The approach to hip instability in children with cerebral palsy: an umbrella review

Purpose: Children with cerebral palsy (CP) are at a high risk of progressive hip displacement, defined as lateral migration of the femoral head measured by the Reimers migration percentage. This condition may impair quality of life, highlighting the need for improved hip care. This umbrella review assessed current evidence on the evaluation, prevention, and treatment of hip displacement in children with CP by synthesizing systematic reviews. Methods: Systematic reviews published in English between 2004 and 2024 were included, focusing on children with CP aged 0-18 years. Searches were conducted in nine databases: PubMed, MEDLINE, Web of Science, Scopus, BVS, CINAHL, Cochrane Library, PEDro, LILACS, and EMBASE. Methodological quality was assessed using AMSTAR 2 for interventional studies and JBI criteria for non-interventional studies. This review has been registered at PROSPERO (registration number: CRD42024618645). Results: In total, 25 systematic reviews addressed key aspects of hip management, including hip surveillance; tone management; preventive, reconstructive, and salvage procedures; and antifibrinolytic use. Hip surveillance reduced hip dislocation rates and the need for salvage surgery, whereas postural and tone management showed no consistent preventive effect. Combined pelvic and femoral osteotomies achieved better outcomes than isolated procedures, while soft-tissue surgeries had high recurrence rates. Proximal femoral hemiepiphysiodesis improved radiographic outcomes but frequently required revision. Salvage procedures such as valgus osteotomy and femoral head resection relieved pain, whereas hip arthrodesis showed poor outcomes. Total hip arthroplasty improved pain and function but was associated with high complication rates. Conclusions: This umbrella review highlights evidence-based practices and important knowledge gaps in the management of hip instability in children with CP, supporting future research and improved clinical care.