Proportion, associated factors and need for surgical intervention of hip dysplasia among children with cerebral palsy attending clinic at Muhimbili National Hospital

Abstract

ABSTRACT Hip dysplasia is not uncommon among children with cerebral palsy (CP) especially those with spasticity. It may result into hip pain and impairment of functions. Customized therapy approaches are necessary based on the child's condition, as the deformity varies greatly depending on the child's CP type, CP topographic pattern, and gross motor function classification score. Early surgical intervention is essential in preventing hip dislocation and improve quality of life. In LMICs like Tanzania, there is a limited data to show magnitude of hip dysplasia, making it difficult to establish standard treatment protocol.

Objective: To determine proportion, associated factors and need for surgical intervention of hip dysplasia among children with cerebral palsy attending clinic at Muhimbili National Hospital.

. Methods: A descriptive cross-sectional study was conducted involving 206 children with CP attended clinic at MNH between June 2023 to December 2023.Ethical clearance was obtained from the MUHAS IRB. Participant parents or legal guardians provided a verbal and/or written informed consent prior to study enrollment A guided questionnaire was used to interview eligible participants; further examinations were also done including hip assessment, Standard AP x ray of Hip taken and was interpreted by principal investigator on RMP. Patients were assigned treatment group based on their RMP value according to standard literatures. The data were coded and entered into a statistical analyzing tool SPSS version 24. A variable with a P-value of 0.05 or less was considered statistically significant. Target population was patient with CP attending at MNH clinic.

Results: 206 patients were recruited for the study, Of the study participants, 112 (54.4%) were male and 115 (55.8%) were over the age of five, with a range of 3 to 9. 155 (75.2%) had spastic type of CP, 100 (48.5%) had Quadriplegia pattern , and 74 (35.9%) had GMFCS IV & V. Hip dysplasia was found in 36 (17.5%) of the patients recruited and 3 (1.5%) of participants had hip dislocation, children with GMFCS IV and V had high risk of hip dysplasia 36.5% p<0.001, Spastic quadriplegia has high risk of hip dysplasia 44.1% p<0.001, Those with children with hip joint pain had higher risk of hip dysplasia by 38.9% p<0.001 . Out of 26 children with hip dysplasia 69.4% needs surgical intervention. Conclusion: The results of this study indicate that a significant percentage of CP patients have hip dysplasia, and the majority require surgery intervention. Despite making numerous clinic visits to the pediatric MNH, large number of individuals with hip dysplasia were previously undiagnosed. This emphasizes the significance of the hip surveillance program, in which patients are evaluated by orthopedic surgeon according to their risk status and pelvic x-rays results. This helps in early identification and treatment of hip dysplasia. Key words: Cerebral palsy: Hip dysplasia: Associated factors: Surgical Intervention