[Neurogenic hip dysplasia and hip dislocation : Pathophysiology, clinical presentation, and management in the context of cerebral palsy].

BACKGROUND

Neurogenic hip dysplasia (NHD) is a clinically significant musculoskeletal complication in children with neurological disorders, particularly infantile cerebral palsy (CP). It contributes substantially to pain, functional limitations, and reduced quality of life. Muscle imbalance and impaired dynamic hip stability lead to progressive deformity of the femoral head and acetabulum, increasing the risk of subluxation and dislocation. Risk strongly correlates with GMFCS level and is highest in non-ambulatory children (levels IV-V).

DIAGNOSTICS: Diagnosis and monitoring rely on radiographic parameters such as the Reimers migration index, Rutz classification and other classification systems, although some measures have limitations in CP. Management requires long-term, interdisciplinary care. GMFCS-based hip surveillance enables early detection and timely intervention before irreversible damage occurs.

THERAPY: Treatment decisions must be individualized, as not all dysplasia is symptomatic. Options range from conservative measures with limited long-term efficacy to soft-tissue procedures and reconstructive surgery (e.g., VDRO with or without pelvic osteotomy), while salvage procedures are reserved for severe cases.

CONCLUSION

Overall, NHD is a multifactorial, complex disease that requires structured diagnostics, continuous monitoring, and early, patient-specific therapy with the active involvement of families, with the aim of improving function and quality of life.