Utility of combined hip abduction angle for hip surveillance in children with cerebral palsy.

Sir,

We read with interest the article titled “A utility of combined hip abduction angle for hip surveillance in children with cerebral palsy” by Divecha and Bhaskar.1 We have a few comments for the authors and readers:

Inter-examiner reliability regarding the goniometric measurement of hip abduction in children with CP is low. Therefore, goniometric measurements should be used cautiously when taking decisions, especially if no standardized protocols have been followed or no coordination/training session has been organized.2

Fourteen children with CHAA >40° had MP >33% on one or both sides. The authors considered it insignificant and assumed it to be due to variation in passive stretching between observers. However, it cannot be considered insignificant as it constitutes 13.59% of the study group.

The authors recommend CHAA of 40° to be taken as the threshold for orthopedic referral and imaging of hips to rule out hip lateralization. It is not clear in the manuscript whether this recommendation is for all patients of cerebral palsy or only for non-ambulators (children in GMFCS 4 and 5).

Measurement of the range of motion is a poor indicator of risk and cannot replace radiographic examinations for hip screening.3

It is of utmost importance that children with CP are identified early and that children at risk are examined radiographically as early as possible. Scrutton and Baird recommended that children with spastic diplegia or quadriplegia should have a first radiograph at age 30 months.4