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Hip surveillance in Tasmanian children with cerebral palsy
Annette Connelly1, Peter Flett, H Kerr Graham
1Royal Hobart Hospital, Hobart, Tasmania 7008, Australia.
Insights
Children with cerebral palsy (CP) face hip subluxation risks. Early detection through hip surveillance programs can prevent dislocation, with Tasmanian data informing updated guidelines for better outcomes.
Area of Science:
- Pediatric Orthopedics
- Developmental Disabilities Research
Background:
- Children with cerebral palsy (CP) are susceptible to hip subluxation, potentially leading to dislocation, deformity, and pain.
- Early identification via hip surveillance (X-ray and clinical exam) is crucial for timely intervention.
- Hip surveillance programs for CP have been implemented in Tasmania since 1992.
Purpose of the Study:
- To audit existing hip surveillance data for children with CP in Tasmania.
- To conduct a literature review on the prevention and management of hip subluxation in CP.
- To update current hip surveillance guidelines based on data and literature.
Main Methods:
- Development and distribution of new hip surveillance guidelines.
- Audit of medical files and X-rays for 218 children over 12 years.
- Analysis of hip subluxation and dislocation incidence, surgical interventions, and Gross Motor Function Classification System (GMFCS) levels.
Main Results:
- Fifteen cases of hip dislocation were recorded during the surveillance period.
- Incidence of subluxation and surgery correlated with GMFCS levels.
- Observed spontaneous improvement in some cases of minor subluxation with weight-bearing.
Conclusions:
- Tasmanian data align with other audits regarding hip subluxation incidence and surgical interventions by GMFCS level.
- The significance of weight-bearing for improving minor subluxation was noted.
- Migration percentage alone is insufficient for outcome assessment; quality of life measures are needed for CP hip surveillance.
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.