Developmental dysplasia of the hip (DDH) is the commonest musculoskeletal condition diagnosed in neonates. Two previous studies showed no statistical advantage with the addition of ultrasound to clinical screening. In the UK, the Standing Medical Advisory Committee (SMAC) (1969) recommended clinical examination at birth and at 6 weeks. The Newborn Infant Physical Examination (NIPE) (2008) guidelines in addition advised ultrasound scanning for clinically unstable hips or for those with risk factors (breech presentation or family history). We compared SMAC and NIPE in the two main hospitals of the East Lancashire Hospitals NHS Trust: Burnley General Hospital (BGH) and the Royal Blackburn Hospital (RBH), respectively. Our outcome measure was the number of irreducible hip dislocations over a two year period (2007–2008). The records of the lead Paediatric Orthopaedic Surgeon were used to identify all cases of irreducible hip dislocations born in 2007 and 2008. Maternity records provided information on birth statistics. Syndromal cases were excluded from further analysis. BGH had 5382 live births and 7 irreducible hip dislocations (incidence 1.3/1000 births). 4/7 met SMAC recommendations and 6/7 met NIPE guidelines. 2/7 had equivocal clinical examinations at birth. 13 children were referred to the clinic with unstable hips (2.42/1000 births). RBH had 7899 total births and 3 irreducible hip dislocations (incidence 0.38/1000 births). 2/3 met NIPE guidance and 1/3 met SMAC recommendations. 33 were referred to the clinic with unstable hips (4.18/1000 births). The difference in the numbers of irreducible hips did not reach statistical significance (p=0.12). This study found no statistically significant advantage with the addition of selective ‘at risk’ ultrasound screening to clinical screening alone. Confounding factors in this study included the age of referral of cases to clinic and the numbers of cases referred as primary instability. These findings are in keeping with two previous studies in Norway

Aims. Developmental dysplasia of the hip (DDH) can be managed effectively with non-surgical interventions when diagnosed early. However, the likelihood of surgical intervention increases with a late presentation. Therefore, an effective screening programme is essential to prevent late diagnosis and reduce surgical morbidity in the population. Methods. We conducted a systematic review and meta-analysis of the epidemiological literature from the last 25 years in the UK. Articles were selected from databases searches using MEDLINE, EMBASE, OVID, and Cochrane; 13 papers met the inclusion criteria. Results. The incidence of DDH within the UK over the last 25 years is 7.3/1,000 live births with females making up 86% of the DDH population (odds ratio 6.14 (95% confidence interval 3.3 to 11.5); p < 0.001). The incidence of DDH significantly increased following the change in the Newborn and Infant Physical Examination (NIPE) guidance from 6.5/1,000 to 9.4/1,000 live births (p < 0.001). The rate of late presentation also increased following the changes to the NIPE guidance, rising from 0.7/1,000 to 1.2/1,000 live births (p < 0.001). However, despite this increase in late-presenting cases, there was no change in the rates of surgical intervention (0.8/1,000 live births; p = 0.940). Conclusion. The literature demonstrates that the implementation of a selective screening programme increased the incidence of DDH diagnosis in the UK while subsequently increasing the rates of late presentation and failing in its goal of reducing the rates of surgical intervention for DDH. Cite this article: Bone Jt Open 2023;4(8):635–642

Purpose. To clarify the true association with pathological DDH and ASC (asymmetrical skin crease). Method. Between 1. st. January 1995 and 31. st. December 2015 all paediatric referrals with suspected hip instability were assessed in a one-stop DDH clinic. All patients had clinical and sonographic assessment with results prospectively recorded onto a database. Result. Over this 21-year period, 103 cases were referred with ASC. Seventy were female and 33 male. The age distribution at initial assessment was bimodal with peaks at 3 and 9 months. Eighty-three cases (81% ) were referred with ASC, but the hip joints were normal on both clinical examination and sonography. Eighteen cases (17% ) were referred with ASC but had an additional risk factor. This group also had normal hips on both clinical examination and sonography. Of the 103 cases, only two had pathological DDH. Both were female and aged 3 and 10 months respectively. They had ASC, but in addition had unilateral limitation of hip abduction, a Galeazzi positive sign and a leg length discrepancy. Radiological assessment diagnosed unilateral irreducible hip dislocations in both cases. Statistical analysis calculated an overall sensitivity for ASC of 100% and a PPV of 1.94% . Conclusion. Public Health England NIPE guidelines state that ASC are a ‘screen positive sign’ and should be referred for expert assessment of the hip joints to exclude DDH. This study confirms the opinions of experts and systemic reviews that isolated ASC is an unreliable clinical sign in the diagnosis of pathological DDH. If the hip joint is clinically normal it is highly unlikely that there will be an association with pathological DDH. Routine radiological and sonographic imaging of the hip joints is unnecessary if there is no limitation of hip abduction and normal leg lengths (negative Galeazzi). National guidelines should reflect this

Aim:. An assessment of the relationship between pathological Developmental Dysplasia of the Hip (DDH) and Congenital Talipes Equinovarus (CTEV). Introduction:. Traditional UK guidelines consider abnormalities of the foot to be a risk factor for DDH. 1,2. Currently, there is controversy whether congenital foot abnormalities are true risk factors for pathological DDH. 3,4. There is a relationship between CTCV and hip dysplasia though the relationship between CTEV and pathological DDH is less clear. 5. In a previous 11 year prospective longitudinal study no case of Graf Types III, IV or irreducible hip dislocation were associated with CTEV. 5. Subsequent correspondence and case histories have challenged this view. 6. Methods:. In order to clarify this issue, a 20-year prospective longitudinal observational study was undertaken. All cases of fixed CTEV (Harold & Walker types 1 to 3) referred to the sub-regional Paediatric Orthopaedic clinic at the Royal Blackburn Hospital were evaluated, the feet and hips clinically assessed (Ortolani & Barlow manoeuvres) and the hips ultra-sounded by the senior author (RWP). Modified Graf and Harcke hip ultrasound classification systems were employed. Graf Type III, IV and irreducible hip dislocation were considered pathological. Results:. The incidence of CTEV was 1.46 per 1000 live births (nationally quoted incidence of 1 to 2 per 1000 live births. 7. ). There was one case of Graf Type III dysplasia with no cases of clinical hip instability. Currently, the clinical significance of this type of dysplasia is uncertain. There were no cases of Graf Type IV dislocations or radiological irreducible hip dislocation. Conclusion:. Fixed CTEV should not be considered as a risk factor for pathological DDH and routine sonographic hip screening of CTEV should not be advocated. This is supportive evidence for the current English NIPE guidelines in which the only risk factors screened are family history and breech presentation. Level of evidence: II

Aims

Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate a novel screening programme that included both the primary risk factors of breech presentation and family history, and the secondary risk factors of oligohydramnios and foot deformities.

Aims

To monitor the performance of services for developmental dysplasia of the hip (DDH) in Northern Ireland and identify potential improvements to enhance quality of service and plan for the future.