Child with cerebral palsy confidently walking with orthopedic support in a playground.

Hip Surveillance in Children with Cerebral Palsy: Why Early Detection Matters

Mira Elwood in Health & Wellness December 2025 • 4 min read.

"A new study reveals the critical need for standardized hip surveillance programs to prevent painful dislocations and improve the quality of life for children with cerebral palsy."

Cerebral palsy (CP) refers to a cluster of neurological disorders that impact movement and posture development. These conditions arise from non-progressive disturbances in the developing fetal or infant brain. A significant complication affecting these children is hip displacement, with studies indicating an incidence rate of approximately 35%.

Hip displacement can significantly impact the quality of life for children with CP, leading to pain, impaired sitting, standing, and walking abilities. Early detection and intervention are crucial to prevent hip dislocations and the need for extensive salvage surgery. This is where hip surveillance programs come in. These programs aim to identify progressive hip displacement early, facilitating timely referral for orthopedic assessment and management.

While countries like Australia and those in Europe have implemented national or state hip surveillance programs for children with CP, the United States lags. Recognizing this gap, researchers from the Pediatric Orthopaedic Society of North America (POSNA) conducted a survey to assess the current practices and attitudes toward hip surveillance among its members. The goal? To identify areas of practice variation and lay the groundwork for national neuromuscular hip surveillance guidelines.

Why is Hip Surveillance So Important for Children with Cerebral Palsy?

Child with cerebral palsy confidently walking with orthopedic support in a playground.

Hip surveillance programs are designed to monitor the hips of children with cerebral palsy regularly, using radiographic imaging, to detect early signs of displacement. Early identification enables prompt intervention, preventing further deterioration that could necessitate extensive surgery. This proactive approach is crucial because hip dislocation can lead to several complications:

Pain: Dislocated hips can cause chronic pain, significantly impacting a child's comfort and well-being.
Functional Impairment: Hip problems can hinder a child's ability to sit, stand, and walk, restricting their independence and participation in daily activities.
Reduced Quality of Life: The combination of pain and functional limitations can negatively affect a child's overall quality of life.

The POSNA survey highlighted the importance of key elements in hip surveillance programs. Factors such as age, Gross Motor Function Classification System (GMFCS) level, and migration percentage (MP) were identified as critical components. Most respondents agreed that a hip MP between 20% and 30% indicates a hip "at risk," warranting close monitoring, while surgery is generally considered when the MP exceeds 40%.

The Path Forward: Toward National Guidelines

The POSNA survey underscores a clear consensus: hip dislocation in children with CP is painful and preventable. The survey also reveals a strong desire among orthopedic surgeons for a national hip surveillance program. Such a program would standardize practices, reduce variations in care, and ultimately improve the outcomes for children with cerebral palsy. The American Academy of Cerebral Palsy and Developmental Medicine (AACPDM), is actively developing a clinical care pathway for hip surveillance. This collaborative effort, with input from POSNA members, promises to provide a unified approach to hip surveillance, ensuring that more children with CP receive the timely care they need to live fuller, more comfortable lives.

About this Article -

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Everything You Need To Know

What is the primary goal of hip surveillance programs for children with Cerebral Palsy?

The primary goal of hip surveillance programs is to detect early signs of hip displacement in children with Cerebral Palsy. Early detection allows for prompt intervention, preventing the progression to hip dislocation and the need for extensive salvage surgery. This proactive approach aims to improve the child's overall well-being by mitigating pain and functional impairments associated with hip displacement.

Why is early detection of hip displacement crucial for children with Cerebral Palsy?

Early detection of hip displacement is crucial because it allows for timely intervention before the condition progresses to hip dislocation. Hip dislocation can lead to chronic pain, impaired sitting, standing, and walking abilities, as well as a reduced quality of life. Early intervention can prevent these complications, improving the child's comfort, mobility, and overall well-being. Hip surveillance programs use radiographic imaging to monitor children and detect early signs of displacement.

What role does the Gross Motor Function Classification System (GMFCS) level play in hip surveillance programs?

The Gross Motor Function Classification System (GMFCS) level is a critical component of hip surveillance programs. It helps healthcare professionals understand the child's functional abilities. Combined with age and migration percentage (MP), the GMFCS level is used to assess the risk of hip displacement and tailor the monitoring and intervention strategies. Children with higher GMFCS levels may be at a greater risk of hip displacement and may require more frequent surveillance.

How does hip displacement impact the quality of life for children with Cerebral Palsy?

Hip displacement can significantly impact the quality of life for children with Cerebral Palsy in several ways. It can cause chronic pain, hindering a child's comfort and well-being. It can also impair their ability to sit, stand, and walk, restricting their independence and participation in daily activities. The combination of pain and functional limitations can lead to a reduced overall quality of life for the child.

What are the key elements that orthopedic surgeons consider in hip surveillance programs for children with Cerebral Palsy?

Orthopedic surgeons consider several key elements in hip surveillance programs for children with Cerebral Palsy. Factors such as age, Gross Motor Function Classification System (GMFCS) level, and migration percentage (MP) are identified as critical components. Most respondents in the survey agreed that a hip MP between 20% and 30% indicates a hip "at risk," warranting close monitoring, while surgery is generally considered when the MP exceeds 40%. These factors help guide the frequency of radiographic imaging and inform decisions regarding intervention strategies.