1. Hip braces can be used as a non-surgical treatment to prevent hip displacement in children with non-ambulatory cerebral palsy
2. The use of hip braces resulted in a significantly decreased hip displacement over the course of 6 and 12 months
Evidence Rating Level: 2 (Good)
Musculoskeletal deformities associated with poor biomechanical alignment during growth are present in many children with cerebral palsy, with progressive hip displacement being the second most common musculoskeletal deformity. The current treatment has mainly been focused on surgery, with some nonsurgical options including braces, postural alignment seating systems, and botulinum toxin. This randomized trial included children aged 1 to 10 years with a diagnosis of cerebral palsy and quadriplegia or diplegia. 66 patients were included, with 33 randomized to the intervention group which involved a hip brace that can stabilize and protect the joint, and 33 patients randomized to the control group. The primary outcomes was the Reimers migration index (MI) on radiography, which is the percentage of femoral head that lies outside the acetabulum, assessed by 3 blinded investigators, with secondary outcomes including MI at 6 months, hip range of motion, Cobb angle, pain intensity, quality of life of the patients and their caregivers, and satisfaction scores for the brace. The MI of the intervention group was significantly decreased by a mean (SD) −2.7 (6.9) percentage points at 6 months and −3.3 (6.9) percentage points at 12 months (mean [SD] annual progression rate: 6 months, −5.4 [13.8] percentage points; 12 months, −3.3 [6.9] percentage points; P < .001). The MI of the control group was significantly increased by a mean (SD) of 5.9 (7.4) percentage points at 6 months and 9.4 (10.9) percentage points at 12 months (mean [SD] annual progression rate: 6 months, 11.8 [14.8] percentage points; 12 months, 9.4 [10.9] percentage points; P < .001). The changes in the Caregiver Priorities & Child Health Index of Life with Disabilities were favorable in the study group and reached statistical significance at the 6-month follow-up compared with the control group (difference, −14.2; 95% CI, −25.2 to −3.3). Multiple factors are associated with hip displacement, requiring complex treatments. This brace was found to be one effective method for reducing hip displacement, while also impacting function and quality of life, and perhaps reducing the need for future surgical interventions. Although this was a small sample, the results suggest that a brace can be used to delay hip surgery in patients with cerebral palsy, while having a positive impact on quality of life.
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