BACKGROUND: Children with cerebral palsy (CP) are at risk of hip subluxation. Over time, subluxation can lead to dislocation, deformity and pain. Hip surveillance in the form of an X-ray and clinical examination of this 'at risk group' can identify early subluxation. Early subluxation can be treated, preventing hip dislocation in many cases. Hip surveillance in CP commenced in Tasmania in 1992. AIMS: To audit the hip surveillance data to date, perform a literature review to understand the emerging evidence for prevention and management of hip subluxation in CP and update hip surveillance guidelines. METHODS: New guidelines were written and distributed, and an audit of the previous 12 years performed by review of medical files and X-rays. RESULTS: Two hundred and eighteen children had been involved in the hip surveillance programme. Fifteen cases of dislocation were recorded in this time. The incidence of subluxation and surgery, as well as the gross motor function classification system (GMFCS) level, was recorded. CONCLUSION: Data from Tasmania showed a similar incidence of hip subluxation according to GMFCS level, and frequency of different surgical interventions as other recent audits. Some children with minor subluxation improved without orthopaedic intervention once weight bearing occurred, which had not before been appreciated. Migration percentage alone is not adequate to fully describe the outcome of hip subluxation. More appropriate measures of outcome in terms of quality of life for children with CP need to be developed.
BACKGROUND:Children with cerebral palsy (CP) are at risk of hip subluxation. Over time, subluxation can lead to dislocation, deformity and pain. Hip surveillance in the form of an X-ray and clinical examination of this 'at risk group' can identify early subluxation. Early subluxation can be treated, preventing hip dislocation in many cases. Hip surveillance in CP commenced in Tasmania in 1992. AIMS: To audit the hip surveillance data to date, perform a literature review to understand the emerging evidence for prevention and management of hip subluxation in CP and update hip surveillance guidelines. METHODS: New guidelines were written and distributed, and an audit of the previous 12 years performed by review of medical files and X-rays. RESULTS: Two hundred and eighteen children had been involved in the hip surveillance programme. Fifteen cases of dislocation were recorded in this time. The incidence of subluxation and surgery, as well as the gross motor function classification system (GMFCS) level, was recorded. CONCLUSION: Data from Tasmania showed a similar incidence of hip subluxation according to GMFCS level, and frequency of different surgical interventions as other recent audits. Some children with minor subluxation improved without orthopaedic intervention once weight bearing occurred, which had not before been appreciated. Migration percentage alone is not adequate to fully describe the outcome of hip subluxation. More appropriate measures of outcome in terms of quality of life for children with CP need to be developed.
Authors: Donna S Hurley; Theresa Sukal-Moulton; Deborah Gaebler-Spira; Kristin J Krosschell; Larissa Pavone; Akmer Mutlu; Julius Pa Dewald; Michael E Msall Journal: Int J Phys Med Rehabil Date: 2015-03-23