Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 11 , Pages 2108-2113, November 2008

Comparison of Botulinum Toxin Type A Injection and Soft-Tissue Surgery to Treat Hip Subluxation in Children With Cerebral Palsy

  • Eun Joo Yang, MD

      Affiliations

    • Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
    • ,
  • Dong-wook Rha, MD

      Affiliations

    • Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
    • ,
  • Hyun Woo Kim, MD

      Affiliations

    • Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
    • ,
  • Eun Sook Park, MD

      Affiliations

    • Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
    • Corresponding Author InformationCorrespondence to Eun Sook Park, MD, 134 Shinchon-dong, Seodaemun-gu, Rehabilitation Hospital, Yonsei University College of Medicine, Seoul, 120-752, Korea

Abstract 

Yang EJ, Rha D-W, Kim HW, Park ES. Comparison of botulinum toxin type A injection and soft-tissue surgery to treat hip subluxation in children with cerebral palsy.

Objective

To compare the effects of botulinum toxin type A (BTX-A) injection into the hip adductor muscles on hip displacement with soft-tissue surgery and assess the factors related to a favorable outcome after intervention in children with bilateral spastic cerebral palsy (CP).

Design

Retrospective chart review with regard to radiographic findings.

Setting

University hospital.

Participants

Children with CP (N=194).

Interventions

BTX-A injection and soft-tissue surgery into the hip adductor muscles.

Main Outcome Measure

The Reimers hip migration percentage (MP).

Results

Sixty-nine children did not receive any therapeutic intervention for hip displacement, whereas 60 children underwent soft-tissue surgery and 65 children took BTX-A injection for the spasticity of their hip muscles. MP was measured on each radiograph of the pelvis. The annual change of MP was improved in both the soft-tissue surgery and BTX-A groups, whereas it worsened in the nonintervention group. The annual improvement of MP in the BTX-A group did not differ significantly from that of the soft-tissue surgery group. The improvement in hip displacement after therapeutic intervention was greater in young children and high-functioning groups compared with older children and low-functioning groups. Hip displacement was progressive in the severely hip subluxated group despite therapeutic intervention.

Conclusions

Comparable effects of BTX-A injection to soft-tissue surgery in our study suggest that BTX-A injection, if timely reinjected, may replace soft-tissue surgery as a prophylactic procedure against progressive hip subluxation or dislocation in children. Age at intervention, functional level, and initial MP before therapeutic intervention were the factors affecting the outcomes.

Key words: Botulinum toxin type A, Cerebral palsy, Rehabilitation

List of Abbreviations: BTX-A, botulinum toxin type A, CP, cerebral palsy, GMFCS, Gross Motor Function Classification System, MP, migration percentage

 

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

 Reprints are not available from the author

PII: S0003-9993(08)00553-4

doi:10.1016/j.apmr.2008.04.019

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 11 , Pages 2108-2113, November 2008

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