Screening of selected risk factors in developmental dysplasia of the hip: an observational study

• Published in: Archives of disease in childhood Vol. 98; no. 9; pp. 692 - 696
• Main Authors: Talbot, Christopher L, Paton, Robin W
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01-09-2013; BMJ Publishing Group; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Biological and medical sciences; Births; Breech Presentation; Care and treatment; Cohort Studies; Demographic aspects; Dislocation; Dysplasia; Epidemiology; Families & family life; Family (Sociological Unit); Family medical history; Female; Females; General aspects; Genetics; Government regulation; Guidelines; Hip dislocation; Hip Dislocation, Congenital - diagnosis; Hip Dislocation, Congenital - epidemiology; Hip Dislocation, Congenital - etiology; Hip joint; Hip Joint - abnormalities; Hip Joint - diagnostic imaging; Humans; Incidence; Infant; Infant, Newborn; Infants; Infants (Newborn); Laws, regulations and rules; Longitudinal Studies; Male; Medical Evaluation; Medical examination; Medical referrals; Medical sciences; Miscellaneous; Neonatal screening; Neonatal Screening - methods; Neonates; Newborn babies; Observational studies; Orthopaedics; Orthopedics; Outcome Measures; Pediatrics; Physical Examinations; Pregnancy; Prevention and actions; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Referral; Risk Assessment - methods; Risk Factors; Screening; Screening Tests; Ultrasonic imaging; Ultrasonography; United Kingdom - epidemiology; Young Children; United Kingdom; United Kingdom > UK; British Isles; Human; Pediatrics; Observational study; Hip dysplasia; Malformation; Diseases of the osteoarticular system; Risk factor; Development; Medical screening; Child; Epidemiology; Public health; Screening; Orthopaedics
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2013-303647

Background Developmental dysplasia of the hip (DDH) is the most common neonatal musculoskeletal condition. In 2008, the NHS Newborn and Infant Physical Examination committee added selective ‘at risk’ screening to the existing universal neonatal and general practitioner clinical hip screening guidelines. Objective Assessment of breech and family history risk factors in DDH. Design A 15 year prospective, observational, longitudinal cohort study. Method Breech presentation and evidence of a strong family history for DDH were the ‘risk factors’ studied. All infants referred were clinically and sonographically screened by one consultant paediatric orthopaedic surgeon. Results From a cohort of 64 670 live births, 2984 neonates/infants, 46.1 (95% CI 44.6 to 47.8) per 1000 live births, were referred and sonographically screened with these risk factors alone. 1360 were male, of which four were identified as having ‘pathological’ DDH (an incidence of 0.003 (95% CI 0.001 to 0.008)). 1624 were female, of which 45 were identified as having ‘pathological’ DDH (an incidence of 0.028 (95% CI 0.021 to 0.037)). This difference in incidence of 0.025 (95% CI 0.016 to 0.033) was statistically significant (p<0.001). From those who were clinically stable and screened with either or both of the two risk factors, four individuals were diagnosed with irreducible hip dislocation (0.06 (95% CI 0.024 to 0.159) per 1000 live births). All were females. Conclusions This study questions the current UK screening policy for DDH in clinically stable males referred with risk factors, and may influence future DDH screening programme policy.