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The role for hip surveillance in children with cerebral palsy
Benjamin Shore1, David Spence, Hk Graham
1Department of Orthopaedic Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Hunnewell 221, Boston, MA, 02115, USA, Benjamin.Shore@childrens.harvard.edu.
Insights
Hip displacement in children with cerebral palsy (CP) can cause pain and functional loss. Hip surveillance, guided by the Gross Motor Functional Classification System (GMFCS), helps identify at-risk hips for timely intervention.
Area of Science:
- Orthopedics
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Spastic hip displacement is a common, debilitating complication in children with cerebral palsy (CP).
- Progressive hip displacement can lead to dislocation, causing severe pain, functional impairment, and reduced quality of life.
- The Gross Motor Functional Classification System (GMFCS) is a key predictor for identifying children with CP at risk for hip displacement.
Purpose of the Study:
- To review the treatment options for progressive hip displacement in children with CP.
- To examine the effectiveness of current hip surveillance programs.
- To present an example of a GMFCS-level-stratified hip surveillance program.
Main Methods:
- Literature review of treatments for spastic hip displacement.
- Analysis of studies on the success rates of hip surveillance protocols.
- Description of a GMFCS-stratified hip surveillance program example.
Main Results:
- Hip surveillance is increasingly adopted in developed countries for managing spastic hip displacement in children with CP.
- GMFCS level is a critical factor in identifying hips at risk for progressive lateral displacement.
- Effective hip surveillance programs can lead to earlier detection and intervention, potentially improving outcomes.
Conclusions:
- Early detection and management of spastic hip displacement in children with CP are crucial.
- Hip surveillance programs, particularly those stratified by GMFCS level, are essential components of comprehensive CP care.
- Further research is needed to optimize surveillance protocols and treatment strategies for spastic hip displacement.
Abstract:
Spastic hip displacement is the second most common deformity seen in children with cerebral palsy (CP), and the long-term effects can be debilitating. Progressive hip displacement leading to dislocation can result in severe pain as well as impaired function and quality of life. Recent population-based studies have demonstrated that a child's Gross Motor Functional Classification System (GMFCS) level is most predictive for identifying hips "at-risk" for progressive lateral displacement. As a result, in many developed countries, hip surveillance has now been adopted as an integral piece of the comprehensive care puzzle for the management of children with spastic hip displacement. This paper reviews the spectrum of treatments available for progressive hip displacement, examines the current literature on the success of hip surveillance, and illustrates an example of a current hip surveillance program stratified by the GMFCS level.
