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Hip Displacement in CP — RACP Paediatrics MCQ

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HardNeurology & DevelopmentHip Displacement in CPRACP Paediatrics

A 7-year-old with GMFCS V cerebral palsy has serial hip migration percentages of 28%, 37% and 46% at 12-month intervals. Pain is absent and passive abduction has fallen. What is the best next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Arrange paediatric orthopaedic assessment and continue scheduled hip surveillance

Explanation lettering: E = shown as A · D = shown as C · A = shown as D · C = shown as E

B is correct because progressive migration above 30% in a child at high GMFCS risk requires orthopaedic referral and continued surveillance; management is based on trajectory and anatomy, not pain alone. A allows silent displacement to progress. C may address selected tone problems but does not substitute for orthopaedic assessment of progressive bony displacement. D is not the standard surveillance modality. E delays referral until reconstructive options may be more complex. The precise operation is individualised, so the question appropriately tests referral and escalation rather than declaring surgery solely from one percentage.

Reference: AusACPDM, Australian Hip Surveillance Guidelines for Children with Cerebral Palsy 2020: https://www.ausacpdm.org.au/wp-content/uploads/2020/12/200240-Hip-survey-A5-booklet-WEB.pdf