Outcomes of hip surveillance for ambulatory children with cerebral palsy: GMFCS I and WGH Type IV gait pattern

Abstract

Objective: To report the outcomes from 10 years of a Hip Surveillance (HS) programme for two cohorts of ambulatory children with cerebral palsy (CP) within a large state-wide population: those highly functional children classified as Gross Motor Classification System 1 (GMFCS I) and those children with unilateral involvement, classified with Winter Gage & Hicks (WGH) hemiplegic gait pattern type IV. HS programmes have been challenged by paucity of evidence supporting protocols for these two cohorts as identified in the most recent Australian HS Guidelines (2014). Study Design: Prospective population study. Methods: Recruitment to the Queensland (Qld) HS programme was coordinated by the tertiary paediatric health service. The HS programme adhered to national guidelines (2008, 2014). A population of 2278 children with CP, born in the years 1995-2016 were registered for HS. Children were grouped according to GMFCS and those with hemiplegia were classified by WGH gait pattern. The primary outcome measures included Reimer's migration percentage (MP) where a radiographic measure of MP≥30% was used to denote a problem of displacement and hip dislocation. Results: Of the total cohort (n=2278), the two cohorts discussed in this paper include: GMFCS I: 837 children (37%) were classified GMFCS I: 80 were discharged as highly functional with no pelvic radiograph taken. The remaining 757 children had one or more pelvic radiographs, with 31 (3.7%) having an MP≥30%. Of this subset, 10 remain on active surveillance (age≤5 years). All the discharged patients resolved to MP below 30% by skeletal maturity, with the exception of two. The average age of resolution of MP to below 30% was 4.4 years (range 1.6 to 12.6 years). WGH IV: 650 children were classified with hemiplegia (28.5%). WGH gait classification was identified for 492 (76%) of these children, representing classifications: WGH I n=113, WGH II n=306, WGH III n=49 and WGH IV n=24. Of the subset WGH IV, 11 children remain on active surveillance, 3 lost to follow-up, 4 discharged by protocol, 6 under orthopaedic care including two with displaced hips. Conclusions: Our data, based this population cohort, demonstrates that although some GMFCS I children may show early hip displacement this generally resolves, providing argument for either later age of single X-ray or no X-ray at all. Children presenting as WGH IV were a small subset of our cohort. Six (25%) of these children required orthopaedic intervention. This highlights the need for this patient group being followed up carefully.L6213533352018-03-27 <br />