This prospective study from a tertiary children's hospital examined what happened to surgical practice after a dedicated hip surveillance clinic (HSC) was established for children with cerebral palsy in 1997. The clinic used standardised clinical and radiological screening to detect hip displacement early, aiming to shift surgery from salvage operations toward simpler preventive procedures.
Every child with bilateral cerebral palsy should have a pelvic radiograph by 18 months of age. This is not optional screening — hip displacement in quadriplegia reaches 75% incidence, is radiologically silent in early stages, and is irreversible once dislocation occurs.
When you see a child with spastic quadriplegia or diplegia, migration percentage and acetabular index should be tracked every 6 to 12 months. If migration hits 40% or rises more than 10% in a year, refer for preventive adductor release before the window closes.
This paper is why we operate early and simply rather than late and expensively. The conventional model let children reach surgical clinics with already-dislocated hips, forcing reconstructive or salvage procedures with high morbidity and variable results. A structured surveillance programme reversed that pattern within three years.
The Miller classification (preventive, reconstructive, salvage) is the framework to know: the goal of surveillance is to keep every child in Stage I surgery territory.
This prospective study from a tertiary children's hospital examined what happened to surgical practice after a dedicated hip surveillance clinic (HSC) was established for children with cerebral palsy in 1997. The clinic used standardised clinical and radiological screening to detect hip displacement early, aiming to shift surgery from salvage operations toward simpler preventive procedures.
Every child with bilateral cerebral palsy should have a pelvic radiograph by 18 months of age. This is not optional screening — hip displacement in quadriplegia reaches 75% incidence, is radiologically silent in early stages, and is irreversible once dislocation occurs.
When you see a child with spastic quadriplegia or diplegia, migration percentage and acetabular index should be tracked every 6 to 12 months. If migration hits 40% or rises more than 10% in a year, refer for preventive adductor release before the window closes.
This paper is why we operate early and simply rather than late and expensively. The conventional model let children reach surgical clinics with already-dislocated hips, forcing reconstructive or salvage procedures with high morbidity and variable results. A structured surveillance programme reversed that pattern within three years.
The Miller classification (preventive, reconstructive, salvage) is the framework to know: the goal of surveillance is to keep every child in Stage I surgery territory.