Since September 1964, neonates born in New Plymouth have undergone clinical examination for Neonatal Instability of the Hip (NIH) in a structured clinical screening programme. Forty one thousand, five hundred and sixty three babies were born during the period of this study, of which 1,638 were diagnosed as having unstable hips. Six hundred and thirty three with persisting instability were splinted (1.6%), with five hips failing splintage. In addition, three unsplinted hips progressed to CDH, and there were four late-presenting (walking) cases of CDH, giving an overall failure rate for the programme of 0.29 per 1000 live births, with a late-presenting (walking) CDH incidence of 0.1 per 1000 live births. This study confirms that clinical screening for NIH by experienced orthopaedic examiners significantly lowers the incidence of late-presenting (walking) CDH.
There is concern that the positive predictive value (PPV) of neonatal screening for instability may have deteriorated over recent years, this study aims to evaluate this. This is a prospective observational longitudinal study from 2012 – 2016. Patients that were referred from paediatric neonatal screening with hip instability (Ortolani / Barlow positive, clunks) were identified and underwent ultrasound and clinical examination in the one stop hip clinic by the senior author. Referrals were taken from a range of screeners from paediatric doctors to midwives and advanced neonatal practitioners. Syndromic or neurological dislocated hips were excluded. The outcome measures were the presence of a subluxated / dislocated hip on ultrasound as per Graf and Harcke classification and a positive provocative manoeuvre on examination. This allowed a PPV to be evaluated for both ultrasound and clinical examination.Purpose
Method
The purpose of this study was to audit screening and treatment programmes for Developmental Dysplasia of the Hip (DDH) over a 12-year period from 1989 to 2000 with respect to late presentation and treatment rate and duration. All babies born in Queen Mary Hospital are clinically screened for DDH by a consultant orthopaedic surgeon. Unstable hips are treated by Pavlik Harness and attend an ultrasound clinic run by an orthopaedic surgeon within 2 weeks. High-risk babies or those with suspected instability can also be referred for ultrasound. Serial ultrasound exams assisted with determining the duration of splintage. Radiographs are taken at 4 to 6 months. Late presenters were identified and analysed. Over the 12-year period 13 cases of late presenting DDH were identified (0.6 per 1000). Half of these had not been screened. None had ultrasound screening. Our treatment rate was approximately 4 per 1000 live births. Our screening programme can be improved by increased capture of patients for clinical screening. Ultrasound is a useful tool in managing neonatal hip instability allowing duration of splintage to be tailored to the individual and allows early detection of treatment failure.
A clicky hip is a common referral for clinical and sonographic
screening for developmental dysplasia of the hip (DDH). There is
controversy regarding whether it represents a true risk factor for
pathological DDH. Therefore a 20-year prospective, longitudinal,
observational study was undertaken to assess the relationship between
the presence of a neonatal clicky hip and pathological DDH. A total of 362 infants from 1997 to 2016 were referred with clicky
hips to our ‘one-stop’ paediatric hip screening clinic. Hips were
assessed clinically for instability and by ultrasound imaging using
a simplified Graf/Harcke classification. Dislocated or dislocatable
hips were classified as Graf Type IV hips.Aims
Patients and Methods
The aim of this prospective cohort study was to evaluate the
effectiveness of the neonatal hip instability screening programme. The study involved a four-year observational assessment of a
neonatal hip screening programme. All newborns were examined using
the Barlow or Ortolani manoeuvre within 72 hours of birth; those
with positive findings were referred to a ‘one-stop’ screening clinic
for clinical and sonographic assessment of the hip. The results
were compared with previous published studies from this unit.Aims
Patients and Methods
