Australian hip surveillance guidelines for children with cerebral palsy: 5‐year review

Abstract

Aim To ensure hip surveillance guidelines reflect current evidence of factors influencing hip displacement in children with cerebral palsy (CP). Method A three‐step review process was undertaken: (1) systematic literature review, (2) analysis of hip surveillance databases, and (3) national survey of orthopaedic surgeons managing hip displacement in children with CP. Results Fifteen articles were included in the systematic review. Quantitative analysis was not possible. Qualitative review indicated hip surveillance programmes have decreased the incidence of hip dislocation in populations with CP. The Gross Motor Function Classification System was confirmed as the best indicator of risk for displacement, and evidence was found of hip displacement occurring at younger ages and in young adulthood. Femoral geometry, pelvic obliquity, and scoliosis were linked to progression of hip displacement. A combined data pool of 3366 children from Australian hip surveillance databases supported the effectiveness of the 2008 Consensus Statement to identify hip displacement early. The survey of orthopaedic surgeons supported findings of the systematic review and database analyses. Interpretation This review rationalized changes to the revised and renamed Australian Hip Surveillance Guidelines for Children with Cerebral Palsy 2014, informing frequency of radiographic examination in lower risk groups and continuation of surveillance into adulthood for adolescents with identified risk factors.

Hip-joint congruity after Dega osteotomy in patients with cerebral palsy: long-term results

“…Salter osteotomies in cases of a high hip dislocation produced good functional results and better congruity at long-term follow up [3]. With the surveillance programmes described by Hägglund [10] and the Australian Hip Surveillance Working Group [32,33], it is possible to detect hip decentration in patients with CP very early, and situations with a high hip dislocation with destruction of the femoral head can be avoided. The technique used currently for bony hip reconstruction in cases of decentration in patients with CP is the modified Dega osteotomy [21], which gives a better coverage of the femoral head in the superior and posterior part of the acetabulum.…”

“…Pain reduces time in a wheelchair and thus participation in activities of daily living. Prevention programmes such as that described by Hägglund [10] and the Australian Hip Surveillance Working Group [32,33] avoid painful hips, and hip surgery is not performed unless pain and femoral-head destruction has already developed. The MP according to Reimers appears to be a reliable tool for pre-and post-operative monitoring [23].…”

Screening and referral for children with physical disabilities

“…The linear relationship between GMFCS level and hip displacement provided the foundation for the development of hip surveillance guidelines for children with CP, for which a group of Australian researchers played a distinguished and pivotal role . Over a period of 15 years, a national group of Australian researchers has used emerging studies on the link between GMFCS and hip displacement to develop a series of recommendations for the early detection of hip displacement in children with CP, permitting more efficient management . From the onset, it was recognised that physical examination is unreliable in detecting early hip displacement and that the basis of surveillance must be periodic anteroposterior radiographs of the hip .…”

“…Over a period of 15 years, a national group of Australian researchers has used emerging studies on the link between GMFCS and hip displacement to develop a series of recommendations for the early detection of hip displacement in children with CP, permitting more efficient management . From the onset, it was recognised that physical examination is unreliable in detecting early hip displacement and that the basis of surveillance must be periodic anteroposterior radiographs of the hip . The Australian Hip Surveillance Guidelines have been widely disseminated, have been recently updated and are providing a template for similar guidelines being developed in the UK and in North America by groups such as the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) and the Pediatric Orthopaedic Society of North America (POSNA).…”

More than an X‐ray: Experiences and perspectives of parents of children with cerebral palsy when engaging in hip surveillance

“…Clinical guidelines for hip surveillance have been developed in Australia and many other countries . Guidelines have been implemented through population‐based hip surveillance programmes in some areas, significantly reducing the incidence of hip dislocation in those populations of children .…”