Approach to Neuromuscular Hip Dysplasia in Children with Cerebral Palsy : Principles of management and Long-term Radiographic Outcome

Dr. Sulabh Kumar Shrestha¹, Dr. Rajendra Aryal², Dr. Nitesh Raj Pandey², Dr. Bibek Banskota^2
1AKBEF Fellow, ²Unit-1 (Hip, Pelvi-acetabulum & Arthroplasty), B&B Hospital
Poster presentation at Orthocon 2026

Introduction

Progressive hip subluxation is a common orthopedic problem in children with cerebral palsy (CP), with strong correlation to Gross Motor Function Classification System (GMFCS).1Terjesen T. Natural history of acetabular dysplasia and later total hip arthroplasty in late-detected DDH. Acta Orthop. 2023;94:152–157

	GMFCS I	GMFCS V
Hip dislocation	0%	90%
Reimer’s migration (MP)	0.2%/year	9.5%/year

Hip dislocation in CP is caused by 5 factors:

1. Muscle imbalance (spasticity of hip adductors & flexors & weakness of hip abductors & extensors)
2. Increased femoral anteversion
3. Increased femoral neck shaft angle (NSA)
4. Acetabular dysplasia
5. Pelvic obliquity

Painful hips in CP are common and proportional to the extent of hip displacement and GMFCS level.2Alshryda S, Sattar S, Howard JJ, Huntley JS, Schoenecker JG. The hip in cerebral
palsy. In: The Pediatric and Adolescent Hip: Essentials and Evidence. 2019:467–530

Management requires early identification, risk stratification, & morphology-based surgical correction.

Objectives

To demonstrate:

• Principles of management of neuromuscular hip dysplasia in CP
• Long-term radiographic outcomes following surgical correction

Case Description

A 9-year-old boy with:

• Spastic Cerebral Palsy
• GMFCS Level IV
• Dislocated left hip
• Associated acetabular dysplasia

The child had progressive displacement with functional limitations in sitting and mobility.

Why Reduce the Hip?

Reduction and reconstruction are necessary to: 3Aroojis A, Mantri N, Johari AN. Hip displacement in cerebral palsy: role of surveillance. Indian J Orthop. 2020.

Hip dysplasia in CP is progressive and GMFCS-dependent. Untreated subluxation may lead to painful fixed dislocation.

How we do it?

Management is based on Reimer’s MP (RMP): 4Alshryda S, Sattar S, Howard JJ, Huntley JS, Schoenecker JG. The hip in cerebral palsy. In: The Pediatric and Adolescent Hip: Essentials and Evidence. 2019:467–530

What we did?

A single-stage multilevel interventions were done.

Primary pathology	Targeted surgeries
1. Muscular imbalance	Adductor tenotomy + Anterior release
2. Coxa valga	Varus osteotomy + Shortening
3. Increased femoral anteversion	Derotation osteotomy
4. Acetabular dysplasia	Dega acetabuloplasty
5. Spastic posterior chain	Hamstring release + Vulpius procedure

Results (Radiographic outcomes)

A. Serial X-rays

Fig. 2: Radiographic measurements (RMP: Reimer’s Migration Percentage; NSA: Neck Shaft Angle)
A – Preoperative; B – Early postoperative; C – At 11 years followup

B. Quantitative comparisons over time

Discussion

1. Radiographic parameters showed early and sustained correction to maturity.
2. Hip dysplasia in CP is progressive and GMFCS dependent.
3. Treatment must address femoral and acetabular pathology together.
4. RMP guides surveillance and intervention timing.

Conclusion

1. A structured decision-making approach is essential in neuromuscular hip dysplasia.
2. Early, comprehensive reconstruction can maintain hip stability and long-term function.