The hip is the joint most exposed to orthopaedic complications in
cerebral palsy (CP), which is the main cause of spasticity in paediatric patients. The initial immaturity of the hip allows the forces applied by the
spastic and retracted muscles to displace the femoral head, eventually causing it to dislocate. The risk of
hip dislocation increases with the severity and extent of CP, exceeding 70% in the most severe cases.
Hip dislocation causes
pain in up to 30% of cases, carries a risk of orthopaedic and cutaneous complications and hinders patient installation and
nursing care. These adverse outcomes warrant routine screening, which has been proven effective in lessening the frequency and severity of
hip displacement. Preventive techniques including
physical therapy,
orthoses and treatments to alleviate spasticity are strongly recommended in every case. The beneficial effects of treating spasticity, if needed via
neurosurgical procedures, have been convincingly established. Orthopaedic surgery is required when prevention fails. Soft-tissue release is designed to correct the asymmetry in the forces applied by the muscles. Femoral
osteotomy creates the possibility for spontaneous correction of secondary acetabular dysplasia. Progress has been made in standardising the use of multilevel surgery involving the soft tissues, femur and pelvis, which is often effective in correcting the morphological abnormalities and stabilising the joint. When hip
pain or alterations are severe, hip resection or
total hip arthroplasty are highly effective in alleviating the
pain and improving patient comfort. The
spastic hip is a complex condition in which currently available screening protocols and treatment strategies have been proven effective in benefitting patient outcomes.