Zhe Yuan, Alexander Aretakis, Chris Church, M Wade Shrader, Freeman Miller, Anuj Gupta, Arianna Trionfo, Jason J Howard

Abstract

Background: Hip displacement (HD), common in cerebral palsy (CP), is reportedly less prevalent for spastic hemiplegia. Patients with a Winter-Gage-Hicks (WGH) type IV gait pattern are believed at increased risk of HD, but true prevalence is unknown. This study aimed to analyze the rates of HD according to the sagittal plane-based WGH classification and identify associated risk factors.

Methods: Patients with hemiplegic CP, ≥1 instrumented gait analysis (IGA), hip surveillance radiograph(s), and minimum 2-year follow-up were included. The primary outcome was presence of an "unsuccessful hip" defined as a migration percentage ≥30% and/or undergoing reconstructive osteotomies for HD. Secondary outcome variables included WGH type, previous surgery, sex, scoliosis, epilepsy, ventriculoperitoneal shunt, gastrostomy tube, and IGA-derived hip kinematics.

Results: Included were 144 patients (39.6% female), classified as Gross Motor Function Classification System I (45.1%) or II (54.9%), mean follow-up 9.6 ± 4.6 years. Seventeen patients (11.8%) had an unsuccessful hip outcome (age 11.6 ± 3.6 years). Stratified by WGH type, unsuccessful hip outcome rates were I: 9.5% (2/21), II: 9.4% (6/64), III: 6.7% (2/30), and IV: 24.1% (7/29); age at onset was not different between WGH types (p = 0.8). Multivariate analysis identified hip internal rotation (odds ratio [OR]: 4.7, confidence interval [CI]: 1.2-18.1, p = 0.02) and hip adduction (OR: 5.2, CI: 1.2-22.1, p = 0.02) as significant independent risk factors.

Conclusion: The rates of HD in spastic hemiplegia were higher than expected for all WGH types, particularly IV. A high index of suspicion and regular hip surveillance radiographs is required for patients with hip internal rotation and adduction, starting during preadolescence.

Level of evidence: III-Retrospective cohort observational study. See Instructions for Authors for a complete description of levels of evidence.

EACD 2026 - Galway, Ireland. "‘Mol an Óige agus Tiocfaidh Siad’​ - Encourage the young and they will flourish​".

We catch up with Dr Hazel Killeen President, EACD Annual Congress 2026 Lecturer in Occupational Therapy College of Medicine, Nursing and Health Sciences, University of Galway

and Dr Rory O'Sullivan Scientific Chair, EACD Annual Congress 2026 Head of Strategy & Innovation, Central Remedial Clinic.

It was an honour to sit down with the organisers of this years European congress and discuss the upcoming conference and encourage you to visit Galway this June (2026). It will be an incredible conference and the ResearchWorks team will also be there to interview keynotes and other incredible speakers from across the globe!

There is still time to register, so visit the link below for more information.

https://www.eacd2026.com/

Join Dayna and Marissa on an extended episode back, after the Oceania Conference 2026, with the one and only Dr Brian Hoare.

A candid conversation about: More isn’t always better: getting smarter about therapy dosage in children with cerebral palsy.

Join us for a wonderful look at why it isn't just about doing more - dosage is far more complex than that and we - as therapists and researchers - need to get smarter about this, especially for children with cerebral palsy.