Does botulinum toxin A combined with bracing prevent hip displacement in children with cerebral palsy and 'hips at risk'?

Graham, H. Kerr, Boyd, Roslyn, Carlin, John B., Dobson, Fiona, Lowe, Kevin, Nattrass, Gary, Thomason, Pam, Wolfe, Rory and Reddihough, Dinah (2008) Does botulinum toxin A combined with bracing prevent hip displacement in children with cerebral palsy and 'hips at risk'?. Journal of Bone and Joint Surgery: American volume, 90 1: 23-33. doi:10.2106/JBJS.F.01416


Author Graham, H. Kerr
Boyd, Roslyn
Carlin, John B.
Dobson, Fiona
Lowe, Kevin
Nattrass, Gary
Thomason, Pam
Wolfe, Rory
Reddihough, Dinah
Title Does botulinum toxin A combined with bracing prevent hip displacement in children with cerebral palsy and 'hips at risk'?
Journal name Journal of Bone and Joint Surgery: American volume   Check publisher's open access policy
ISSN 1535-1386
0021-9355
Publication date 2008-01-01
Sub-type Article (original research)
DOI 10.2106/JBJS.F.01416
Volume 90
Issue 1
Start page 23
End page 33
Total pages 11
Place of publication Needham, MA, United States
Publisher Journal of Bone and Joint Surgery
Language eng
Subject 1103 Clinical Sciences
1117 Public Health and Health Services
1114 Paediatrics and Reproductive Medicine
Formatted abstract
Background: Cerebral palsy is the most common cause of childhood physical disability in developed countries, affecting two children per 1000 live births. Hip displacement affects about one-third of children with cerebral palsy and may result in pain, deformity, and impaired function. The prevention of hip displacement has not been studied in a randomized trial as far as we know.

Methods: A randomized, controlled trial was conducted to examine the effect of intramuscular injections of botulinum toxin A combined with use of a variable hip abduction brace on the progression of hip displacement in children with cerebral palsy. The patients in the treatment group received injections of botulinum toxin A to the adductor and hamstring muscles every six months for three years and were prescribed a hip abduction brace to be worn for six hours per day. In the control group, no hip bracing was used nor were injections performed. The primary outcome measure was hip displacement from the acetabulum as determined by serial measurements of the migration percentage.

Results: Ninety children with bilateral cerebral palsy and so-called hips at risk (a migration percentage of >10% but <40%) were entered into the study. Fifty-nine patients were boys, and the mean age was three years. Progressive hip displacement, as determined by serial measurements of the migration percentage, was found in both the treatment and control groups. The rate of hip displacement was reduced in the treatment group by 1.4% per year (95% confidence interval, –0.6% to 3.4%; p = 0.16) when weighted for the uncertainty in rates due to the differing numbers of migration percentage measurements per subject.

Conclusions: There may be a small treatment benefit for the combined intervention of intramuscular injection of botulinum toxin A and abduction hip bracing in the management of spastic hip displacement in children with cerebral palsy. However, progressive hip displacement continued to occur in the treatment group, and our data do not support recommending this treatment.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
Keyword Cerebral Palsy
Childhood phyiscal disability
Botulinum toxin A
Brace
Hips at risk
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes A Randomized, Controlled Trial

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Fri, 08 Jan 2010, 01:52:46 EST by Elissa Saffery on behalf of Faculty Of Health Sciences