{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:47:11Z","timestamp":1787755631218,"version":"build-2784847793"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,1,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Recommendations with regard to the need for continued hip surveillance after skeletal maturity are based on expert opinion rather than evidence. This study aimed to determine the prevalence of and risk factors associated with progressive hip displacement in cerebral palsy (CP) after triradiate cartilage (TRC) closure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Patients who had spastic nonambulatory CP (Gross Motor Function Classification System IV to V) and hypertonic (spastic or mixed-type) motor type and follow-up of at least 2 years after TRC closure were included. The primary outcome variable was the hip migration percentage (MP). The secondary outcome variables included patient age at the time of TRC closure, prior preventative or reconstructive surgery, a prior intrathecal baclofen pump, history of scoliosis, history of epilepsy, a prior gastrostomy tube, a previous tracheostomy, and gender. An unsuccessful hip outcome was defined as a hip with an MP of \u226540% and\/or requiring a reconstructive surgical procedure after TRC closure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In this study, 163 patients met the inclusion criteria, with a mean follow-up of 4.8 years (95% confidence interval [CI], 4.4 to 5.1 years) after TRC closure at a mean patient age of 14.0 years (95% CI, 13.7 to 14.3 years). Of these hips, 22.1% (36 of 163) had an unsuccessful hip outcome. In multivariate analysis, the first MP at TRC closure (hazard ratio [HR] per degree, 1.04; p &lt; 0.001) and pelvic obliquity (HR per degree, 1.06; p = 0.003) were independent risk factors for an unsuccessful hip outcome, but gender was not found to be significant (HR for male gender, 1.7 [95% CI, 0.8 to 3.58; p = 0.16]; female gender was the reference). However, the mean survival time for progression to an unsuccessful hip outcome was longer for female patients at 9.2 years [95% CI, 8.1 to 10.2 years]) compared with 6.2 years (95% CI, 5.6 to 6.9 years) for male patients (p = 0.02). There was also a significant improvement in survivorship for prior reconstructive surgical procedures (p = 0.002). The survivorship in patients who underwent reconstructive surgery performed at a patient age of \u22656 years was significantly higher compared with those who underwent surgery performed at &lt;6 years of age (p &lt; 0.05). A first MP at TRC closure of \u226535% was associated with an unsuccessful hip outcome, as determined by receiver operating characteristic (ROC) curve analysis (p &lt; 0.001; area under the ROC curve of 0.891, sensitivity of 81%, and specificity of 94%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The risk factors for the progression of hip displacement after TRC closure in patients with CP included a higher MP and increased pelvic obliquity; there was decreased survivorship for male patients and patients with no prior reconstructive surgery. Patients with these risk factors and\/or an MP of \u226535% at TRC closure should have continued radiographic surveillance to detect late hip displacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.22.00648","type":"journal-article","created":{"date-parts":[[2022,12,28]],"date-time":"2022-12-28T00:01:49Z","timestamp":1672185709000},"page":"27-34","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":11,"title":["Hip Displacement After Triradiate Cartilage Closure in Nonambulatory Cerebral Palsy"],"prefix":"10.2106","volume":"105","author":[{"given":"Ali","family":"Asma","sequence":"first","affiliation":[{"name":"Nemours Children\u2019s Hospital, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5092-6317","authenticated-orcid":false,"given":"Armagan Can","family":"Ulusaloglu","sequence":"additional","affiliation":[{"name":"Nemours Children\u2019s Hospital, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8207-2109","authenticated-orcid":false,"given":"M. Wade","family":"Shrader","sequence":"additional","affiliation":[{"name":"Nemours Children\u2019s Hospital, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Freeman","family":"Miller","sequence":"additional","affiliation":[{"name":"Nemours Children\u2019s Hospital, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth J.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Nemours Children\u2019s Hospital, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3049-6345","authenticated-orcid":false,"given":"Jason J.","family":"Howard","sequence":"additional","affiliation":[{"name":"Nemours Children\u2019s Hospital, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,11,18]]},"reference":[{"issue":"9","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1111\/dmcn.12754","article-title":"Australian hip surveillance guidelines for children with cerebral palsy: 5-year review","volume":"57","author":"Wynter","year":"2015","journal-title":"Dev Med Child Neurol."},{"issue":"1","key":"bib2-20250430","first-page":"95","article-title":"Prevention of dislocation of the hip in children with cerebral palsy. The first ten years of a population-based prevention programme","volume":"87-B","author":"H\u00e4gglund","year":"2005","journal-title":"The Journal of Bone and Joint Surgery. British volume."},{"issue":"6","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/BPB.0000000000000707","article-title":"Developing a province-wide hip surveillance program for children with cerebral palsy: from evidence to consensus to program implementation: a mini-review","volume":"29","author":"Miller","year":"2020","journal-title":"Journal of Pediatric Orthopaedics B."},{"issue":"8","key":"bib4-20250430","first-page":"575","article-title":"Elevated prevalence of osteoarthritis among adults with cerebral palsy","volume":"51","author":"French","year":"2019","journal-title":"J Rehabil Med."},{"issue":"1","key":"bib5-20250430","first-page":"121","article-title":"Hip displacement in cerebral palsy","volume":"88","author":"Soo","year":"2006","journal-title":"The Journal of Bone and Joint Surgery-American Volume."},{"issue":"10","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/j.1469-8749.2012.04385.x","article-title":"The natural history of hip development in cerebral palsy","volume":"54","author":"Terjesen","year":"2012","journal-title":"Developmental Medicine & Child Neurology."},{"issue":"1","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1186\/1471-2474-12-284","article-title":"Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: a cross sectional study in Sweden and Norway","volume":"12","author":"Elkamil","year":"2011","journal-title":"BMC Musculoskelet Disord."},{"issue":"5","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1111\/j.1469-8749.1995.tb12028.x","article-title":"Age and migration percentage as risk factors for progression in spastic hip disease","volume":"37","author":"Miller","year":"2008","journal-title":"Developmental Medicine & Child Neurology."},{"issue":"10","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1302\/0301-620X.97B10.35390","article-title":"The radiological assessment of pelvic obliquity in cerebral palsy and the impact on hip development","volume":"97-B","author":"Heidt","year":"2015","journal-title":"The Bone & Joint Journal."},{"issue":"5","key":"bib10-20250430","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s11832-013-0515-6","article-title":"Hip surveillance and management of the displaced hip in cerebral palsy","volume":"7","author":"Robb","year":"2013","journal-title":"Journal of Children's Orthopaedics."},{"issue":"9-10","key":"bib11-20250430","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1111\/j.1440-1754.2005.00687.x","article-title":"Cerebral palsy in Victoria: motor types, topography and gross motor function","volume":"41","author":"Howard","year":"2005","journal-title":"J Paediatr Child Health."},{"issue":"4","key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1111\/j.1469-8749.1997.tb07414.x","article-title":"Development and reliability of a system to classify gross motor function in children with cerebral palsy","volume":"39","author":"Palisano","year":"2008","journal-title":"Developmental Medicine & Child Neurology."},{"issue":"6","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1097\/BPO.0b013e3181373ba8","article-title":"Role of the triradiate cartilage in predicting curve progression in adolescent idiopathic scoliosis","volume":"27","author":"Ryan","year":"2007","journal-title":"Journal of Pediatric Orthopaedics."},{"issue":"3","key":"bib14-20250430","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1097\/BPO.0b013e3182471eb4","article-title":"Prediction of contralateral slipped capital femoral epiphysis using the modified Oxford bone age score","volume":"32","author":"Popejoy","year":"2012","journal-title":"Journal of Pediatric Orthopaedics."},{"issue":"sup184","key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/ort.1980.51.suppl-184.01","article-title":"The stability of the hip in children. A radiological study of the results of muscle surgery in cerebral palsy","volume":"51","author":"Reimers","year":"1980","journal-title":"Acta Orthopaedica Scandinavica."},{"issue":"Suppl 58","key":"bib17-20250430","article-title":"Studies on dysplastic acetabula and congenital subluxation of the hip joint with special reference to the complication of osteoarthritis","volume":"83","author":"Wiberg","year":"1939","journal-title":"Acta Chir Scand."},{"issue":"3","key":"bib18-20250430","doi-asserted-by":"crossref","first-page":"e0148","DOI":"10.2106\/JBJS.RVW.19.00148","article-title":"Management of hip disorders in patients with cerebral palsy","volume":"8","author":"Hosseinzadeh","year":"2020","journal-title":"JBJS Reviews."},{"issue":"9","key":"bib19-20250430","doi-asserted-by":"crossref","first-page":"e800","DOI":"10.1097\/BPO.0000000000001898","article-title":"Hip displacement in MECP2 disorders: prevalence and risk factors","volume":"41","author":"Kanashvili","year":"2021","journal-title":"J Pediatr Orthop."},{"issue":"6","key":"bib20-20250430","first-page":"841","article-title":"Surgical treatment of paralytic scoliosis associated with myelomeningocele","volume":"64","author":"Osebold","year":"1982","journal-title":"The Journal of Bone & Joint Surgery."},{"key":"bib21-20250430","doi-asserted-by":"crossref","first-page":"e530","DOI":"10.1016\/j.wneu.2018.06.071","article-title":"Rod fracture after apparently solid radiographic fusion in adult spinal deformity patients","volume":"117","author":"Daniels","year":"2018","journal-title":"World Neurosurgery."},{"issue":"5","key":"bib22-20250430","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1111\/dmcn.14782","article-title":"Hip pain in adolescents with cerebral palsy: a population-based longitudinal study","volume":"63","author":"Larsen","year":"2021","journal-title":"Dev Med Child Neurol."},{"issue":"12","key":"bib23-20250430","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1111\/dmcn.13171","article-title":"Hip health at skeletal maturity: a population-based study of young adults with cerebral palsy","volume":"58","author":"Wawrzuta","year":"2016","journal-title":"Dev Med Child Neurol."},{"issue":"2","key":"bib24-20250430","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1080\/17453674.2016.1262685","article-title":"Severe hip displacement reduces health-related quality of life in children with cerebral palsy","volume":"88","author":"Ramstad","year":"2017","journal-title":"Acta Orthopaedica."},{"issue":"5","key":"bib25-20250430","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/BPO.0000000000001765","article-title":"Why the hips remain stable when the spine strays: a deeper analysis of the relationship between hip displacement and severe scoliosis in patients with cerebral palsy","volume":"41","author":"Hadad","year":"2021","journal-title":"Journal of Pediatric Orthopaedics."},{"issue":"6","key":"bib26-20250430","doi-asserted-by":"crossref","first-page":"500","DOI":"10.2106\/JBJS.N.00676","article-title":"Long-term results and outcome predictors in one-stage hip reconstruction in children with cerebral palsy","volume":"97","author":"Rutz","year":"2015","journal-title":"Journal of Bone and Joint Surgery."},{"issue":"1","key":"bib27-20250430","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/S0197-0070(80)80005-2","article-title":"Normal ages of pubertal events among American males and females","volume":"1","author":"Lee","year":"1980","journal-title":"Journal of Adolescent Health Care."},{"issue":"24","key":"bib28-20250430","first-page":"2024","article-title":"Proximal femoral varus derotation osteotomy in children with cerebral palsy: the effect of age, Gross Motor Function Classification System level, and surgeon volume on surgical success","volume":"97","author":"Shore","year":"2015","journal-title":"The Journal of Bone and Joint Surgery-American Volume."},{"issue":"6","key":"bib29-20250430","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1302\/1863-2548.13.190064","article-title":"Migration percentage and odds of recurrence\/subsequent surgery after treatment for hip subluxation in pediatric cerebral palsy: a meta-analysis and systematic review","volume":"13","author":"Agarwal","year":"2019","journal-title":"Journal of Children's Orthopaedics."},{"issue":"11","key":"bib30-20250430","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1111\/dmcn.13480","article-title":"Prevention of hip displacement in children with cerebral palsy: a systematic review","volume":"59","author":"Miller","year":"2017","journal-title":"Dev Med Child Neurol."},{"issue":"4","key":"bib31-20250430","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/BPO.0000000000001760","article-title":"Factors influencing outcomes of the dysplastic hip in nonambulatory children with cerebral palsy","volume":"41","author":"Carroll","year":"2021","journal-title":"Journal of Pediatric Orthopaedics."},{"issue":"6","key":"bib32-20250430","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1080\/17453674.2017.1365471","article-title":"To what extent can soft-tissue releases improve hip displacement in cerebral palsy?","volume":"88","author":"Terjesen","year":"2017","journal-title":"Acta Orthopaedica."},{"issue":"14","key":"bib33-20250430","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.2106\/JBJS.15.01063","article-title":"Effect of hip reconstructive surgery on health-related quality of life of non-ambulatory children with cerebral palsy","volume":"98","author":"DiFazio","year":"2016","journal-title":"Journal of Bone and Joint Surgery."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.22.00648","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:45:28Z","timestamp":1787751928000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.22.00648"}},"subtitle":["Who Needs Continued Radiographic Surveillance?"],"short-title":[],"issued":{"date-parts":[[2022,11,18]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.22.00648","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,18]]}}}