Give Us a Call : + 0800 24 66 721
Treatments & Expertise
Contact Dr. Assad Qureshi
Does Your Child suffer from Hip Dislocation due to cerebral palsy?
Discover specialized care for hip dislocation in cerebral palsy as we focus on improving your child’s hip stability for better comfort and function. Schedule a consultation today to ensure your child receives the best pediatric orthopedic care possible. We’re committed to supporting you throughout your child’s treatment journey.
Cerebral palsy is a group of disorders that affect movement and posture. It is caused by damage to the developing brain in the first 2 years of life. The impact on function is very variable. Some children will have the ability to walk whilst others may need assistance or use a wheelchair. According to Dr. Qureshi, Pediatric Orthopedic Surgeon in Dubai, the greater the impact on mobility, the greater the risk that over time one or both hips dislocate. Weakness of the hip muscles may contribute but in many cases, tightness in specific muscles creates an imbalance of forces around the hip. This imbalance in muscle forces can cause the hips to slowly dislocate over time.
Hip dislocation can have several negative health related effects if left untreated;-
- Altered sitting position : Often the dislocation is greater in one hip compared with the other. This leads to an asymmetric sitting position with the child slumping to one side over time.
- Scoliosis : The asymmetric sitting position causes the spine to develop abnormal curvature known as scoliosis. The scoliosis can also drive the asymmetric sitting posture. Scoliosis may become quite painful over time and affect breathing if severe.
- Difficulty maintaining hygiene : Hip dislocation is often accompanied by tightness across the hips which can interfere with washing and dressing. Cleaning between the legs can become challenging for caregivers and uncomfortable for the child.
- Pain : Although hip dislocation may not cause any pain, over time the dislocated hips can become painful due to pressure damage where they are pressed against the pelvis. This can make sitting for long periods uncomfortable. Sleep may be disturbed for the child and care-givers as the sleeping position becomes uncomfortable and has to be changes several times a night.
Request an Appointment to Consult with Dr. Assad Qureshi
Case A : Progressive hip dislocation in cerebral palsy
Dr. Qureshi is a passionate believer in early detection of hip dislocation to prevent these problems occurring. Structured surveillance with regular examination and hip x-rays at defined time points help to identify children at risk of hip dislocation early before secondary problems develop. Dr. Qureshi undertakes and advocates structured hip surveillance for all of his patients with cerebral palsy. Dr. Qureshi works alongside a multi-disciplinary team including physiotherapy, orthotists and pediatric neurology to promote good hip health in children with cerebral palsy.
Physiotherapy to maintain flexible muscles and avoid contractures and postural management with custom made seating and sleep systems are crucial to reduce the risk of hips from dislocating during growth.
However, in many cases despite optimal management with physiotherapy and postural support, the hips can still progressively dislocate due to the underlying muscle imbalance. a hip has migrated more than 50% out of the confines of the socket on x-ray then it can be assumed that it will keep migrating until it has completely dislocated. In this case, pre-emptive surgery to reconstruct the hips and prevent further dislocation is advisable. Dr. Qureshi is a firm believer in the scientific evidence base supporting early surgical treatment for hip dislocation.
Patients are reviewed in a multi-disciplinary setting alongside pediatric anaesthesia and pediatric intensive care expertise to determine whether it is safe to proceed to proceed with surgery and to plan the patient journey from any pre-operative assessment through to discharge.
Single stage hip reconstruction is the gold standard treatment for hip dislocation in cerebral palsy and Dr. Qureshi is a keen proponent of this approach. The type of reconstruction is determined by how the hip has dislocated on x-ray and clinical examination findings. Key components include
- Deformity correction : Cerebral palsy causes muscles to become contracted and shortened. These forces are transmitted to the bone and over time cause deformity in the shape of the bone. The femur is divided (osteotomy). A specific amount of angulation and rotation are introduced to point the ball back into the socket. Femoral shortening – Shortening the thigh bone as part of the osteotomy allows the surrounding muscles to become less tight, reducing the deforming forces causing the dislocation. The bone removed during the osteotomy is used to augment the socket if this is being undertaken.
- Improving the muscle balance : Certain muscles need to be lengthened whilst some muscles need to be released to correct the overall muscle balance of the hip to prevent it from re-dislocating.
- Difficulty maintaining hygiene : Hip dislocation is often accompanied by tightness across the hips which can interfere with washing and dressing. Cleaning between the legs can become challenging for caregivers and uncomfortable for the child.
- Socket augmentation : Hip dislocation due to muscle imbalance frequently causes deformity in the socket as the ball pushes out of the socket. Augmenting the socket with a Dega pelvic osteotomy helps to capture the ball in the socket and minimise the risk of re-dislocation.
Case B : 5 year old with left hip dislocation after right hip reconstruction
Case C : 14 year old with long standing right hip dislocation
Dr. Qureshi believes that every child with CP with hip dislocation needs expert clinical assessment to determine the need for hip reconstruction as part of structured surveillance.
