The Need for Hip Surveillance in Children with CP

By Tammy Van der Kamp

 

Importance of Early Detection

The Cerebral Palsy Association of BC was pleased to welcome Dr. Kashore Malpuri at this year’s Annual General Meeting in September.  Dr. Malpuri is a clinical Instructor in Pediatric Orthopedics at UBC, who has a special interest in gait and hip abnormalities associated with neuromuscular disorders.  The evening’s presentation highlighted the importance of early detection of hip problems in children with cp.

Hip problems are the second most common musculoskeletal deformity associated with cp in children.  About one third of all children with cp develop hip displacement.  Hip displacement is serious – it can involve pain, contractures, problems with sitting, standing and walking, fractures, skin ulcerations, difficulty with perineal care, pelvic obliquity, and scoliosis.

The risk of developing hip displacement is directly related to gross motor function, as determined by the Gross Motor Functional Scale Classification (GMFSC) used by physicians and other health care professionals.

Early detection of hip problems is important because once a hip reaches a certain stage of migration, hip displacement is almost certainly inevitable, and reconstruction becomes impossible.  And that is where Hip Surveillance comes in: Hip Surveillance is the process of identifying and monitoring the critical early indicators of progressive hip displacement.  Hip Surveillance progress depends on patient age, x-rays, clinical assessment, and the patient’s GMFCS level.

Many effective treatment and management options, including Botox injections, soft tissue procedure, and surgery, dramatically reduce the incidence of hip displacement – but in order to make the best use of these procedures, hip migration needs to be caught before it progresses to hip displacement.   In a nutshell, the sooner the problems are detected, the less often drastic interventions become necessary.

Benefits of Hip Surveillance

A Swedish study looked at 206 kids with cp, born between 1992 and 1997, who took part in a regular hip surveillance program.  None of them developed hip displacement.  And of 48 children who moved into the area during the study, and subsequently took part in the program, none developed hip displacement.   Clearly, the preventive measures taken due to Hip Surveillance resulted in a dramatic reduction in hip displacement among those children.

It’s clear that early diagnosis and treatment minimizes the need and extent of further surgery.  And early intervention usually involves simpler procedures, lower hospital costs, and a lower likelihood of complications.

Parents are their children’s strongest advocates: the better informed they are about the prevalence of hip problems, and the effectiveness of Hip Surveillance, the better their child’s chances of avoiding hip displacement associated with cp.

It’s important that parents work together with physicians,  physiotherapists, and other health-care professionals to make Hip Surveillance a regular part of the child’s health care regimen.

An ounce of prevention is worth a pound of cure.

Dr. Mulpuri is a Clinical Instructor in Pediatric Orthopaedics, Department of

Orthopaedics, University of British Columbia. He recently completed an MSc in

Epidemiology at the University of British Columbia and is involved in a wide range of

research projects in paediatric orthopaedics. Dr. Mulpuri is most interested in studying the

clinical outcomes of orthopaedic treatment so that improvements in treatments will continue

to be made.

 

For more information on the Gross Motor Functional Scale Classification (GMFSC) see

http://www.canchild.ca/en/aboutcanchild/resources/GMFCS.pdf

 

For more information please visit: http://www.orthosurgery.ubc.ca/faculty_bios/mulpuri.html