This paper reports the first ten years of a population-based programme in southern Sweden designed to prevent hip dislocation in children with cerebral palsy. The programme used standardised radiologic screening with migration percentage (MP) and early surgical intervention when lateral displacement was detected. It compared outcomes in 206 screened children (born 1992-1997) against 103 historical controls (born 1990-1991) who predated the programme.
Hip dislocation in CP carries a grim natural history: 50-90% of affected children experience pain, and nearly every child develops pelvic obliquity, scoliosis, and progressive functional decline. Before structured surveillance programmes, the population-level dislocation rate approached 15-20%, and there was no systematic framework for when or how to intervene.
This paper established the surveillance protocol now used as the template for CP hip programmes worldwide. When you see a child with spastic diplegia, tetraplegia, or dystonic CP, annual AP pelvis radiographs starting early are standard of care. At MP >33%, begin watchful waiting with 6-month films; above MP 42%, operate — adductor-iliopsoas tenotomy first, proximal varus femoral osteotomy if no improvement within one year.
Children with spastic hemiplegia and pure ataxia have lower risk and need only a single radiograph at age 4 under this protocol.
This paper reports the first ten years of a population-based programme in southern Sweden designed to prevent hip dislocation in children with cerebral palsy. The programme used standardised radiologic screening with migration percentage (MP) and early surgical intervention when lateral displacement was detected. It compared outcomes in 206 screened children (born 1992-1997) against 103 historical controls (born 1990-1991) who predated the programme.
Hip dislocation in CP carries a grim natural history: 50-90% of affected children experience pain, and nearly every child develops pelvic obliquity, scoliosis, and progressive functional decline. Before structured surveillance programmes, the population-level dislocation rate approached 15-20%, and there was no systematic framework for when or how to intervene.
This paper established the surveillance protocol now used as the template for CP hip programmes worldwide. When you see a child with spastic diplegia, tetraplegia, or dystonic CP, annual AP pelvis radiographs starting early are standard of care. At MP >33%, begin watchful waiting with 6-month films; above MP 42%, operate — adductor-iliopsoas tenotomy first, proximal varus femoral osteotomy if no improvement within one year.
Children with spastic hemiplegia and pure ataxia have lower risk and need only a single radiograph at age 4 under this protocol.