Standing in Abduction Helps Prevent Hip Surgery for a Child with Cerebral Palsy
By Maryann M. Girardi, PT, DPT, ATP
When Caroline heard the orthopedist say, “Your daughter needs hip surgery,” it was a devastating moment. Her daughter Briella was at risk for bilateral hip dysplasia due to cerebral palsy, with surgery being a likely outcome if her hips continued to displace. Determined to explore other options, Caroline sought solutions—and thanks to her perseverance, a standing program ultimately prevented the need for surgery.
Understanding Hip Dysplasia and Cerebral Palsy
Hip dysplasia, also referred to as neuromuscular hip displacement, occurs when the acetabulum (hip socket) doesn’t adequately cover the femoral head. Unlike developmental dysplasia of the hip (DDH), which is present at birth, children with cerebral palsy often develop hip displacement over time due to muscle imbalances and insufficient weightbearing.
This condition affects about 35% of children with cerebral palsy, with severity correlating directly to their Gross Motor Function Classification Scale (GMFCS) level. While children at GMFCS Level I rarely experience hip displacement, the incidence climbs to 90% for children at Level IV. Displacement can lead to pain, restricted movement, and a decline in quality of life if left untreated.
Hip Surveillance
Early detection through hip surveillance programs can prevent painful dislocations. Surveillance typically includes clinical evaluations, such as GMFCS level determination, and radiological exams, particularly migration percentage (MP) measurements. An MP above 30% indicates risk of dislocation, necessitating orthopedic intervention.
While countries like Sweden and Australia have national hip surveillance programs, the U.S. relies on guidelines from the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) and Pediatric Orthopedic Surgeons of North America (POSNA). These guidelines recommend screenings starting at age 2 and continuing until skeletal maturity.
Briella’s Journey
Briella was born prematurely at 34 weeks, and her early development was marked by delays. Diagnosed with cerebral palsy at 21 months, her condition was classified as spastic diplegia at GMFCS Level III. She began physical therapy at 1.5 years old and later underwent a selective dorsal rhizotomy to manage lower extremity spasticity. Despite progress in mobility, Briella’s hip x-rays showed concerning MP levels, making her a candidate for reconstructive surgery.
Caroline, hesitant to proceed with surgery, explored alternative treatments. Through her research and support from therapists, she discovered the potential benefits of a standing program.
The Role of Standing in Abduction
Research shows that standing in a frame with the hips abducted 15–30 degrees for at least 10 hours per week can help stabilize hips in children with cerebral palsy. This positioning encourages proper acetabular development and maintains hip alignment.
With the help of her therapist and a durable medical equipment (DME) vendor, Briella began using a stander with adjustable abduction in January 2021. Over time, she built up to two one-hour sessions daily, standing in 60 degrees of total abduction.
Results Without Surgery
Briella’s x-rays in April 2021 showed stable MP levels, with no significant progression. By October 2021, her orthopedist confirmed she no longer required surgical intervention. Additionally, her standing program improved her posture, gait, lower body strength, and even bowel function.
The Broader Implications
While large-scale studies on the effectiveness of standing programs are limited, available evidence suggests that this intervention can significantly benefit children with cerebral palsy. For Briella, it was the key to avoiding surgery and achieving greater stability and quality of life.
Her story is a testament to the impact of perseverance, informed decision-making, and the potential of non-surgical treatments to transform outcomes for children with cerebral palsy.
Leave a Reply