• Mulpuri, Kishore

    Titles

    Investigator, BC Children's Hospital
    Pediatric Orthopaedic Surgeon, Department of Orthopaedic Surgery, BC Children’s Hospital
    Associate Professor, Division of Pediatric Orthopedics, Department of Orthopedics, University of British Columbia

    Degrees / Designations

    MBBS, MS(Ortho), MHSc(Epi)

    Primary Area of Research
    Evidence to Innovation
    Secondary Area(s) of Research
    Phone
    604-875-2054
    Fax
    604-875-2275
    Lab Phone
    604-875-2359
    Assistant
    Jennifer Farr, Krystle Singh and Tammie Teo
    Mailing Address

    BC Children's Hospital
    1D.69 – 4480 Oak Street
    Vancouver, BC, V6H 3V4

    Affiliate Websites
    Research Areas
    • Paediatric outcomes research
    • Developmental dysplasia of the hip
    • Cerebral palsy
    • Legg–Calvé–Perthes disease
    • Slipped capital femoral epiphysis
    • Pediatric trauma
    • Orthopaedic engineering
    • Osteogenesis imperfecta
    Summary

    Dr. Mulpuri’s clinical practice and research interests have a major focus on the pediatric hip and cerebral palsy. He regularly treats patients with a wide range of conditions including but not limited to: Developmental Dysplasia of the Hip (DDH), Cerebral Palsy (CP), Legg–Calvé–Perthes disease, osteogenesis imperfecta (OI), slipped capital femoral epiphysis (SCFE) and trauma.

    He is the Research Director of the International Hip Dysplasia Institute (IHDI) and currently holds the medical lead position for the Child Health BC Hip Surveillance Program for Children with Cerebral Palsy. He also is Co-Lead for the Evidence to Innovation Theme at CFRI. He is the Founding President of the Canadian Pediatric Orthopaedic Group (CPOG), which facilitates the academic and scientific exchange of thoughts and ideas between Canadian pediatric orthopaedic surgeons and creates invaluable opportunities for educational activities and collaborative research across Canada.

    In addition, he leads the Bone Health & Mobility Research Team at BC Children’s Hospital and currently acts as Principal Investigator or Co-Investigator on various local and international multi-centre research studies. He is regularly involved with the development of new clinical practice guidelines, most recently chairing the work group that developed the guidelines for non-operative treatment and management of DDH.

    Current Projects

    Developmental Dysplasia of the Hip
    Dr. Mulpuri holds the role of Research Director for the International Hip Dysplasia Institute (IHDI). The IHDI is a not-for-profit organization that is driven by advocacy and philanthropic efforts, with the goal of improving diagnosis, treatment and patient outcomes for children with DDH. DDH is the most common pediatric hip condition that ranges in severity from a mildly dysplastic but reduced hip to a frankly dislocated hip. In order to identify best practices and standardize screening and management decisions, the IHDI began a multi-centre, prospective observational study of infants aged 0 to 18 months with dislocated hips at rest in 2010, and is currently in the process of expanding the study into the first comprehensive prospective DDH registry worldwide. The IHDI study coordinator is a postdoctoral research fellow at UBC and BC Children’s Hospital and the study database is housed at CFRI. This database will have a direct impact on the treatment methods and standard of care for DDH not only in BC, but also around the world. Every child born is screened for hip instability, with a DDH diagnosis in 15-20/1000 live births, and a dislocated hip diagnosis in 1-2/1000 live births.

    Cerebral Palsy
    Cerebral palsy (CP) is a term that encompasses a group of neurological disorders that affect body movement, posture, muscle coordination and balance. It appears in infancy or early childhood and may lead to chronic disability. Children with severe CP are at high risk for hip dislocations and different treatment strategies exist which have a direct impact on the physical function and quality of life for these children. Dr. Mulpuri was instrumental in creating the first formal hip surveillance program for children with CP in North America – the Child Health BC Hip Surveillance Program for Children with Cerebral Palsy - and is currently active as the medical lead. This province-wide program was developed with the goal of enrolling all patients with cerebral palsy to eventually establish comprehensive monitoring and intervention guidelines for their hips. Dr. Mulpuri is also actively involved in a number of research projects at BC Children’s Hospital which have the aim of assessing and improving the management and functional outcomes of children with CP. He is collaborating with an international network of pediatric orthopaedic surgeons on a multi-centre prospective comparative cohort study investigating the outcomes of hip interventions for children with CP, the first of its scope to systematically study the impact of hip instability and its management on patient quality of life using the validated Child Health Index of Life with Disabilities (CPCHILD©) questionnaire.

    Legg–Calvé–Perthes Disease 
    Legg–Calvé–Perthes (Perthes) disease is a self-limiting pediatric hip disorder characterized by disruption of blood flow to the hip joint causing avascular necrosis of the femoral head. It most commonly occurs in children ages 2-12 and is more common in males than in females. Dr. Mulpuri is a member of the Coordinating Committee for the International Perthes Study Group (IPSG), comprised of pediatric orthopaedic surgeons from around the world who each have the goal of advancing knowledge and care of patients with Perthes disease through international collaborative research. Currently, Dr. Mulpuri is leading a number of research studies on Perthes disease being conducted at BC Children’s Hospital, including the international multi-centre IPSG study on the role of non-weightbearing on femoral head shape and outcome after hip surgery for patients with Perthes disease. Other current studies include a Perthes disease-specific validation study for pediatric functional outcome scores.

    Slipped Capital Femoral Epiphysis
    Slipped capital femoral epiphysis (SCFE) is a disorder of the adolescent hip that occurs when the femoral head slips backward through the growth plate, resulting in pain, instability and possibly limited range of motion. The growing occurrence of obesity in the adolescent population has been linked to the increased prevalence of SCFE in recent years. The diagnosis and treatment of SCFE remain controversial, with ambiguity surrounding the ideal treatment and management plan to minimize long-term impairment. Dr. Mulpuri is currently leading the development of a prospective database of all patients with SCFE who are treated at BC Children’s Hospital, with the goal of examining clinical, functional and radiographic outcomes after treatment. This database has the potential for expansion and inclusion of additional sites both nationally and internationally. Findings from this database will be valuable in determining a reliable means of diagnosis for SCFE, while improving the decision-making process for orthopaedic surgeons in the treatment and management of SCFE in the future.

    Pediatric Trauma         
    Dr. Mulpuri is the Principal Investigator or Co-Investigator on a number of pediatric trauma research studies at BC Children’s Hospital that are ongoing or have been recently completed:

    1. A prospective randomized controlled trial investigating treatment via casting versus splinting for Type I (non-displaced) supracondylar humerus fractures.
    2. A prospective multi-centre observational cohort study on non-operative versus operative management for Type II (displaced with a hinged cortex) supracondylar humerus fractures.
    3. A prospective randomized controlled trial to examine the surgical management of Type III (completely displaced) supracondylar humerus fractures using lateral versus crossed K-wires.
    4. A prospective cohort study to develop a risk factor prediction model for growth arrest after physeal fractures in non-skeletally mature patients.
    5. A prospective cohort study in collaboration with the Centre for Hip Health and Mobility investigating factors such as risk taking behaviour and bone microstructure that underpin fractures in boys compared to girls during growth.
    In addition, Dr. Mulpuri is leading the development of a larger prospective registry of all patients who are treated at BC Children’s Hospital for musculoskeletal trauma. This registry will serve as a source of valuable information regarding the diagnosis and treatment of different types of orthopaedic injuries in pediatric patients, and has the potential to help improve overall management of trauma in the pediatric population. Data collected could also be used in medical student and resident teaching, quality improvement initiatives, and decisions regarding hospital resource utilization.

    Engineering Research and Collaborations
    As an active collaborator with the Centre for Hip Health and Mobility as well as the UBC Departments of Mechanical Engineering and Electrical and Computer Engineering, Dr. Mulpuri is involved in a number of research projects that aim to improve the screening, diagnosis and management of a number of pediatric orthopaedic conditions. In particular, he acts as co-lead with Dr. Antony Hodgson, Dr. Rafeef Abugharbieh and Dr. Anthony Cooper on an initiative to develop and implement a fully automatic, reliable and non-invasive hip dysplasia diagnostic system. Using three-dimensional ultrasound technology, this system aims to improve the efficacy of DDH screening and management and ultimately avoid early hip replacements for patients with DDH. He also collaborates with Dr. Agnes d’Entremont on a number of MRI and CT modelling studies, including an MRI study examining the relation of cartilage health to femoral head shape after treatment in patients with Perthes disease and CT modelling studies investigating the reliability of measures used to assess the hip in patients with SCFE.

    Selected Publications

    Mulpuri K, Schaeffer EK, Andrade J, Sankar WN, Williams N, Matheny TH, Mubarak SJ, Cundy PJ, Price CT, IHDI Study Group. What risk factors and characteristics are associated with late-presenting dislocations of the hip in infants? Clin Orthop Relat Res. 2016;474(5):1131-1137. PMID: 26728512

    Mulpuri K, Schaeffer EK, Kelley SP, Castaneda P, Clarke NM, Herrera-Soto JA, Upasani V, Narayanan UG, Price CT, IHDI Study Group. What is the impact of center variability in a multicenter international prospective observational study on developmental dysplasia of the hip? Clin Orthop Relat Res. 2016;474(5):1138-1145. PMID: 26891895

    Miller S, Harris SR, Mulpuri K. Agreement between a physical therapist and an orthopedic surgeon in children referred for gait abnormalities. Pediatr Phys Ther. 2016;28(1):85-92. PMID: 27088694

    Nitikman M, Mulpuri K, Reilly CW. Internet–administered health related quality of life questionnaires compared with pen and paper in an adolescent scoliosis population: A randomized crossover study. J Pediatr Orthop. 2016. PMID: 26756988

    Hesketh K , Sankar WN, Joseph B, Narayanan U, Mulpuri K. Inter-observer and intra-observer reliability in the radiographic diagnosis of avascular necrosis of the femoral head following reconstructive hip surgery in children with cerebral palsy. J Child Orthop. 2016;10(2):143-147. PMID: 26972813

    Hesketh K, Leveille L, Mulpuri K. The frequency of AVN following reconstructive hip surgery in children with cerebral palsy: A systematic review. J Pediatr Orthop. 2016;36(2):e17-24. PMID: 26849636

    Vaccaro AR, Fisher CG, Prasad SK, Patel AA, Chi J, Mulpuri K, Thomas KC, Whang PG. Evidence–based recommendations for spine surgery. Spine. 2016;41(3):E165–173. PMID: 26650873

    Jones CE, Cooper AP, Doucette J, Buchan LL, Wilson DR, Mulpuri K, d’Entremont AG. Relationships between severity of deformity and impingement in slipped capital femoral epiphysis. J Pediatr Orthop. 2015. PMID: 26356312

    Mulpuri K, Song KM, Gross RH, et al. The American Academy of Orthopaedic Surgeons evidence-based guideline on detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age. J Bone Joint Surg Am. 2015;97:1717–1718. PMID: 26491137

    Hyman JE, Trupia EP, Wright ML, Matsumoto H, Jo CH, Mulpuri K, Joseph B, Kim HKW, International Perthes Study Group Members. Interobserver and intraobserver reliability of the modified Waldenström classification system for staging of Legg–Calvé–Perthes disease. J Bone Joint Surg Am. 2015;97(8):643-50. PMID: 25878308

    Määttä M, Macdonald HM, Mulpuri K, McKay HA. Deficits in distal radius bone strength, density and microstructure are associated with forearm fractures in girls: An HR–pQCT study. Osteoporosis Int. 2015;26:1163–1174. PMID: 25572041

    Mulpuri K, Song KM. AAOS Clinical Practice Guideline: Detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age. J AAOS. 2015;23:206–207. PMID: 25716003

    Mulpuri K, Song KM, Goldberg MJ, Sevarino K. Detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age. J AAOS. 2015;23(3):202-5. PMID: 25656273

    d'Entremont AG, Cooper AP, Johari A, Mulpuri K. What clinimetric evidence exists for using hip–specific patient–reported outcome measures in pediatric hip impingement? Clin Orthop Relat Res. 2015;473:1361–1367. PMID: 25367111

    Cooper AP, Doddabasappa SN, Mulpuri K. Evidence–based management of developmental dysplasia of the hip. Orthop Clin North Am. 2014;45(3):341–54. PMID: 24975762

    Dodwell E, Dua S, Dulai SK, Astone K, Mulpuri K. The quality of randomized controlled trials in pediatric orthopaedics: Are we improving? J Pediatr Orthop. 2015;35:536–545. PMID: 25494022

    Gill C, Ansermino MJ, Sanatani S, Mulpuri K, Doan Q. Paediatric patient family engagement with clinical research at a tertiary care paediatric hospital. Paediatr Child Health. 2014;19(10):537–542. PMID: 25587233

    Mulpuri K, Brighton B. Evidence-based medicine and clinical trials in pediatric orthopedics. J Pediatr Orthop. 2014;34(1):S71-3. PMID: 25207742

    Narayanan U, Mulpuri K, Sankar WN, Clarke NMP, Hosalkar H, Price CT. Reliability of a new radiographic classification for developmental dysplasia of the hip. J Pediatr Orthop. 2015;35:478–484. PMID: 25264556

    Sims–Gould J, Race D, Hamilton L, Macdonald H, Mulpuri K, McKay H. “I fell off and landed badly”: Children’s experiences of forearm fracture and injury prevention. J Child Health Care. 2014;20(1):98-108. PMID: 25326540

    Miyanji F, Newton PO, Samdani AF, Shah SA, Varghese RA, Reilly CW, Mulpuri K. The impact of surgical waiting-list times of scoliosis surgery: The surgeon’s perspective. Spine. 2015; 40(11):823-8. PMID: 24430712

    American Academy of Orthopaedic Surgeons.  The Management of Pediatric Supracondylar Humerus Fractures: Appropriate Use Criteria. Published September 8, 2014.

    Arneja S, McConkey MO, Mulpuri K, Chin P, Gilbart MK, Regan WD, Leith JM. 2009. Graft Tensioning in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Randomized Controlled Trials. Arthroscopy: J Arthroscopic Rel Surg 25(2):200-207. PMID: 19171281

    Blair J, Perdios A, Babul S, Young K, Beckles J, Pike I, Cripton P, Sasges D, Mulpuri K, Desapriya E. The appropriate and inappropriate use of child restraint seats in Manitoba. Int J Injury Cont Safe Promo 2008;15(3):151–156. PMID: 18821379

    Louman-Gardiner K, Mulpuri K, Perdios A, Tredwell S, Cripton PA. Pediatric lumbar Chance fractures in British Columbia: chart review and analysis of the use of shoulder restraints in MVAs. Accid Anal Prev. 2008;40(4):1424-9. PMID: 18606276

    Mulpuri K, LeBlanc JG, Reilly CW, Poskitt KJ, Choit RL, Sahajpal V, Tredwell SJ. Sternal Split Approach to Cervicothoracic Junction in Children. Spine. 2005;30(11):305-10. PMID: 15928540

    Joseph B, Rao N, Mulpuri K, Varghese G, Nair S. How does a femoral varus osteotomy alter the natural evolution of Perthes' disease? J Pediatr Orthop B. 2005;14(1):10-5. PMID: 15577301

    Joseph B, Varghese G, Mulpuri K , Rao NKL, Nair NS. The natural evolution of Perthes Disease - A study of 610 children under 12 years of age at the onset of the disease. J Pediatr Orthop. 2003;23(5):590-600. PMID: 12960621

    Joseph B, Nair N S, Rao N K L, Mulpuri K , Varghese G. What is the optimal timing for containment surgery for Perthes' disease? J Pediatr Orthop. 2003;23(5):601-6. PMID: 12960622

    Foster BK, Furness ME, Mulpuri K. Prenatal ultrasonography in antenatal orthopaedics: a new subspecialty. J Pediatr Orthop. 2002;22(3):404-9. PMID: 11961465

    Joseph B, Mulpuri K, Verghese G. Perthes' disease in the adolescent. J Bone Joint Surg Br. 2001;83(5): 715-20. PMID: 11476312

    Joseph B, Mulpuri K. Delayed fracture - separation of the capital femoral epiphysis following an ipsilateral transcervical fracture of the femoral neck. J Orthop Trauma 2000;14(6):446-8. PMID: 11001422

    Mulpuri K , Joseph B. Intra Medullary Rodding in Osteogenesis Imperfecta. J Pediatr Orthop. 2000;20:267-273. PMID: 10739296

    Grants
    Honours & Awards
    Research Group Members
    • Ivan Cepeda, MD, MSc – E2i Theme Research Manager
    • Emily Schaeffer, PhD – Postdoctoral Research Fellow
    • Yasmin Yassin – E2i Research Coordinator
    • Tammie Teo – Research Assistant