Hip Surveillance is Important to Children with Cerebral Palsy: Stop Waiting, Start Now

One in three children with cerebral palsy (CP) will develop hip displacement.1,2 Displacement is often silent, with no clinical symptoms. Left undetected and untreated, displacement can progress to dislocation and cause pain and decreased quality of life.3,4 Population-based hip surveillance programs for children with CP are effective in preventing hip dislocations in children with CP.5,6 Programs in Sweden and Australia have demonstrated that systematic screening can identify hip displacement early and, when combined with timely orthopaedic management, reduce the prevalence of hip dislocations in children with CP.5,6 The development of such programs is complex with implementation highly dependent on the local system of care for children with CP. Population-based programs should always be the aim of hip surveillance initiatives, but the challenge of designing a systemwide approach should not discourage individuals from acting. All clinicians should be following guidelines within their individual practice. Despite the awareness that surveillance is effective, established guidelines for hip surveillance are underutilized. A 2016 survey of the Pediatric Orthopaedic Society of North America membership found widespread agreement that a dislocated hip in a child with CP should be prevented by hip surveillance (93%), yet only a small proportion (18%) followed a regular surveillance program.7 In 2017, the American Academy of Cerebral Palsy and Developmental Medicine released a hip surveillance care pathway that was developed by a group of international experts (AACPDM.org [Internet]. Wilwaukee, WI, AACPDM, c2017. http:// www.aacpdm.org/publications/ care-pathways/hip-surveillance). The resultant pathway represents the consensus reached on the recommended components of surveillance, frequency, and referral criteria. Using such resources is a good starting point to initiate hip surveillance and can have an immediate impact. Notably, the authors from the Child Health BC Hip Surveillance Program saw a difference in the rate of dislocations and surgical interventions required once a systematic approach to hip surveillance was established in their center, even before a formal program was initiated (Child Health BC Hip Surveillance Program for Children with Cerebral Palsy [Internet]. Vancouver, BC, Child Health BC, c2018. www. childhealthbc.ca/hips). The introduction of mobile solutions, such as the HipScreen app (www. hipscreen.org, Shriners Hospitals for Children, Sacramento, California), makes hip surveillance resources and guidelines readily accessible in a busy clinical practice. Patients and families are strong advocates for system change and should be educated on hip displacement and the importance of hip screening. Similarly, every opportunity should be undertaken to educate the team of clinicians within one’s healthcare system that support children with CP, Stacey D. Miller, BSc, MRSc