The impact of botulinum toxin A and abduction bracing on long-term hip development in children with cerebral palsy

Aim To study the long-term impact of 3 years of botulinum toxin A (BoNT-A) injections and abduction bracing on hip development in children with bilateral spastic cerebral palsy (CP). We wanted to know if early treatment improved hip development and reduced the need for surgery. Method A long-term review of hip morphology and surgery requirements in children who participated in a multicentre, randomized controlled trial. The trial investigated short-term effects of BoNT-A injections combined with an abduction brace, compared with usual care, on hip displacement in children with bilateral spastic CP. Results Forty-six children with bilateral spastic CP (31 males, 15 females; 10 with diplegia, 36 with quadriplegia; mean age at enrolment of 3y 2mo, mean age at most recent clinical review 13y 11mo [range 10y 6mo16y 8mo]; three children in Gross Motor Function Classification System level II, 11 in level III, 20 in level IV, 12 in level V) were followed for a mean of 10 years 10 months from recruitment to the trial. Mean migration percentage was 15.9% in the BoNT-A group and 15.2% in the comparison group (t=0.26, p=0.79). Eighty-nine percent of hips in the treatment group and 91% hips in the comparison group had satisfactory development, using a valid scale (MannWhitney U test=867.50, z=-1.59, p=0.11). Forty children had preventive surgery (21 treatment group, 19 comparison group) and 18 children had reconstructive surgery (10 treatment, 8 comparison). Interpretation In children with bilateral spastic CP, early treatment with BoNT-A and hip abduction bracing does not reduce the need for surgery or improve hip development at skeletal maturity.