Should we recommend hip surveillance radiographs in children with bilateral cerebral palsy earlier than current local guidance of 30 months?

Abstract

Objectives: Current local guidance for hip surveillance in children with bilateral cerebral palsy (CP) recommends routine radiograph of the pelvis at age 30 months (earlier if clinical concern e.g. not sitting by 18 months, abnormal clinical examination) and referral to orthopaedic team if migration indices 30% or more (indicating subluxation). This clinical audit examines adherence to this guideline, ascertains the number of children with significant abnormalities on initial radiograph and the number who subsequently require intervention within a 3-5 year followup period. Methods: 33 children with bilateral CP born between January 2007 and December 2009 were identified via the physiotherapy database. Each child's electronic health records were used to ascertain age at first hip radiograph and outcome. Data was captured regarding migration index at first radiograph, highest migration index and any intervention undertaken. Results: 82% of eligible children had at least one hip radiograph, 37% by age 30 months. 33% had a migration index >30% at first radiograph. 18% required treatment (9% botu-linum toxin, 9% orthopaedic surgery). Conclusion: Adherence to guidance seems low. We have consistently found that 25-30% of all children with bilateral CP within our population have migration indices >30% at first hip radiograph regardless of age and thus recommend that: Clinicians be alerted to the need for clinical surveillance as well as routine radiological surveillance Current age for start of routine radiological surveillance should be reviewed.