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Joseph PJS, Khattak M, Masudi ST, Minta L, Perry DC. Radiological assessment of hip disease in children with cerebral palsy: development of a core measurement set. Bone Jt Open 2023; 4:825-831. [PMID: 37909150 PMCID: PMC10618048 DOI: 10.1302/2633-1462.411.bjo-2023-0060.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Aims Hip disease is common in children with cerebral palsy (CP) and can decrease quality of life and function. Surveillance programmes exist to improve outcomes by treating hip disease at an early stage using radiological surveillance. However, studies and surveillance programmes report different radiological outcomes, making it difficult to compare. We aimed to identify the most important radiological measurements and develop a core measurement set (CMS) for clinical practice, research, and surveillance programmes. Methods A systematic review identified a list of measurements previously used in studies reporting radiological hip outcomes in children with CP. These measurements informed a two-round Delphi study, conducted among orthopaedic surgeons and specialist physiotherapists. Participants rated each measurement on a nine-point Likert scale ('not important' to 'critically important'). A consensus meeting was held to finalize the CMS. Results Overall, 14 distinct measurements were identified in the systematic review, with Reimer's migration percentage being the most frequently reported. These measurements were presented over the two rounds of the Delphi process, along with two additional measurements that were suggested by participants. Ultimately, two measurements, Reimer's migration percentage and femoral head-shaft angle, were included in the CMS. Conclusion This use of a minimum standardized set of measurements has the potential to encourage uniformity across hip surveillance programmes, and may streamline the development of tools, such as artificial intelligence systems to automate the analysis in surveillance programmes. This core set should be the minimum requirement in clinical studies, allowing clinicians to add to this as needed, which will facilitate comparisons to be drawn between studies and future meta-analyses.
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Affiliation(s)
| | - Mohammed Khattak
- University of Liverpool, Liverpool, UK
- Alder Hey Children’s Hospital, Liverpool, UK
| | | | | | - Daniel C. Perry
- University of Liverpool, Liverpool, UK
- Alder Hey Children’s Hospital, Liverpool, UK
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Hedelin H, Larnert P, Laine T, Sansone M, Hebelka H. The Ambiguity of Names and Landmarks in Radiographs of the Pediatric Pelvis: Variations and a Historical Perspective. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202309000-00012. [PMID: 37734040 PMCID: PMC10516389 DOI: 10.5435/jaaosglobal-d-23-00120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/20/2023] [Indexed: 09/23/2023]
Abstract
For over a century, the plain radiograph has been used to measure and predict the development of pediatric hip conditions. Classic measurements, such as the acetabular index, the center-edge angle, and the migration percentage, have stood the test of time and remain the default tools for any pediatric orthopaedic surgeons. However, in contemporary research, the terminology regarding these measurements has become markedly inconsistent. A substantial number of synonyms, acronyms, and similar, but not identical, terms are used to label measurements. This is perhaps unsurprising, considering decades of use and numerous suggested modifications. The results of treatment cannot be reliably compared if the measured parameters are not identical, and scientific analysis of disease requires consistent terminology. In this review, we aim both to provide historical definitions and identification of radiographic landmarks commonly used in three parameters of interest on pediatric AP radiographs and to examine the variability of landmarks and definitions in contemporary research.
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Affiliation(s)
- Henrik Hedelin
- From the Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden (Dr. Hedelin, Dr. Larnert, Dr. Laine, and Dr. Sansone); the Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden (Dr. Hebelka); and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (Dr. Hedelin, Dr. Larnert, Dr. Laine, Dr. Sansone, and Dr. Hebelka)
| | - Per Larnert
- From the Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden (Dr. Hedelin, Dr. Larnert, Dr. Laine, and Dr. Sansone); the Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden (Dr. Hebelka); and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (Dr. Hedelin, Dr. Larnert, Dr. Laine, Dr. Sansone, and Dr. Hebelka)
| | - Tero Laine
- From the Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden (Dr. Hedelin, Dr. Larnert, Dr. Laine, and Dr. Sansone); the Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden (Dr. Hebelka); and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (Dr. Hedelin, Dr. Larnert, Dr. Laine, Dr. Sansone, and Dr. Hebelka)
| | - Mikael Sansone
- From the Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden (Dr. Hedelin, Dr. Larnert, Dr. Laine, and Dr. Sansone); the Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden (Dr. Hebelka); and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (Dr. Hedelin, Dr. Larnert, Dr. Laine, Dr. Sansone, and Dr. Hebelka)
| | - Hanna Hebelka
- From the Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden (Dr. Hedelin, Dr. Larnert, Dr. Laine, and Dr. Sansone); the Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden (Dr. Hebelka); and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (Dr. Hedelin, Dr. Larnert, Dr. Laine, Dr. Sansone, and Dr. Hebelka)
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Barik S, Jain A, Nongdamba H, Chaudhary S, Yasam RP, Goyal T, Singh V. Imaging Parameters of Hip Dysplasia in Cerebral Palsy: A Systematic Review. Indian J Orthop 2022; 56:939-951. [PMID: 35669024 PMCID: PMC9123123 DOI: 10.1007/s43465-022-00610-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/03/2022] [Indexed: 02/04/2023]
Abstract
Background Cerebral Palsy is the leading cause of childhood physical disability globally. The motor disorders of CP are often associated with musculoskeletal anomalies, of which hip displacement is the second most common abnormality after abnormalities of foot and ankle. Various radiological parameters have been described in the literature which detects and quantifies hip dysplasia, with MP being the current gold standard. This study aims to review these radiological indicators of hip dysplasia in children with cerebral palsy from the published literature. Methods A literature search using PubMed, Embase, and Google Scholar was done on 15th June 2021 focusing on surveillance of hip dysplasia in cerebral palsy. The studies to be included were to have used anyone or more radiological parameter for detection of hip dysplasia with the use of any of the radiological methods. Results The initial search yielded 1184 results. After the screening of the abstracts and full texts, a final of 30 studies was included for this systematic review. The majority of the studies were graded as Level 3 evidence (16/30), followed by Level 2 studies (14/30). X-ray was the most common modality of detection of dysplasia followed by CT scan, ultrasonography, and arthrogram. The reproducibility of the various parameters shows good to excellent intraclass coefficients. Conclusions Parameters other than MP can be used to screen hips in CP. This would be useful in patients in whom either the lateral acetabular edge is not discernible on a plain anteroposterior radiograph or there are issues in the positioning of the patient. Additional views and structures can be visualized which can lead to improved screening and planning. Further investigations are required to appreciate the full potential of these parameters and how they can be better utilized. Graphical abstract
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Affiliation(s)
- Sitanshu Barik
- Department of Orthopaedics, All India Institute of Medical Sciences, Deoghar, Jharkhand India
| | - Aakash Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Hawaibam Nongdamba
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Sunny Chaudhary
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Rama Priya Yasam
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhatinda, Punjab India
| | - Vivek Singh
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
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