renowned cerebral palsy expert Dr. Henry Chambers. He also has a special interest in participating in medical mission trips to treat patients with cerebral palsy in under-developed countries.
Symptoms of Hip Subluxation & Dislocation
In children with cerebral palsy, hip subluxation occurs due to muscles contracting around the hip. This muscle tightness places abnormal forces on the hip, pulling it out of its proper placement in the socket. Eventually, the hip may dislocate completely.
Hip subluxation and dislocations usually occur gradually in patients with cerebral palsy. Changes in the hip can be more difficult to spot in children with CP because they tend to have other rotational or gait abnormalities, as well. Also, because the dislocation occurs gradually, symptoms like pain may not immediately be present like they would in a child who has dislocated a hip with a sudden injury.
Though the gradual progression of CP-related hip subluxation can be difficult to spot in a child, if you notice decreased range of motion in one of the hips or differences in the two legs, you should mention this to your doctor. Pain is also a symptom of hip dislocation, though pain is often not immediately present in these cases.
Regular check-ups with your child’s doctors are often key in spotting progressive changes like hip subluxation. If hip abnormalities are detected, Dr. Bland typically recommends check-ups at regular intervals to monitor the progression of the problem. He then works with the child’s doctors and therapists to determine a course of treatment, with the ultimate goal of preventing early-onset arthritis in the hip.
Treatments for Hip Subluxation & Dislocation
Whenever possible, Dr. Bland recommends nonsurgical treatments for hip abnormalities like subluxation and dislocation, coordinating with other specialists in the patient’s care team to provide necessary treatments. Surgery is typically delayed for as long as possible, since surgery can be especially taxing on young patients.
Even if a child is unable to walk, it is still very important to get treatment for hip subluxation. If the condition progresses to dislocation, the child may develop early-onset arthritis. It is important to try to prevent arthritis because patients with cerebral palsy are typically not good candidates for arthritis-related procedures like joint replacement. While treating hip subluxation early on may not alter the prognosis for being able to walk independently, as this is more related to weakness from the underlying condition, it can prevent pain, loss of motion and difficulty with positioning and hygiene care down the road.
Physical therapy plays a critical role in the treatment of cerebral palsy, including hip subluxation problems. Physical therapists work with children to help keep the hip muscles as flexible as possible to help avoid contracture. Braces may also be used to help keep the hip in place.
While patients work with physical therapy to try to prevent the hip from completely dislocating, Dr. Bland recommends a regular check-up schedule to monitor the hip so that any changes can be addressed as soon as possible. The checkup schedule is based on the severity of the child’s cerebral palsy.
If the hip subluxation progresses to dislocation, and nonsurgical treatments are no longer helpful in preventing progression of the condition, surgery may be recommended.
Surgery for hip subluxation in cerebral palsy patients may include a procedure to lengthen the muscles that are pulling the hip out of its socket. This procedure is minimally invasive and involves making a small incision in the skin above the muscle, then making a small incision into part or all of the muscle. This small incision can help to relax muscle tightness, allowing it to stretch more.
If the problem persists, Dr. Bland may recommend an osteotomy, a procedure in which the hip bones are cut and repositioned at a better angle to fit within the socket. The repositioned bones are held in place with plates and screws.
Whenever possible, our cerebral palsy specialists will coordinate to complete multiple procedures at once if the child needs them. This can help to reduce recovery times and time spent away from physical therapy during the healing process.
Hip Surgery for Cerebral Palsy Patients in Tampa Bay
Patients with cerebral palsy often develop hip conditions like subluxation and dislocation. Our cerebral palsy specialists at Children’s Orthopaedic & Scoliosis Surgery Associates, including our lower extremity specialist Dr. Bland, work with the patient’s care teams in association with Johns Hopkins All Children’s Hospital to ensure regular monitoring of hip positioning. Our goal with treatment is to delay surgery whenever possible; however, if surgery is needed, our experts are fellowship trained and experienced in surgical procedures to correct hip subluxation and dislocation.