Aim

The objective was to assess whether late presentation of DDH leads to an increase in treatment magnitude and cost.

Objective

The objective was to assess whether late presentation of DDH leads to an increase in treatment magnitude and cost.

Purpose of study: To assess whether a plane x-ray at five months is needed in a DDH screening program.

Method: Between 1990 and 2004 we operated selective hip screening, including ultrasound. Hips screened as normal had an X-ray at 5 months, initially instituted to cover the ultrasound learning curve. These were reported by a consultant radiologist and referred if thought abnormal. For the purposes of this study the notes, scans and X-rays of all patients referred at 5 months were reviewed.

Results: In Nottingham there were approximately 108,500 births between 1990 and 2004. Of these 11,425 were referred for ultrasound scan. 53 were referred to orthopaedics following the x-ray at 5 months. 47 of these had a complete data set. Of these 47 children, 30 (64%) were watched, 9 (19%) had arthrograms only, 5 (11%) had adductor tenotomy and application of a hip spica. One (2%) child had Pavlik harness treatment and 2 (4%) had a femoral osteotomy.

Graf’s alpha angles and percentage cover were reviewed from the original ultrasounds, many of which were of poor quality. This demonstrated that there was less than 50% cover for 14/30 (47%) who were watched, for 6/9 (78%) who had arthrograms, for 1/1 (100%) treated by harness, for 4/5 (80%) treated with adductor tenotomy and hip spica and for 2/2 (100%) requiring surgery. Alpha angles less than 60 degrees did not predict the need for intervention. There were no late cases from the group that had X-rays classed as normal at 5 months.

Conclusions: The importance of measuring head cover was established and is now routine in the hip instability clinic. It was clear that a large population had received unnecessary X-rays. X-rays are now only performed if US at 6 weeks reveals a low alpha angle or less than 50% cover.