Hip Surveillancing in Cerebral Palsy

Question 1

When should regular hip monitoring begin? How often should reviews occur?

Answer 1

Commence at 12 months of age or at time of diagnosis. Reviews occur every 6-12 months

Question 2

What treatment is used to manage hip dislocation risk?

Answer 2

• BTX-A injection to the adductors + SWASH brace

- Early hip adductor release +/- obturator nerve block

Question 3

What is Hilgenreiner’s line?

Answer 3

The H-line is through the mid point of the tri-radiate cartilage.

Question 4

What is Perkin’s line?

Answer 4

A vertical line drawn perpendicular to the H-line at the lateral margin of acetabulum.

Question 5

What is the migration percentage? What is the normal value?

Answer 5

Percent of femoral head uncovered by acetabular roof. Normal adult hip = 0 or negative

Question 6

What is the acetabular index (AI)?

Answer 6

Slope of acetabular roof

Question 7

At what acetabular index value should close monitoring begin?

Answer 7

Over 27 degrees

Question 8

At what migration percentage should close monitoring and orthopaedic intervention be considered?

Answer 8

20% = close monitoring
30% = consider surgery

Question 9

What is Shenton’s line? What does a break suggest?

Answer 9

The apparent line between the medial femoral neck curve and superior obturator foramen. A break suggests a superior displacement

Question 10

What does a larger femoral neck angle suggest?

Answer 10

A straighter femoral neck and a higher risk of hip displacement

Question 11

When should orthopaedic referral be made?

Answer 11

• MP >20-30%
• Increased of 10% in MP over 6 months
• <25 degrees ROM hip abduction
• Marked asymmetry
• Difficulties with hygiene care or apparent pain/discomfort