Introduction Children with Cerebral palsy (CP) are at risk of hip sublaxation. Over time, hip sublaxation can lead to hip dislocation, deformity and pain. Hip surveillance in the form of Hip X-ray can identify early sublaxation. Evidence shows that early intervention may prevent the need for major surgical procedure.
Aim To evaluate our practice of Hip Surveillance for Children with Cerebral palsy.
Method We retrospectively looked at the database of children with CP in our Health Board. We then searched on the clinical work station for more details regarding CP type, gross motor function classification system (GMFCS), frequency of hip X-ray, migration index measurement on the hip X-ray and any orthopaedic intervention. NICE Guidance for hip surveillance was used as the reference.
Results 60 patients below 18 years of age with diagnosis of CP were identified. 65% of these children had bilateral CP. NICE guidance advises hip X-ray for all children with Bilateral CP by 2 years of age. In our cohort of children only 28% of patients with Bilateral CP had first X-ray by 2 years. NICE also recommend annual X-ray for all children with GMFCS 5/4/3. Only 20% of our patients with GMFCS 5/4/3 had an annual X-ray as per NICE recommendation. 25% of the hip X-ray reports mentioned about the migration index. We introduced local hip surveillance guidelines in our trust and since then annual X-ray rate in patient with GMFCS 5/4/3 has improved from 20% to 50% and now 100% of the hip X-ray reports mention about the migration index. We also noted that 13% of children on hip X-ray had Migration Index >30%, of which half had hip dislocation and were awaiting hip surgery.
Conclusions There is need for increased awareness of hip surveillance in children with CP. We have seen improvement in annual hip X-ray since introduction of local hip surveillance guidelines. Timely recognition of patient with symptoms or radiological evidence of hip subluxation is vital to minimise hip dislocation.
Recommendation To improve awareness of hip surveillance in all Multi disciplinary team members looking after Children with CP.
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