Three-dimensional ultrasound in the monitoring of hip dysplasia in cerebral palsy

Abstract

The primary purpose of this work was to investigate the validity of using 3D ultrasound to monitor hip dysplasia in children with cerebral palsy. The thesis starts with an in-depth review and critique of current clinical methods for identification of hip dysplasia, as well as setting out background knowledge and context required to understand and critique the work presented. I then investigated, using simulation, the impact of measurement uncertainty within a typical hip surveillance programme on the clinical management of a child. Collectively these chapters highlight the motivation for the investigation and development of a novel index (lateral head coverage (LHC)) derived from 3D ultrasound data to assess hip dysplasia in this population. An in vitro study was conducted to assess the performance of this index as well as another novel index, designed to quantify the posterior displacement of the femoral head relative to the acetabulum, (femoral head posterior position ratio (FHPPR)). Finally, a clinical study was conducted which included 25 children with cerebral palsy. Initially, the agreement between the clinical standard measurements taken from X-ray acquired in the routine care of these patients, and LHC from 3D ultrasound was investigated. The measurement of FHPPR was also taken on the images acquired as part of the study, however there was no conventional 3D imaging of the hips in these children to compare these results too. Finally, I draw together the findings from the simulation, in vivo and in vitro studies and suggest the impact that these findings might have on our understanding, monitoring and care of hip dysplasia in children with cerebral palsy.

This work is a contribution to progress and requires both the clinical and scientific communities to challenge, replicate and extend the studies described; two of the four studies have been published and are therefore visible to the community for discussion.

Date of Award	1 Jun 2022
Original language	English
Awarding Institution	King's College London
Supervisor	Adam Shortland (Supervisor) & Stephen Keevil (Supervisor)