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    The document provides guidelines for hip surveillance in children with cerebral palsy. It recommends initial clinical assessment and pelvic radiographs between 12-24 months of age or at identification if older. Follow-up is recommended based on the child's Gross Motor Function Classification System (GMFCS) level, with more frequent follow-up for higher GMFCS levels or if the child has abnormal hip morphology or gait deterioration. Surveillance continues until skeletal maturity is reached.

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    The document provides guidelines for hip surveillance in children with cerebral palsy. It recommends initial clinical assessment and pelvic radiographs between 12-24 months of age or at identification if older. Follow-up is recommended based on the child's Gross Motor Function Classification System (GMFCS) level, with more frequent follow-up for higher GMFCS levels or if the child has abnormal hip morphology or gait deterioration. Surveillance continues until skeletal maturity is reached.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    300 views1 page

    Hip Surveillance

    Uploaded by

    smartie_chai
    The document provides guidelines for hip surveillance in children with cerebral palsy. It recommends initial clinical assessment and pelvic radiographs between 12-24 months of age or at identification if older. Follow-up is recommended based on the child's Gross Motor Function Classification System (GMFCS) level, with more frequent follow-up for higher GMFCS levels or if the child has abnormal hip morphology or gait deterioration. Surveillance continues until skeletal maturity is reached.

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    © All Rights Reserved
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    of 1

    Australian Hip Surveillance Guidelines

    for children with Cerebral Palsy 2014


    • Initial clinical assessment and antero-posterior ~ If GMFCS level has changed, ongoing surveillance ~ If GMFCS I is confirmed, repeat clinical
    (AP) pelvic radiograph at 12-24 months of age according to confirmed classification assessment. AP pelvic radiograph is NOT
    (or at identification if older than 24 months) – I f identified as Winters, Gage and Hicks (WGH) required and if nil other significant signs,
    GMFCS I

    IV hemiplegia, ongoing surveillance according discharge from surveillance


    • Review at 3 years of age ~ If GMFCS level has changed, ongoing
    to WGH IV classification
    – Verify GMFCS level surveillance according to confirmed
    ~ If GMFCS I is confirmed, repeat clinical • Review at 5 years of age classification
    assessment. AP pelvic radiograph is – Verify GMFCS level – I f identified as WGH IV hemiplegia,
    NOT required ongoing surveillance according to WGH IV
    classification

    • Initial clinical assessment and AP pelvic radiograph • Review at 4-5 years of age ~ If GMFCS II confirmed, repeat clinical
    at 12-24 months of age (or at identification if older – Verify GMFCS level assessment and AP pelvic radiograph
    than 24 months) ~ If GMFCS level has changed, or if identified
    ~ If GMFCS II confirmed, repeat clinical
    assessment and AP pelvic radiograph as WGH IV hemiplegia, ongoing surveillance
    • Review 12 months later
    GMFCS II

    according to confirmed classification


    – Verify GMFCS level ~ If GMFCS level has changed, or if identified
    as WGH IV hemiplegia, ongoing surveillance – I f MP is stable, discharge from surveillance
    ~ If GMFCS II confirmed, repeat clinical
    according to confirmed classification – I f MP is abnormal and/or unstable, continue 12
    assessment and AP pelvic radiograph
    – I f MP is stable, review at 8-10 years of age monthly surveillance until stability is established
    ~ If GMFCS level has changed, ongoing surveillance or skeletal maturity
    according to confirmed classification – I f MP is abnormal and/or unstable, continue 12
    monthly surveillance until stability is established • In the presence of pelvic obliquity, leg length
    – If MP is abnormal and/or unstable, continue 12
    monthly surveillance until stability is established • Review at 8-10 years of age, prepuberty discrepancy or deteriorating gait, continue
    12 monthly surveillance
    – When MP is stable, review at 4-5 years of age –V
     erify GMFCS level

    • Initial clinical assessment and AP pelvic radiograph – When MP is stable, reduce frequency to 12 monthly – I f MP is stable, below 30%, and gross motor
    at 12-24 months of age surveillance function is stable, AP pelvic radiographs may
    be discontinued until prepuberty
    GMFCS III

    • Review 6 months later • Review at 7 years of age


    – 12 monthly AP pelvic radiographs
    – Verify GMFCS level – Verify GMFCS level must resume prepuberty and continue until
    ~ If GMFCS III confirmed, repeat clinical ~ If GMFCS III confirmed, repeat clinical skeletal maturity
    assessment and AP pelvic radiograph assessment and AP pelvic radiograph
    ~ If GMFCS level has changed, ongoing surveillance ~ If GMFCS level has changed, ongoing surveillance • At skeletal maturity, in the presence of pelvic
    according to confirmed classification according to confirmed classification obliquity, leg length discrepancy or deteriorating
    gait, continue 12 monthly surveillance
    – If MP is abnormal and/or unstable, continue 6 – If MP is abnormal and/or unstable, continue 6
    monthly surveillance until MP stability is established monthly surveillance until MP stability is established

    • Initial clinical assessment and AP pelvic radiograph – I f MP is abnormal and/or unstable, continue 6 • Independent of MP, when clinical and/or
    at 12-24 months of age monthly surveillance until MP stability is established radiographic evidence of scoliosis or pelvic
    – When MP is stable, reduce frequency of surveillance obliquity is present, 6 monthly surveillance
    GMFCS IV

    • Review 6 months later is required until skeletal maturity


    to 12 monthly
    – Verify GMFCS level • At skeletal maturity, if MP is abnormal
    ~ If GMFCS IV confirmed, repeat clinical • Review at 7 years of age and progressive scoliosis or significant
    assessment and AP pelvic radiograph – If MP is stable, below 30% and gross motor pelvic obliquity is present continue
    ~ If GMFCS level has changed, ongoing surveillance function is stable, surveillance may be discontinued 12 monthly surveillance
    according to confirmed classification until prepuberty
    – 12 monthly AP pelvic radiographs must resume
    prepuberty and continue until skeletal maturity

    • Initial clinical assessment and AP pelvic radiograph ~ If GMFCS level has changed, ongoing • I ndependent of MP, when clinical and/or
    at 12-24 months of age surveillance according to confirmed radiographic evidence of scoliosis or pelvic
    classification obliquity is present, 6 monthly surveillance
    GMFCS V

    • Review 6 months later is required until skeletal maturity


    • Review at 7 years of age
    • Repeat clinical assessment and AP pelvic radiograph – I f MP is stable, below 30% and gross motor • At skeletal maturity, if MP is abnormal
    function is stable, continue 12 monthly surveillance and progressive scoliosis or significant
    – Verify GMFCS level
    until skeletal maturity pelvic obliquity is present, continue
    ~ If GMFCS V confirmed, continue 6 monthly 12 monthly surveillance
    surveillance until 7 years of age or until
    MP stability is established
    Hicks hemiplegia group

    WGH IV gait pattern clearly declares itself by 4-5 years •R


     eview at 10 years of age Group I Group II Group III Group IV
    Winters, Gage and

    of age. The child with a classification of WGH IV has the – Verify WGH IV Foot drop True equinus True equinus/ Equinus/ Pelvic rotation, hip flexed,
    jump knee jump knee adducted, internal rotation
    potential for late onset progressive hip displacement
    IV (WGH IV)

    ~ If WGH IV confirmed, repeat clinical


    regardless of GMFCS level.
    assessment and AP pelvic radiograph
    • Review at 5 years of age ~ Continue 12 monthly surveillance
    – Verify WGH and GMFCS until skeletal maturity
    ~ If WGH I-III, ongoing hip surveillance according
    • At skeletal maturity if significant scoliosis, pelvic
    160698 October 2016

    to confirmed GMFCS
    obliquity, leg length discrepancy or deteriorating
    ~ If WGH IV and MP stable, review 10 years of age gait, continue 12 monthly surveillance
    – If MP is abnormal and/or unstable, continue 12
    monthly surveillance until MP stability established Gait patterns in hemiplegia (Winters, Gage and Hicks, 1987)

    Australian Hip Surveillance Guidelines Endorsed by:

    for children with Cerebral Palsy 2014


    Wynter M, Gibson N, Kentish M, Love SC, Thomason P, Willoughby K, Graham HK
    Due for review by December 2019
    Download available from: www.ausacpdm.org.au/professionals/hip-surveillance

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