CONFLICTS OF INTEREST The authors declare no conflicts of interest.
The pathogenesis of osteoarthritis in cerebral palsy
Article first published online: 3 SEP 2009
© 2009 Mac Keith Press No claim to original government works
Developmental Medicine & Child Neurology
Special Issue: Adults with Cerebral Palsy: A workshop to define the challenges of treating and preventing the secondary musculoskeletal and neuromuscular complications in this rapidly growing population.
Volume 51, Issue Supplement s4, pages 79–83, October 2009
How to Cite
CARTER, D. R. and TSE, B. (2009), The pathogenesis of osteoarthritis in cerebral palsy. Developmental Medicine & Child Neurology, 51: 79–83. doi: 10.1111/j.1469-8749.2009.03435.x
- Issue published online: 3 SEP 2009
- Article first published online: 3 SEP 2009
The morphogenesis, remodeling, and degeneration of diarthroidial joints are directly under the control of the loading histories created by the musculoskeletal system during development and aging. The altered loading histories in individuals with cerebral palsy (CP) lead to aberrations in joint morphogenesis and an acceleration of joint degeneration. To understand this process in the hip, the normal ontogeny of the hip joint is reviewed with special attention to the mechano-biological factors associated with joint morphogenesis, endochondral ossification, and cartilage degeneration. A contrast is then made with the mechano-biological alterations observed with CP and the consequent influence on joint destruction. The features of the pathogenesis are: (1) altered muscular activity and restricted range of motion result in abnormal joint morphology, subluxation, and poor coverage of the femoral head; (2) joint incongruities created in early development cause local stress concentrations that can mechanically damage the articular cartilage; (3) the reduced magnitudes of muscular forces reduce the contact pressures at the joints, creating thinner cartilage and osteopenia; and (4) the thinner cartilage degenerates early, and subchondral bone collapse further contributes to the mechanical destruction of the remaining cartilage.