This prospective population-based study from southern Sweden reports 20-year outcomes of the CPUP programme, which uses serial radiographic screening and early preventive surgery to prevent hip dislocation in children with cerebral palsy. Three cohorts totaling 792 children were compared: a historical control group (born 1990–1991) and two surveillance cohorts (born 1992–1997 and 1998–2007).
Hip dislocation in untreated CP occurs in 15–20% of children, develops silently between ages 2 and 5, and causes chronic pain and progressive deformity by the time it is clinically apparent. Waiting for symptoms guarantees you are already too late.
When you see a child with CP at GMFCS levels III–V, they need annual AP pelvis radiographs starting at diagnosis — not when the hip starts hurting. The trigger for surgery is an MP exceeding 40%, not symptoms.
For GMFCS IV–V children, plan for roughly a 1-in-2 chance of needing preventive surgery, and counsel families that re-operation (especially after tenotomy alone) is part of the management plan through skeletal maturity, not a complication.
This paper is the evidence base for hip surveillance programmes now adopted across Scandinavia and Australia, and is directly relevant to any OITE question on CP hip management thresholds or the role of GMFCS in surgical planning.
This prospective population-based study from southern Sweden reports 20-year outcomes of the CPUP programme, which uses serial radiographic screening and early preventive surgery to prevent hip dislocation in children with cerebral palsy. Three cohorts totaling 792 children were compared: a historical control group (born 1990–1991) and two surveillance cohorts (born 1992–1997 and 1998–2007).
Hip dislocation in untreated CP occurs in 15–20% of children, develops silently between ages 2 and 5, and causes chronic pain and progressive deformity by the time it is clinically apparent. Waiting for symptoms guarantees you are already too late.
When you see a child with CP at GMFCS levels III–V, they need annual AP pelvis radiographs starting at diagnosis — not when the hip starts hurting. The trigger for surgery is an MP exceeding 40%, not symptoms.
For GMFCS IV–V children, plan for roughly a 1-in-2 chance of needing preventive surgery, and counsel families that re-operation (especially after tenotomy alone) is part of the management plan through skeletal maturity, not a complication.
This paper is the evidence base for hip surveillance programmes now adopted across Scandinavia and Australia, and is directly relevant to any OITE question on CP hip management thresholds or the role of GMFCS in surgical planning.