CPIP hip surveillance

What is hip surveillance?

Hip surveillance are regular check-ups to monitor the position of a child’s hips. Sometimes a child’s hip can gradually move out of joint which can cause them problems. Hip surveillance aims to pick up on these problems early to allow appropriate management and better outcomes.

What hip problems are we looking for?

Typical hip

The hip is a ball and socket joint. The top of the thigh bone makes up the ball and part of the pelvis makes up the ‘socket’. In a healthy hip, the ball is completely covered by the socket.

Hip displacement

Hip displacement is when the ball gradually moves from under the socket. The more difficulty your child has with movement, particularly with standing and walking, the more at risk they of developing hip displacement. An X-ray is needed to see these changes.

Hip dislocation

Hip dislocation is when the ball has moved completely out from under the socket.

With increasing hip displacement and dislocation, your child may have or develop:

• pain
• decreased ability to move the hip, particularly taking their leg out to the side
• difficulty with personal care or toileting
• difficulty sitting or lying comfortably
• difficulty standing or walking
• pressure sores

Some children may have none of these signs or symptoms but still be experiencing changes to the position of their hips.

Who is hip surveillance important for?

Any child who is delayed in standing and walking can be at risk of developing hip problems. The more difficulty a child has with standing and walking, the greater the risk to their hips. Their hips can develop differently and will often have tight muscles making movements more difficult and encouraging them to rest in poor positions.

CPIP stands for the Cerebral Palsy Integrated Pathway. Children with Cerebral Palsy are at risk of developing hip problems. This is due to the impact their condition can have on their ability to stand and walk. The CPIP hip surveillance programme however is helpful for any child who has difficulty standing and walking regardless of their diagnosis.

If you are not sure if your child is at risk for hip displacement, please discuss with your child’s physiotherapist, or paediatrician.

What is involved in hip surveillance?

Hip surveillance includes assessments of your child’s hips by a physiotherapist and hip X-rays at scheduled times. Hip X-rays are taken to look at the position of the hip because hip displacement can happen without any signs or symptoms. Taking part in hip surveillance allows your child’s health care team to find hip displacement early and help your child before the hip becomes dislocated.

The CPIP hip surveillance program for children is supported by an orthopaedic consultant, physiotherapist and sometimes their paediatrician at Sheffield Children’s Hospital who work together. 

When will my child be seen for hip surveillance?

Your child should have their first CPIP assessment and hip X-ray at the age of 2. They should have an assessment every 6 months until the age of 6 and then every year up to the age of 16. How often they will need X-ray’s will depend on their age and ability to move.

What happens at a CPIP assessment ?

At each Clinical assessment, your child’s physiotherapist will:

• review your child’s ability to move
• measure the movement and muscle tone in your child’s legs
• review the position of your child’s spine in sitting or supported sitting
• ask you and your child questions about any pain when changing positions, difficulty during personal care, or a decrease in their ability to walk, sit, or stand
• if appropriate, watch your child’s walking

How are the X-rays done?

Your child’s physiotherapist will book them into an X-ray clinic at Sheffield Children’s Hospital. They will need to try and rest still with their legs as straight as possible.

The X-ray will be reviewed by the orthopaedic team at Sheffield Children’s Hospital. The amount of the ball that is outside the socket will be measured on the X-ray.

You and your child’s physiotherapist will receive a letter with the results and next steps.

What happens if the results are within normal limits?

Your child will continue to have assessments and X-rays as stated by CPIP, based in their age and ability to move.

What happens if my child has signs of hip displacement?

Your child will be referred to a paediatric orthopaedic surgeon who is experienced in treating hip displacement. They will ask questions about your child’s development, current abilities and any problems or pain they may be experiencing. The X-rays will be reviewed, another X-ray might be taken and they will assess the movement in your child’s hips. They will then discuss the options of how to move forwards. This may involve surgery but it may involve closer monitoring initially.

What is the treatment for hip displacement?

The treatment options will depend on your child’s needs. The goal of treatment will be to keep your child’s hip in place, make sure the hip moves easily, and prevent pain as your child gets older. If the hip moves to a certain point an operation is often needed to improve the hips position. Once a hip is fully dislocated, the process of trying to put the ball back into the socket becomes a more difficult procedure. The outcome of surgery can be less successful if the hip is dislocated.

The aim of CPIP hip surveillance is to detect and treat hip displacement early when treatment is simpler and has fewer complications. If your child’s orthopaedic team decide surgery is indicated they will discuss this with you in clinic. Any considerations around surgery will be dependent on your feelings, your child’s individual needs and overall health. Children who have surgery to treat their hip displacement should return to hip surveillance after surgery until they have stopped growing.

If you would like to discuss CPIP hip surveillance further please talk to your child’s physiotherapist.