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Australian hip surveillance guidelines for children with cerebral palsy: 5-year review
Meredith Wynter1, Noula Gibson2, Kate L Willoughby3
1Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Qld.
Insights
Updated hip surveillance guidelines for children with cerebral palsy (CP) incorporate new evidence. The Gross Motor Function Classification System remains key for identifying displacement risk, with surveillance now extending into adulthood.
Area of Science:
- Orthopaedics
- Paediatric Neurology
- Rehabilitation Medicine
Background:
- Hip displacement is a significant concern in children with cerebral palsy (CP).
- Existing hip surveillance guidelines require updating to reflect current evidence on risk factors and disease progression.
Purpose of the Study:
- To revise and update hip surveillance guidelines for children with CP based on the latest evidence.
- To ensure guidelines accurately reflect factors influencing hip displacement in this population.
Main Methods:
- A three-step review process: systematic literature review, analysis of hip surveillance databases, and a national survey of orthopaedic surgeons.
- Qualitative review of 15 articles and analysis of data from 3366 children in Australian hip surveillance databases.
Main Results:
- Hip surveillance programs have reduced hip dislocation incidence in children with CP.
- The Gross Motor Function Classification System (GMFCS) is the primary risk indicator.
- Hip displacement occurs at younger ages and into young adulthood; femoral geometry, pelvic obliquity, and scoliosis are linked to progression.
Conclusions:
- The review informed the revised Australian Hip Surveillance Guidelines for Children with Cerebral Palsy 2014.
- Guideline changes include adjusted radiographic examination frequency for lower-risk groups and extended surveillance into adulthood for at-risk adolescents.
Aim:
To ensure hip surveillance guidelines reflect current evidence of factors influencing hip displacement in children with cerebral palsy (CP).
Method:
A three-step review process was undertaken: (1) systematic literature review, (2) analysis of hip surveillance databases, and (3) national survey of orthopaedic surgeons managing hip displacement in children with CP.
Results:
Fifteen articles were included in the systematic review. Quantitative analysis was not possible. Qualitative review indicated hip surveillance programmes have decreased the incidence of hip dislocation in populations with CP. The Gross Motor Function Classification System was confirmed as the best indicator of risk for displacement, and evidence was found of hip displacement occurring at younger ages and in young adulthood. Femoral geometry, pelvic obliquity, and scoliosis were linked to progression of hip displacement. A combined data pool of 3366 children from Australian hip surveillance databases supported the effectiveness of the 2008 Consensus Statement to identify hip displacement early. The survey of orthopaedic surgeons supported findings of the systematic review and database analyses.
Interpretation:
This review rationalized changes to the revised and renamed Australian Hip Surveillance Guidelines for Children with Cerebral Palsy 2014, informing frequency of radiographic examination in lower risk groups and continuation of surveillance into adulthood for adolescents with identified risk factors.
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