Hip Surveillance in Children with Cerebral Palsy: Why It Matters and What You Need to Know
"Discover the importance of hip surveillance programs for children with cerebral palsy, addressing practice variations and improving quality of care."
Cerebral palsy (CP) encompasses a group of conditions affecting movement and posture due to non-progressive disturbances in the developing brain. A significant concern for children with CP is the risk of hip displacement, which can lead to pain, impaired mobility, and reduced quality of life. Studies show that approximately 35% of children with CP experience hip displacement.
Hip surveillance programs are designed to detect progressive hip displacement early, enabling timely referral for orthopedic assessment and management. Early intervention can prevent hip dislocation and avoid the need for more extensive salvage surgery later on. While these programs have been adopted in various countries, a standardized approach is lacking in the United States.
A 2016 survey of the Pediatric Orthopaedic Society of North America (POSNA) aimed to understand current orthopedic practices regarding hip surveillance in children with CP, identify areas of variation, and explore the potential for developing national guidelines.
Surveillance as Active Monitoring
Hip surveillance is defined as the active monitoring process used to identify early indicators of hip displacement in children with cerebral palsy, with the expectation that all eligible children in a population participate. A 2024 systematic review examined evidence on whether integrated hip surveillance pathways improve pain, function, and quality-of-life outcomes. Hip dysplasia is described as the second most common orthopedic issue in children with cerebral palsy after equinus, and hip dislocation may cause pain and disability.
From Natural History to Guidelines
Sources describe hip displacement in cerebral palsy as a process in which a hip that is normal at birth may develop subluxation or dislocation because of abnormal development. Dislocation can lead to difficulty sitting, problems with custodial care, and hip pain. Professional societies, including the Australasian Academy of Cerebral Palsy and Developmental Medicine, the American Academy for Cerebral Palsy and Developmental Medicine, and the Pediatric Orthopaedic Society of North America, have contributed to establishing hip surveillance. Guidelines were introduced by AusACPDM in 2008 and AACPDM in 2016 to screen for hip displacement.
Understanding Hip Surveillance for Cerebral Palsy
The POSNA survey revealed several key insights. A majority of respondents (90%) agreed that a dislocated hip in a child with CP is painful and should be prevented through hip surveillance and surgical treatment. An overwhelming 93% indicated they would support a national surveillance program if one were available. Critical elements for a hip surveillance program were identified as age (79%), Gross Motor Function Classification System (GMFCS) level (81%), and migration percentage (MP) (78%).
- Age and GMFCS Level: When to start the first screening.
- Migration Percentage (MP): A key indicator of hip displacement.
- Radiographic Views: Standardized methods for taking radiographs.
Current Evidence and Operative Planning
Recent work is consolidating knowledge on diagnosis, surveillance protocols, and interventions for preventing and treating hip instability in children with cerebral palsy. A 2025 systematic review examined the effectiveness of European hip surveillance programmes in identifying and managing hip displacement and dislocation. A 2025 operative framework presents hip surveillance as foundational while also discussing emerging knee surveillance, growth modulation, coordinated spine considerations, and gait analysis for multilevel surgical decision-making.
Implementation Is Not One-Size-Fits-All
Hip surveillance guidelines must be adapted to the requirements of the local healthcare system. A province-wide implementation strategy was based on the strengths of that province's service delivery model and the authors caution that it may not be appropriate for every jurisdiction. The AACPDM pathway combines current best evidence with expert consensus where evidence is unavailable. Sources also report less agreement about the timing and choice of the initial intervention.
Comparing Planning Methods
A 2026 study examined how treatment plans based on Reimers migration percentage thresholds compare with plans made by an orthopedic surgeon after reviewing hip CT scans. The study retrospectively identified CT scans from children aged 18 years or younger with cerebral palsy performed between November 2018 and July 2024. The comparison addresses the reported uncertainty about the accuracy of migration percentage for treatment planning.
Moving Forward: Standardizing Hip Surveillance
The POSNA survey underscores the need for a standardized approach to hip surveillance in children with CP in the United States. While there is agreement on the importance of early detection and intervention, significant practice variations exist. The American Academy of Cerebral Palsy and Developmental Medicine (AACPDM), with input from POSNA members, is developing a clinical care pathway for hip surveillance. This initiative aims to synthesize current surveillance programs into a unified guideline, ultimately improving the quality and value of care for patients and families.
Surveillance as Preventive Care
The Pediatric Annals review recommends that all children with cerebral palsy be referred for hip surveillance at age 2 years. It reports that a growing body of literature links hip surveillance and appropriate orthopedic management with decreased or prevented hip dislocation. The review further connects this approach with implications for overall quality of life.
Impact on Surgical Management
A prospective study examined the impact of a hip surveillance clinic on the management of spastic hip disease in children with cerebral palsy at a tertiary referral centre. The study used a combination of approaches to evaluate that impact. Its focus highlights how surveillance can influence real-world clinical management rather than serving only as an imaging process.