Hip surveillance and management of the displaced hip in cerebral palsy

Abstract

Introduction: This article provides an overview of the management of a displaced hip in children with cerebral palsy and considers surveillance programmes, principles of surgical reconstruction and options for the salvage of an unreconstructable hip in these children.

Conclusion: Hip dislocation in CP is potentially preventable if children are included from an early age in a surveillance programme that includes repeat radiographic and clinical examinations, and preventive treatment for hips that are displacing. A surveillance programme should be based on the child's age, GMFCS level and migration percentage (MP), and surgical prevention may be considered in children with a MP exceeding 33 %.

Keywords: Cerebral palsy; Child; Hip displacement; Operative management; Surveillance programme.

Fig. 1

Measurement of the migration percentage (MP). MP = a/b × 100)

Fig. 2

Number of children versus age (years) at first registration of an MP above 33 % (yellow) and 40 % (red) in the total population of children with CP

Fig. 3

Proportion of children (%) with an MP of <33 % (green), 33–39 % (yellow) and ≥40 % (red) in relation to GMFCS level in the total population of children with CP

Fig. 4

Schematic presentation of the radiographic examinations in the Australian and Swedish surveillance programmes. Green examination yearly, red examination twice a year, yellow no examination, grey individually based examinations