Clipboard, Search History, and several other advanced features are temporarily unavailable. Method A three‐step review process was undertaken: (1) systematic literature review, (2) analysis of hip surveillance databases, and (3) national survey of orthopaedic surgeons managing hip displacement in children with CP. The initial search yielded 290 articles to be considered for inclusion (Fig. No radiograph is required at the 3‐year review unless the GMFCS or WGH classification has changed since previous assessment, or other risk factor has been identified, No radiograph is required at the 5‐year review unless the GMFCS or WGH classification has changed since previous assessment, or other risk factor has been identified, Recommendation to continue surveillance after 10y of age for adolescents with additional risk factors, Recommendation to continue surveillance after skeletal maturity for adolescents with additional risk factors, Recommendation to reduce surveillance between 5y and 10y of age, in the absence of additional risk factors, This aims to decrease the number of radiographs required and focus surveillance on the identified period of risk. Bony reconstruction of hip in cerebral palsy children Gross Motor Function Classification System levels III to V. Combined pelvic and femoral reconstruction in children with cerebral palsy. Should we include recommendations for children with acquired brain injury? Where eligibility could not be determined from the title and abstract alone, the full text of the article was obtained. Conclusions that may be drawn from the results of the survey are limited by the 63% response rate. A systematic review was conducted following the PRISMA guidelines,18 which examined published evidence of the effectiveness of formal hip surveillance programmes and factors that may be associated with progression of hip displacement in children with CP. These services collate longitudinal data related to the child's hip status (radiographic data including migration percentage), CP classification by movement disorder, topography, and functional ability (GMFCS), as well as information related to physiotherapy, spasticity, and surgical management. GMFCS, Gross Motor Function Classification System; WGH, Winters, Gage, and Hick's gait classification; QLD, Queensland; SA, South Australia; TAS, Tasmania; WA, Western Australia; NR, not recorded. The guideline was prepared for the NSW Ministry of Health by an expert clinical reference group and is aimed at achieving the best possible paediatric care in all parts of the state. Articles were excluded if (1) fewer than three participants were included, (2) hip displacement was due to congenital pathology, (3) the full‐text article was unavailable or it was an editorial or general opinion piece (level V evidence by the Oxford Levels of Evidence20), (4) non‐English language publication, or (5) published before 1985. This strategy was then modified for other databases. A second study reported excessive femoral anteversion having a higher correlation with hip displacement than neck shaft angle in ambulant children.24 Earlier work reported increased neck shaft angle (defined as coxa valga exceeding 160%) in children under 5 years of age as being a poor prognostic sign for future ambulatory ability, and associated with a higher rate of progression of migration percentage.30 All three studies found that changes in femoral geometry contributed to hip displacement and to ambulatory function, but that ambulatory function itself had a clearer relationship with progressive migration percentage. Any disagreement about eligibility was resolved by discussion, with inclusion requiring the agreement of at least two of the three reviewers. In 21 children (64%), hip displacement had resolved to a migration percentage <30% at subsequent radiographic review. Australian hip surveillance guidelines for children with cerebral palsy: five year review. If identified as group IV hemiplegia as described by WGH IV, ongoing surveillance according to WGH classification, Repeat clinical assessment and radiograph, If MP is stable, discharge from surveillance, If MP is abnormal and/or unstable, continue 12‐monthly surveillance until stability is established or skeletal maturity, In the presence of pelvic obliquity, leg length discrepancy, or deteriorating gait, continue 12‐monthly surveillance, If MP is stable, below 30%, and gross motor function is stable, radiographs may be temporarily discontinued until pre‐puberty, Twelve‐monthly radiographs must resume pre‐puberty and continue until skeletal maturity, If MP is abnormal and/or unstable, continue 6‐monthly surveillance until MP stability established, If MP is stable, below 30%, and gross motor function is stable, AP pelvic radiographs may be discontinued until pre‐puberty, Twelve‐monthly AP pelvic radiographs must resume pre‐puberty and continue until skeletal maturity, At skeletal maturity, in the presence of pelvic obliquity, leg length discrepancy, or deteriorating gait, continue 12‐monthly surveillance, If MP is stable, below 30%, and gross motor function is stable, surveillance may be temporarily discontinued until pre‐puberty, Independent of MP, if clinical and/or radiographic evidence of scoliosis or pelvic obliquity is present, 6‐monthly surveillance is required until skeletal maturity, If MP is stable, below 30% and gross motor function is stable, surveillance may be discontinued until pre‐puberty, At skeletal maturity, if MP is abnormal and progressive scoliosis or significant pelvic obliquity is present, continue 12‐monthly surveillance, If MP is stable, below 30%, and gross motor function is stable, continue 12‐monthly surveillance until skeletal maturity, Independent of MP, when clinical and/or radiographic evidence of scoliosis or pelvic obliquity is present, 6‐monthly surveillance is required until skeletal maturity, Hip surveillance continues 12‐monthly until skeletal maturity, If MP is abnormal and/or unstable, continue 12‐monthly surveillance until MP stability established, Following the postoperative period for any child who has undergone surgery for hip management, Following an unplanned break in surveillance for any other medical reason, Following neurosurgical interventions such as selective dorsal rhizotomy, or intrathecal baclofen, As part of the transition plan the hip should be classified according to the MCPHCS, Ongoing referral for orthopaedic review should occur in the presence of pain, progressive scoliosis, significant pelvic obliquity, and/or deteriorating function.

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