Novel Hip Brace May Delay Hip Surgery in Pediatric Patients With Cerebral Palsy

Hip bracing effectively prevented progressive hip displacement in pediatric patients with cerebral palsy (CP) and improved caregiver and patient quality of life compared to no bracing, according to study findings published in JAMA Network Open.

Researchers conducted a multicenter, prospective, single-blinded, randomized, controlled clinical trial, The Clinical Efficacy of Hip Protection Orthosis for the Protection of Hip Dislocation (ClinicalTrials.gov Identifier: NCT04033289), from July 26, 2019 to November 30, 2021 across the rehabilitation units in 4 teaching hospitals in South Korea. They divided 66 pediatric patients with CP with hip displacement between the ages of 1 and 10 years into 2 groups: 33 in the intervention group and 33 in the control group. By the end of the study, 8 patients in the intervention group and 4 patients in the control group dropped out due to brace sizing issues, need for surgery, visit problems, and refusal.

The intervention group received a hip brace designed to prevent hip displacement, coxa valga, and hip adduction. The brace compresses the hip capsule and ligaments, adding external support to prevent displacement and improve tibiofemoral joint alignment. The control group did not receive the brace.

The primary outcome was the migration index using the Reimers scale to measure progressive hip displacement. This scale calculated the percentage of the femoral head that lies outside of the acetabulum based on radiographic imaging. Secondary outcomes included pain intensity, the Cobb angle to measure the effect of bracing on scoliosis, hip range of motion at 0 and 90 degrees of hip flexion, patient/caregiver quality of life, and overall satisfaction ratings of the brace.

Hip bracing effectively prevented progressive hip displacement in pediatric patients with CP compared with individuals in the control group.

At baseline, the average migration index totaled 37.4%±19.3% in the intervention group and 30.6%±16.3% in the control group. After 6 months, the average migration index percentage difference between the 2 groups was -8.7% (95% CI, -10.2 to -7.1). After 12 months, this percentage difference between the groups increased to -12.7 (95% CI, -14.7 to -10.7). This indicated that hip displacement progressed faster in individuals in the control group compared with those in the bracing group.

Additionally, hip bracing significantly improved quality of life for the patients with CP and their caregivers after 6 months of intervention. Scores on the Caregiver Priorities and Child Health Index of Life with Disabilities differed on average between the 2 groups by -14.2 points (95% CI, -25.2 to -3.3), suggesting that quality of life for caregivers and patients improved in the intervention group.

The researchers did not observe any appreciable changes in pain intensity or hip range of motion.

“The novel hip brace was significantly effective in preventing the progression of hip displacement, compared with the control group,” the researchers stated. “Hip brace use could be a promising treatment method to delay hip surgery and improve the quality of life of patients with nonambulatory cerebral palsy,” they added.

Study limitations included high dropout rate due to faster growth rates than anticipated, enrollment and follow-up difficulties due to the COVID-19 pandemic, lack of assessment of adherence to wearing the hip brace 12 hours per day, and statistically significant differences in migration index between the 2 groups at baseline.

Disclosures: Some study authors declared patents. Please see the original reference for a full list of authors’ disclosures.