Southampton surgeons lead development of national hip surveillance programme

Alex AarvoldOrthopaedic surgeons at Southampton Children’s Hospital are leading the development of a hip screening programme for children with cerebral palsy and other neuromuscular disorders to reduce the need for surgery.

The condition, a brain disorder that can cause the muscles to tighten and pull the hip joint out of place or lead to dislocation, affects around one in 500 people in the UK, with displacement or dislocation occurring in 60% of children who are not walking by the age of five.

However, as damage to the hip is gradual, it can be prevented if identified early.

Despite hip surveillance programmes being established in Scotland three years ago and in Sweden 20 years ago to address the problem, there is not currently any standard programme in England.

Now, by developing an electronic database of patients screened in southern England – known as the Cerebral Palsy Integrated Pathway, Southern England (CPIPSE) – the team in Southampton hope to create a standard model that can be rolled out nationwide.

Evidence from both Sweden and Scotland has shown that a standardised surveillance programme enables earlier detection of movement in the hips, with the proportion of children with cerebral palsy requiring surgery to treat their musculoskeletal deformity decreasing from 40% to 15%.

“Hip displacement or dislocation can have a major impact on a child’s life, including pain, deformity, limited mobility and an inability to carry out normal everyday activities,” explained Alex Aarvold, a consultant paediatric orthopaedic surgeon at Southampton Children’s Hospital and project lead.

“Yet we know there is progressive movement in the hip to full dislocation in patients with cerebral palsy and other neuromuscular disorders and movement can be easily quantified on a hip radiograph, which is inexpensive and simple to perform.

“As a result, it seems nonsensical to not have a standard programme in place nationwide to manage this group effectively.”

He explained that, while many local cerebral palsy hip surveillance programmes exist in specialist hospitals across England – including at Southampton Children’s Hospital – barriers to regional implementation currently exist due to difficulties in data sharing and lack of a database of children who should be having hip surveillance.

“Current hip surveillance guidelines in England are variably implemented due to the difficulty of data sharing in the community and, where local programmes do exist, patients often fall between community and hospital teams.”

Caroline Edwards, clinical lead for orthopaedics at Southampton Children’s Hospital, added: “This project will help to identify the volume of cerebral palsy patients in the community that have not been included in recommended hip surveillance programmes.”

Posted on Tuesday 4 July 2017