A 15 year prospective, observational cohort study was undertaken to assess selective screening of DDH in males and females referred with risk factors only.

Individuals born breech or with evidence of a strong family history for DDH were the ‘risk factors’ studied. All were clinically examined and sonographically screened by one Consultant Paediatric Orthopaedic surgeon. Irreducible hip dislocation rate was the primary outcome measure.

From a cohort of 64670 live births, 2,984 neonates/infants, 46.1 per 1000 live births [95% CI 44.6 to 47.8 per 1000 live births] were referred and sonographically screened with ‘pure’ risk factors of breech presentation and/or family history, with clinical stability. 1360 were male, of which 4 were identified as having ‘pathological’ DDH; an incidence of 1 in 333 of those males referred [95 CI 0.001, 0.008]. 1624 were female, of which 45 were identified as having ‘pathological’ DDH; an incidence of 1 in 36 of those females referred [95% CI 0.021, 0.037]. There was a significant difference in the number of female individuals sonographically diagnosed as having ‘pathological’ DDH compared to males (p<0.001). Four individuals were diagnosed with irreducible hip dislocation, 0.06 per 1000 live births [95% CI 0.24, 0.159 per 1000 live births]. All were in females. Additionally, there were 2 female individuals; both with family history of DDH (1^st cousin splinted and sister splinted, respectively) as a risk factor, referred late.

Our study suggests that there is a significant difference between the incidence of female and male individuals diagnosed with ‘pathological’ DDH, in those referred purely with risk factors (breech and family history). These findings question the current screening policy for ultrasound examination of males with risk factors in the absence of clinical instability, and may influence future DDH screening programme policy.

Level of evidence: II

Aim: To assess the relationship between different types of foot deformity as risk factors in developmental dysplasia of the hip.

Methods: In the Blackburn district foot deformities were referred as risk factors in a screening programme for DDH. All hips were imaged ultrasonographically using a modified Graf morphological and Harcke dynamic method: type I, II, III and IV.

Statistical analysis compared relative risks, odds ratios, 95% confidence intervals for relative risk and P values using Chi the squared test.

Results: Total 585 cases, 432 postural equinovarus deformities (TEV), 60 fixed congenital talipes equinovarus (CTEV), 93 congenital talipes calcaneovalgus (CTCV) & 25 metatarsus adductus.

Conclusion: Routine screening for DDH in cases of postural TEV & fixed CTEV is no longer advocated. The deformity of postural TEV is poorly defined in the literature leading to over diagnosis. The screening of CTCV & metatarsus adductus should continue.

Purpose of study: Recent literature suggests the mode of delivery; either normal vaginal delivery (NVD) or caesarean section (LSCS) influences the incidence of DDH for term breech infants. This study examines whether the incidence of DDH amongst term breech infants is related to the mode of delivery.

Methods: All term infants born breech between 1^st April 1995 and 31^st March 2002 were included. All infants who presented breech were screened by ultrasound as part of an ongoing longitudinal cohort study. Data regarding mode of delivery, either NVD or LSCS elective or LSCS emergency was obtained from hospital records. DDH is a spectrum from minor dysplasia to dislocated irreducible hips. DDH was recorded according to the modified Graf classification.

Results: During the 7-year period 25,919 infants were born in the study population. 996 infants presented as breech, fulfilling the inclusion criteria. 164 (16.5%) were normal vaginal deliveries. 167 (16.8%) had emergency caesarean section. 664 (66.7%) had elective caesarean section.

In total 48 patients were diagnosed with DDH. 10 patients had bilateral DDH giving a total of 58 dysplastic hips.

Conclusions: Infants delivered by normal vaginal delivery or emergency caesarean section had a significantly higher incidence of DDH than those delivered by elective caesarean section. This study suggests that the mode of delivery does influence the stability of hips in infants lying breech at term.

The use of targeted ultrasound screening for ‘at risk’ hips in order to reduce the rate of surgery in developmental dysplasia of the hip (DDH) is unproven. A prospective trial was undertaken in an attempt to clarify this matter.

Over an 8-year period, there were 28, 676 live births. Unstable and ‘at risk’ hips were routinely targeted for ultrasound examination. One thousand eight hundred and six infants were ultrasounded, 6. 3% of the birth population.

Twenty-six children (19 dislocations and 7 dysplasia) required surgical intervention (0. 91 per 1000 births for DDH/0. 66 per 1000 births for dislocation)

Targeted ultrasound screening does not reduce the overall rate of surgery compared with the best conventional clinical screening programmes. The development of a national targeted ultrasound screening programme for ‘at risk’ hips cannot be justified on a cost or result basis.