Universal neonatal screening of developmental dysplasia of the hip (DDH) remains controversial and a few centres have adapted this practice in the United Kingdom. Our institute has established a DDH screening programme for many years. The following shows our result after a recent hospital relocation and changes to the screening programme. All infants born in Coventry are screened for DDH by a clinical examination and ultrasound scan (USS). 5,084 babies were born over a 12-months period. Normal examination and USS were detected in over 90% of the cases. Abnormality detected through either clinical examination or USS was referred to a special orthopaedic/USS clinic. However, in the majority of the cases, subsequent assessments were normal and only 23 babies required treatments. In these cases, the majority had not shown any signs of clinical abnormality. However, serial USS had shown persistent abnormality of at least Graf grade II or higher. The average time from birth to a treatment with a Pavlik Harness was 35 days and the average duration of a treatment was 48 days. Those with Graf III or higher at initial presentation, but spontaneous reduced without treatment were follow-up to one year. The acetabular index in these cases was normal. Apart from one case, all the babies were treated successfully. The unsuccessful cases had a Graf grade IV at the presentation and had shown no sign of improvement on sequential USS. While the sensitivity of detecting DDH through clinical examination remains poor, USS has become an essential tool in our screening programme. Many initial abnormalities are secondary to hip immaturity and they tend to resolve. Those with clinical instability and persistent USS Graf grade II or higher should be treated with early Pavlik Harness. Early detection has led to better results than late diagnosis, and in addition to this, the overall number of operations required could be reduced

Universal neonatal screening of developmental dysplasia of the hip (DDH) remains controversial and a few centres have adapted this practice in the United Kingdom. Our institute has established a DDH screening programme over the last 19 years. The following shows our result after a recent change in our screening programme protocol. All infants born in Coventry are screened for DDH by a clinical examination and ultrasound scan (USS). 5,084 babies were born over a 12-months period. Normal examination and USS were detected in over 90% of the cases. Abnormality detected through either clinical examination or USS was referred to a special orthopaedic/USS clinic. However, in the majority of the cases, subsequent assessments were normal and only 23 babies required treatment. In these cases, the majority had not shown any signs of clinical abnormality. However, serial USS had shown persistent abnormality of at least Graf grade II or higher. The average time from birth to a treatment with a Pavlik Harness was 35 days and the average duration of a treatment was 48 days. Apart from one case, all the babies were treated successfully. The unsuccessful cases had a Graf grade IV at the presentation and had shown no sign of improvement on sequential USS. No complications were noted. While the sensitivity of detecting DDH through clinical examination remains poor, USS has become an essential tool in our screening programme. Many initial abnormalities are secondary to hip immaturity and they tend to resolve. Those with clinical instability and persistent USS Graf grade II or higher should be treated with early Pavlik Harness. Early detection has led to better results than late diagnosis, and in addition to this, the overall number of operations required could be reduced. Yet, the need for a major surgical intervention has been all but eliminated

Objective: The aim of this study was to show the effect of a universal (all neonates) ultrasound screening in newborns on the incidence of operative treatment of hip dysplasia. Materials: A retrospective study was performed and all newborns of the county Tyrol (Austria) between 1978 and 1998 (8257 births / year ((range: 7766 – 8858)) were reviewed regarding hip dysplasia and following hip surgeries. Between 1978 and 1983 clinical examination alone was performed to detect hip dysplasia. Between 1983 and 1988 an ultrasound screening programme according to Graf was initiated in our county. Between 1988 and 1998 ultrasound screening was performed in all newborns. Hence two observation periods were determined: 1978–1983 and 1993–1998. The time period between 1983 and 1993 was excluded to minimize bias and learning curve regarding the initiation of the ultrasound screening programme. A retrospective comparative analysis of the two observation periods regarding surgical treatment and costs caused by hip dysplasia was performed. During the observation period indication for surgery did not change, however new treatment techniques were introduced. Patients with neuromuscular and Perthes diseases were excluded. According to age dependent surgical procedures three patient samples were determined: Group A: 0–1.5 years, Group B: 1.5–15 years and Group C: 15–35 years. Results: Comparison of the two observation periods showed no influence on the number of interventions for dysplastic hips in group C (pelvic osteotomies and VDROs). In group A, a decrease of hip reductions was seen from 25.6±3.2 to 7.0± 1.4 cases per year. In group B, there was a decrease of operative procedures for dysplastic hips from 18.0±3.2 to 3.4±1.3 interventions per year. Since the introduction of universal hip ultrasound screening the decrease of the total number of interventions for all groups was 78.6%. Comparison of costs of the two observation periods showed an increase of all costs caused by DDH and CDH of 57.000 euro/ year for the time period between 1993 and 1998 which was mainly caused by the ultrasound screening programme. There was a significant reduction of costs regarding operative and non operative treatment for dysplastic hips from 410.000 euro (1978–1983) to 117.00 euro (1993–1998). Conclusion: Initially there were higher costs caused by the screening method, but on the other hand total number and costs for operative and nonoperative treatment of dysplastic hips were significantly reduced by the universal ultrasound screening programme. In our mind patient’s and family distress and pain related to interventions performed for CDH and DDH justify the slight increase of costs caused by the universal screening programme. We therefore recommend universal hip ultrasound screening for neonates

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.

Introduction: The quality of newborn hip screening is usually measured as the number of late detected cases of hip dysplasia. There is no consensus concernig the use of ultrasonography in hip joint screening in newborns. At our hospital the number of late detected cases was around 2/1000 births using clinical screening. In a prospective, randomised study we compared universal ultrasound screening and selective ultrasound screening. We reduced the number of late detected cases when using universal ultrasound screening to 0,13/1000, whereas the group with selective ultrasound screening had 0,65/1000, the difference was not significant. We have therefore continued selective ultrasound screening, and present the results concerning late detected cases in the 9-year period 1999–2007 with this screening model. Materials and Methods: Newborns in our county are now offered selective ultrasound hip joint screening, in addition to the stanard clinical screening. The ultrasound examinations are performed 1–3 days after birth. The following risk factors lead to ultrasound examination: positive or doubtful Ortolani or Barlow tests, breech position, family history of hip dysplasia, foot deformities, and some syndromes. In the 9-year period 1999–2007 a total of 34000 babies where born in our county, and 13% had risk factors for hips dysplasia and were examined by ultrasound. Our hospital is the only hospital dealing with lated detected cases in our county. Results: In the 9-year period the primary treatment rate using the Frejka pillow was 0,9/1000 births. In the same period there were 16 children treated for lated detected hip dysplasia. There were 14 girls and 2 boys, giving an incidence of late detected cases of 0,47/1000 births. There were no common characteristics among the children with late detected hip dysplasia. Discussion/Conclusions: It has been assumed that a good clinical hip joint screening in newborns should not give more than 0,5/1000 births of late detected cases. By using selective ultrasound screening we have achieved 0,47/1000 births of late detcted cases in our county. We therefore recommend selective ultrasound hip screening in newborns

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The present study seeks to investigate the correlation of pubofemoral distances (PFD) to α angles, and hip displaceability status, defined as femoral head coverage (FHC) or FHC during manual provocation of the newborn hip < 50%.

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Studies of infant hip development to date have been limited by considering only the changes in appearance of a single ultrasound slice (Graf’s standard plane). We used 3D ultrasound (3DUS) to establish maturation curves of normal infant hip development, quantifying variation by age, sex, side, and anteroposterior location in the hip.

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To establish cut-off values for lateral pubofemoral distance (PFD) measurements for detecting hip dysplasia in early (four days) and standard care (six weeks) screening for developmental dysplasia of the hip (DDH).

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A national screening programme has existed in the UK for the diagnosis of developmental dysplasia of the hip (DDH) since 1969. However, every aspect of screening and treatment remains controversial. Screening programmes throughout the world vary enormously, and in the UK there is significant variation in screening practice and treatment pathways. We report the results of an attempt by the British Society for Children’s Orthopaedic Surgery (BSCOS) to identify a nationwide consensus for the management of DDH in order to unify treatment and suggest an approach for screening.

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Within healthcare, several measures are used to quantify and compare the severity of health conditions. Two common measures are disability weight (DW), a context-independent value representing severity of a health state, and utility weight (UW), a context-dependent measure of health-related quality of life. Neither of these measures have previously been determined for developmental dysplasia of the hip (DDH). The aim of this study is to determine the DW and country-specific UWs for DDH.

The aim was to compare the efficacy of selective ultrasound-screening (SUSS) for developmental dysplasia of the hip (DDH) to clinical screening alone, by comparing outcomes in a contemporary group with those from a 40 year old cohort. This was a retrospective cohort study. The department's DDH and surgical databases were used to identify all cases of DDH, and all cases of surgery for DDH during the study period (2009–13). Patients born outside our region, and teratologic cases were excluded from analysis. The Obstetric database provided the total number of live births over the five-year period. This data was used to calculate the incidence of late-diagnosis (age over 3 months) DDH and the rate of surgery for DDH in our region. These results were compared to those of a similar study from our institution published in 1977, after the introduction of universal clinical screening. Relative risk (RR) was calculated for the two groups, and analysed for statistical significance. The incidence of late-diagnosis DDH over the recent 5-year study period was 0.66/1000 live births, compared to 0.6/1000 in the control group. The RR for late-diagnosis DDH was not significantly different between the two groups (RR 1.14, 95% CI 0.6 to 2.2). The rate of surgery for DDH was 0.86/1000, compared to 0.9/1000 live births in the control group. The RR for surgery for DDH in the current study population compared to the historic control was 0.97, but this difference was not statistically significant (95% C.I. 0.57 to 1.68; p=0.92). Despite advances in screening for DDH over the last 40 years, neither the incidence of late diagnosis DDH, nor rates of surgery for DDH in our region have changed. Whilst previous studies have demonstrated that SUSS does not eliminate late-presenting DDH, this study suggests it confers no advantage over clinical screening alone

Aims. We investigated the local epidemiology of Developmental Dysplasia of the Hip (DDH), in order to define incidence, identify risk factors, and refine our policy on selective ultrasound screening. Methods. Data were recorded prospectively on all live births in the Exeter area from January 1998 to December 2008. We compared those treated for DDH with all other children. Crude odds ratios (OR) were calculated to identify potential risk factors. Logistic regression was then used to control for interactions between variables. Results. There were 182 children with DDH (245 hips) and 37,051 without. The incidence was thus 4.9 per 1000 live births. Female sex (adjusted OR 7.2, 95% CI 4.6–11.2), breech presentation (adjusted OR 24.3, 13.1–44.9), positive family history (adjusted OR 15.9, 11.0–22.9) and first or second pregnancy (adjusted OR 1.8, 1.5–2.3) were confirmed as risk factors (p<0.001). In addition, there was an increased risk with vaginal delivery (adjusted OR 2.7, 1.6–4.5, p<0.001) and postmaturity (OR 1.7, 1.2–2.4, p<0.002). Conclusions. One in 200 children born in our area requires treatment for DDH. Using both established and novel risk factors, we can potentially calculate an individual child's risk. Our work may contribute to the debate about selective versus universal ultrasound screening

Aims. We investigated the local epidemiology of Developmental Dysplasia of the Hip (DDH), in order to define incidence, identify risk factors, and refine our policy on selective ultrasound screening. Methods. Data were recorded prospectively on all live births in the Exeter area from January 1998 to December 2008. We compared those treated for DDH with all other children. Crude odds ratios (OR) were calculated to identify potential risk factors. Logistic regression was then used to control for interactions between variables. Results. There were 182 children with DDH (245 hips) and 37,051 without. The incidence was thus 4.9 per 1000 live births. Female sex (adjusted OR 7.2, 95% CI 4.6-11.2), breech presentation (adjusted OR 24.3, 13.1-44.9), positive family history (adjusted OR 15.9, 11.0-22.9) and first or second pregnancy (adjusted OR 1.8, 1.5-2.3) were confirmed as risk factors (p<0.001). In addition, there was an increased risk with vaginal delivery (adjusted OR 2.7, 1.6-4.5, p<0.001) and postmaturity (OR 1.7, 1.2-2.4, p<0.002). Conclusions. One in 200 children born in our area requires treatment for DDH. Using both established and novel risk factors, we can potentially calculate an individual child's risk. Our work may contribute to the debate about selective versus universal ultrasound screening

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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.

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The coronavirus disease (COVID)-19 pandemic forced an unprecedented period of challenge to the NHS in the UK where hip fractures in the elderly population are a major public health concern. There are approximately 76,000 hip fractures in the UK each year which make up a substantial proportion of the trauma workload of an average orthopaedic unit. This study aims to assess the impact of the COVID-19 pandemic on hip fracture care service and the emerging lessons to withstand any future outbreaks.

Introduction: To measure the incidence of late presenting DDH following the introduction of selective ultrasound screening of neonatal hips with associated risk factors. Method: Retrospective cohort study of children with late diagnosed DDH in a defined population of Greater Glasgow Region. A hip ultrasound program was introduced in the year 1997 for secondary screening of children with risk factors for DDH. The departmental and theatre database was used to identify children with late diagnosed DDH. (Defined as diagnosed 3 months after birth) Demographic details, age at presentation, presence of risk factors (Breech presentation, family history, clicks, caesarian section) and details of treatment were recorded. The number of live births for each year was obtained from the General Registrar Office for Scotland. The incidence of late presenting DDH was calculated taking in to account the year of child’s birth. The incidence of late DDH was then compared between the period 1992 –1996 and 1997– 2001. Results: 78 children were identified, of which 49 babies were between 1992 – 96 and 29 between 1997 –01. The average age at diagnosis was 17 months (Median 15 months, range 5 –84 months). The average annual incidence from 1992 –6 was 0.84 per 1000 live births and from 1997 – 2001 was 0.57 per 1000 live births. This decrease in incidence of late DDH was not significant at 5% level (chi squared p = 0.088). 64 children (82%) with late diagnosed DDH had no factors that could be perceived as risk factors for the condition. Discussion: Targeted ultrasound screening of babies with risk factors appears to have reduced the average incidence of late DDH from 0.84 to 0.57 per 1000 live births. However this reduction in incidence is not statistically significant. The vast majority of late presenters (82%) do not have risk factors. It remains unclear whether universal ultrasound screening program, practiced in some parts of United Kingdom is a cost effective alternative to eliminate the incidence of late presenting DDH

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To assess if congenital foot deformity is a risk factor for developmental dysplasia of the hip (DDH).

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Open reduction in developmental dysplasia of the hip (DDH) is regularly performed despite screening programmes, due to failure of treatment or late presentation. A protocol for open reduction of DDH has been refined through collaboration between surgical, anaesthetic, and nursing teams to allow same day discharge. The objective of this study was to determine the safety and feasibility of performing open reduction of DDH as a day case.