[Shriners Children's logo]
Steven Wilding, M.D., Pediatric Orthopedic Surgeon:
Hi, I'm Dr. Steven Wilding. As parents of a child with cerebral palsy or CP, you're already juggling so much, and we understand this video is designed to make understanding hip surveillance a little easier. We'll explain what can happen with your child's hips and how we can work together to keep them healthy and strong. CP affects how the brain, nervous system, and muscles communicate. While CP is the most common neuromuscular condition, other conditions like spina bifida, muscular dystrophy, and others can also impact muscle control. Because CP is the most common, we'll primarily discuss it today. Children with CP are born with healthy hips. However, because of the way CP affects muscle tone and movement, their hips are at a higher risk of gradually moving out of the socket, a process called hip migration or displacement. Imagine the hip socket as a cup for the ball of the thigh bone.
In hip migration, the ball slowly starts to slip out of that cup. This can happen in up to one third of children with cerebral palsy. The tricky thing is it often happens slowly and painlessly at first. That's why regular checkups are so important. While there might not be any obvious signs at the beginning, untreated hip migration can eventually lead to pain, difficulty moving arthritis, challenges with hygiene for caregivers and an overall lower quality of life. But early intervention can make a huge difference. By catching hip migration early, we can often prevent it from progressing and avoid these problems.
[Diagram explaining "Migration Percentage" and proper positioning for AP pelvic radiographs. On the left, a pelvic X-ray diagram illustrates how to calculate Migration Percentage (MP = A/B x 100%), showing segments A and B within the hip joint. On the right, a guide for correct patient positioning includes illustrations: the top image shows the correct alignment with legs parallel, patellae facing upward, and a horizontal pelvis; the middle image shows an incorrect position with a lordotic lumbar spine; the bottom image shows the correct position with a flat spine supported by padding under the knees. The image is branded with the Shriners Children's logo.]
That's where hip surveillance guidelines come in. These guidelines developed by the Pediatric Orthopedic Society of North America help us track your child's hip health. The first evaluation usually happens around age two or whenever your child is diagnosed with CP. It includes a simple range of motion exam, focusing on how far your child's hips can move outward or hip abduction.
We'll show you what that looks like. This visit will also include an x-ray of their pelvis.
[Infographic titled "Hip Screening Guidelines" for children who are ambulatory without handheld mobility aids (GMFCS Level I & II). On the left are icons representing running, stair climbing, and hip posture labeled "Winters and Gage Type IV" with hip flexion, adduction, and internal rotation. On the right is a pink table detailing screening recommendations:
- Age 2: Clinical exam and AP pelvis.
- Age 6: Clinical exam and AP pelvis.
- Age 10: Clinical exam and AP pelvis. If Winters and Gage Type IV hemiplegia is present, perform clinical exam and AP pelvis every 2 years until skeletal maturity (closed triradiate cartilage).
- Skeletal Maturity: Clinical exam and AP pelvis. Screening can stop at skeletal maturity (triradiate closure) if migration percentage (MP) is less than 30%.]
Depending on your child's type of CP, whether it's mild, moderate, or severe, and their initial visit, we'll recommend how often they need follow-up checks.
[Infographic titled "Hip Screening Guidelines" for children who are ambulatory with handheld mobility aids (GMFCS Level III). On the left, there are icons of a child using a walker and a child in a wheelchair. On the right, a pink table outlines screening recommendations:
- Age 2 – 10: Clinical exam and AP pelvis every 12 months after age 2.
- Age 10 – Skeletal Maturity: Clinical exam and AP pelvis every 2 years, provided migration percentage (MP) was stable over the previous 2 years.
- Skeletal Maturity: Clinical exam and AP pelvis. Screening frequency may decrease if MP is less than 30% and stable over 2 years after skeletal maturity (closed triradiate cartilage).]
This might involve repeat range of motion exams and x-rays. The goal is to monitor their hips closely and catch any changes early.
[Infographic titled "Hip Screening Guidelines" for marginal ambulatory and non-ambulatory children (GMFCS Level IV & V). On the left are icons of children in wheelchairs and one using a walker. On the right, a pink table outlines screening recommendations:
- Age 2 – Skeletal Maturity: Clinical exam and AP pelvis every 6–12 months until age 10. After age 10, visits may decrease to yearly if the migration percentage (MP) is stable and under 30%.
- After Skeletal Maturity: Clinical exam and AP pelvis. Screening frequency may decrease if MP is less than 30% and shows no change over 2 years after skeletal maturity (closed triradiate cartilage).]
You'll be referred to a pediatric orthopedic surgeon if your child has any hip pain, a decrease in hip motion, limited hip abduction, or if the x-ray shows over 30% migration. If a referral is needed, we'll do a thorough assessment and discuss treatment options with you. These could include continued monitoring, minor procedures like tendon lengthening, or more involved bony realignment surgery. We'll explain everything clearly and answer all your questions. Our ultimate goal here at Shriners Children's Northern California is to help your child live a full and happy life. We're here to partner with you every step of the way.
[Title card: Shriners Children's Northern California]
