Table 1.
Table showing similarities and differences between various international hip surveillance models
| Category | Scandinavian | Australian | British Columbian | AAPCDM |
|---|---|---|---|---|
| 1. Year established | 1994 |
2008 Revised 2014 |
2012 | 2017 |
| 2. Evaluation done by whom and what it includes |
Done by physical therapists Evaluation includes Gross and fine motor function Upper limb and lower limb range of motion Spine examination Radiographs |
Done by physical therapists Evaluation includes Gross and fine motor function Upper limb and lower limb range of motion Radiographs Spine examination Limb length Gait |
Done by physical therapists Evaluation includes Gross and fine motor function Upper limb and lower limb range of motion Radiographs Spine examination Limb length Gait |
Done by physical therapists Evaluation includes Gross and fine motor function Upper limb and lower limb range of motion Radiographs Spine examination Limb length Gait |
| 3. Evaluation of various GMFCS levels | ||||
| GMFCS I | ||||
| Clinical examination (CE) | Every 6 months till 6 years of age and then 12 monthly thereafter till skeletal maturity |
Starts at 12–24 months of age Review at 3 and 5 years |
12 monthly till 5 years of age |
Starts at 2 years of age Review at 4 and 6 years of age |
| Radiographs (AP pelvis with both hips) | No X-ray (unless deterioration of hip/spine examination) | No X-ray |
X-ray at 5 years of age If normal, discharge from surveillance |
No X-ray |
| GMFCS II | ||||
| Clinical examination (CE)` |
Every 6 months till 6 years age and then 12 monthly thereafter till skeletal maturity Discharge at skeletal maturity |
12 months after commencement If MP unstable/abnormal, repeat 12 monthly until stabilized. If MP stable, review at 4–5 years of age. At 4–5 years of age, if MP unstable/abnormal, repeat 12 monthly until stabilized. If MP stable, review at 8–10 years of age At 8–10 years, if MP unstable then repeat 12 monthly until stabilized or patient reaches skeletal maturity |
12 monthly till 5 years of age | Every 24 months from 2 to 10 years of age |
| Radiographs (AP pelvis with both hips) |
At age 2 and 6 years After 6 years—if no deterioration on CE and MP < 33%, no further X-rays required |
12 months after commencement If MP unstable/abnormal, repeat 12 monthly until stabilized. If MP stable, review at 4–5 years of age. At 4–5 years of age, if MP unstable/abnormal, repeat 12 monthly until stabilized. If MP stable, review at 8–10 years of age At 8–10 years, if MP unstable then repeat 12 monthly until stabilized or patient reaches skeletal maturity If MP stable, discharge from surveillance |
X-ray at 5 years of age If normal, discharge from surveillance |
X-ray at 2, 6, 10 years of age If MP < 30% at 10 years of age, discharge from surveillance |
| GMFCS III | ||||
| Clinical examination |
Every 6 months till 6 years age and then 12 monthly thereafter till skeletal maturity After skeletal maturity If MP stable/normal and no scoliosis, continue only clinical surveillance |
6 months after commencement If unstable/abnormal repeat every 6 monthly until stabilized If MP stable, repeat every 12 monthly Review at 7 years of age If unstable/abnormal, repeat every 6 monthly until stabilized If MP stable/normal, discontinue surveillance till pre-pubertal age Review at pre-puberty |
After initial clinical examination, review at 24 months of age and 12 monthly thereafter till 6 years of age 12 monthly from 6 years of age till skeletal maturity |
Every 12 monthly from 2 to 8 years of age Every 24 months from 8 to 16 years of age or till skeletal maturity |
| Radiographs (AP pelvis with both hips) |
Every 12 months till 8 years of age After 8 years till skeletal maturity—X-ray frequency individualized based on previous clinical and X-ray findings If MP stable/normal, X-rays every 24 months till skeletal maturity After skeletal maturity, no further X-rays if MP < 33% and no scoliosis. If MP abnormal, progressive scoliosis or pelvic obliquity, continue surveillance |
6 months after commencement If unstable/abnormal repeat every 6 monthly until stabilized If MP stable, repeat every 12 monthly Review at 7 years of age If unstable/abnormal, repeat every 6 monthly until stabilized If MP stable/normal, discontinue surveillance till pre-pubertal age Review at pre-puberty X-ray 12 monthly till skeletal maturity At skeletal maturity If MP stable/normal, discontinue surveillance If MP abnormal, gait deterioration, progressive scoliosis or pelvic obliquity, continue surveillance 12 monthly |
Initial X-ray at 24 months of age and 12 monthly thereafter till 6 years of age. Every 24 months from 6 years of age till skeletal maturity |
Every 12 monthly from 2 to 8 years of age Every 24 months from 8 to 16 years of age or till skeletal maturity If MP unstable/abnormal, repeat every 12 monthly until stabilized At skeletal maturity If MP stable/normal, discontinue surveillance If MP abnormal, progressive scoliosis or pelvic obliquity, continue surveillance |
| GMFCS IV | ||||
| Clinical examination |
Every 6 months till 6 years of age and then 12 monthly thereafter till skeletal maturity After skeletal maturity If MP stable/normal and no scoliosis, continue only clinical surveillance |
6 months after commencement If unstable/abnormal repeat every 6 monthly until stabilized If MP stable, repeat every 12 monthly Review at 7 years of age If MP unstable/abnormal, repeat every 6 monthly until stabilized If MP stable/normal, discontinue surveillance till pre-pubertal age Review at pre-puberty |
After initial clinical examination, review at 24 months of age and 6 monthly thereafter till 6 years of age 12 monthly from 6 years of age till skeletal maturity |
6 monthly from 2 to 4 years of age 12 monthly from 4 years of age till 16 years of age or skeletal maturity |
| Radiographs (AP pelvis with both hips) |
Every 12 months till 8 years of age After 8 years till skeletal maturity—X-ray frequency individualized based on previous clinical and X-ray findings If MP stable/normal, X-rays every 24 months till skeletal maturity After skeletal maturity, no further X-rays if MP < 33% and no scoliosis If MP abnormal, progressive scoliosis or pelvic obliquity, continue surveillance |
6 months after commencement If unstable/abnormal repeat every 6 monthly until stabilized If MP stable, repeat every 12 monthly Review at 7 years of age If MP unstable/abnormal, repeat every 6 monthly until stabilized If MP stable/normal, discontinue surveillance till pre-pubertal age Review at pre-puberty X-ray 12 monthly till skeletal maturity At skeletal maturity If MP stable/normal, discontinue surveillance If MP abnormal, gait deterioration, progressive scoliosis or pelvic obliquity, continue surveillance 12 monthly |
Initial X-ray at 24 months of age and 6 monthly thereafter till 6 years of age 12 monthly from 6 years of age till skeletal maturity |
6 monthly from 2 to 4 years of age If MP unstable/abnormal, repeat every 6 monthly until stabilized If MP stable/normal, 12 monthly from 4 years of age till 16 years of age or skeletal maturity At skeletal maturity If MP stable/normal, discontinue surveillance If MP abnormal, progressive scoliosis or pelvic obliquity, continue surveillance |
| GMFCS V | ||||
| Clinical examination |
Every 6 months till 6 years of age and then 12 monthly thereafter till skeletal maturity After skeletal maturity If MP stable/normal and no scoliosis, continue only clinical surveillance |
6 months after commencement. 6 monthly till 7 years of age Review at 7 years of age If MP stable/normal, 12 monthly till skeletal maturity If MP abnormal, presence of scoliosis or pelvic obliquity, 6 monthly till skeletal maturity At skeletal maturity If MP stable/normal, discontinue surveillance If MP abnormal, progressive scoliosis or pelvic obliquity, continue surveillance 12 monthly |
After initial clinical examination, review at 24 months of age and 6 monthly thereafter till 6 years of age 12 monthly from 6 years of age till skeletal maturity |
6 monthly from 2 to 4 years of age 12 monthly from 4 years of age till 16 years of age or skeletal maturity |
| Radiographs (AP pelvis with both hips) |
Every 12 months till 8 years of age After 8 years till skeletal maturity—X-ray frequency individualized based on previous clinical and X-ray findings If MP stable/normal, X-rays every 24 months till skeletal maturity After skeletal maturity, no further X-rays if MP < 33% and no scoliosis If MP abnormal, progressive scoliosis or pelvic obliquity, continue surveillance |
6 months after commencement 6 monthly till 7 years of age Review at 7 years of age If MP stable/normal, 12 monthly till skeletal maturity If MP abnormal, presence of scoliosis or pelvic obliquity, 6 monthly till skeletal maturity At skeletal maturity If MP stable/normal, discontinue surveillance If MP abnormal, progressive scoliosis or pelvic obliquity, continue surveillance 12 monthly |
Initial X-ray at 24 months of age and 6 monthly thereafter till 6 years of age 12 monthly from 6 years of age till skeletal maturity |
6 monthly from 2 to 4 years of age If MP unstable/abnormal, repeat every 6 monthly until stabilized If MP stable/normal, 12 monthly from 4 years of age till 16 years of age or skeletal maturity At skeletal maturity If MP stable/normal, discontinue surveillance If MP abnormal, progressive scoliosis or pelvic obliquity, continue surveillance |
| 4. WGH type IV | ||||
| Clinical examination | Does not mention |
Review at 5 years of age If MP unstable/abnormal, repeat 12 monthly until stabilized If MP stable, review at 10 years of age After 10 years of age, 12 monthly till skeletal maturity At skeletal maturity If MP stable/normal, discontinue surveillance If MP abnormal, progressive scoliosis or pelvic obliquity, continue surveillance 12 monthly |
12 monthly from 2 years of age till skeletal maturity but review at 5 years of age | Every 24 months from 2 years of age till skeletal maturity |
| Radiographs (AP pelvis with both hips) |
Review at 5 years of age If MP unstable/abnormal, repeat 12 monthly until stabilized If MP stable, review at 10 years of age After 10 years of age, 12 monthly till skeletal maturity At skeletal maturity If MP stable/normal, discontinue surveillance If MP abnormal, progressive scoliosis or pelvic obliquity, continue surveillance 12 monthly |
Review at 5 years of age with X-ray 12 monthly from 5 years of age till skeletal maturity |
X-ray at 2, 6, 10 years of age Every 24 months from 10 to 16 years of age or till skeletal maturity. At skeletal maturity If MP stable/normal, discontinue surveillance If MP abnormal, progressive scoliosis or pelvic obliquity, continue surveillance |
|
| 5. Orthopaedic referral | MP > 33% | MP > 30% and/or unstable MP and/or hip pain |
MP > 30% Hip abduction < 30° Presence of hip pain Difficulty in ADLs related to the hip Decreased ability to walk, sit, or stand related to the hip |
MP > 30% Hip abduction < 30° Presence of hip pain on history or examination |