Abstract
The methods used for any screening programme for developmental dysplasia of the hip (DDH) can be controversial. This was an opportunistic audit of our selective ultrasound screening programme using an X-ray at 5months to prevent inappropriate discharge due to the learning curve of ultrasound. Between 1990 and 2004 in Nottingham, UK, out of a total population of 108,500 births, approximately 11,500 neonates were screened using ultrasound. Any child with an ultrasound scan showing Graf α-angles greater than 60° (Graf Type I) with the hip in joint were discharged from the clinic. All of those discharged were subsequently X-rayed at 5months in order to cover the learning curve of ultrasound. The X-rays were reviewed by a consultant radiologist and referred back to orthopaedics if there was lateralisation of the femoral head or an acetabular index above 30°. Of approximately 11,000 X-rays performed, only 53 patients were referred back to orthopaedics, of which 47 had a complete data set. Of these 47 children, only 8 (17%) required intervention. On review of the original ultrasounds, Graf's α-angle did not seem to correlate well with the need for intervention, as all were Type I hips. The femoral head cover (FHC) appeared to be more predictive of the need for treatment. There have been no late presentations to our unit of DDH following a normal 5-month X-ray. We now check the Graf α-angle, FHC and dynamic stability in the ultrasound assessment and only perform X-ray at 5months if there was a low α-angle or low FHC. Since this change, there have been no late presentations of DDH from the population screened by ultrasound.
Highlights
Screening for developmental dysplasia of the hip (DDH) was first described in the 1930s
Background The methods used for any screening programme for developmental dysplasia of the hip (DDH) can be controversial
Any child with an ultrasound scan showing Graf a-angles greater than 60° (Graf Type I) with the hip in joint were discharged from the clinic
Summary
Screening for developmental dysplasia of the hip (DDH) was first described in the 1930s. This study used the technique described by Marks et al and assessed the femoral head coverage within 48 h of referral for the majority of children [18] For this reason, many authors prefer the use of selective screening programmes assessing those with clinical instability or risk factors for DDH [6, 13, 15, 19]. It has been recommended that screening should occur at 6–10 weeks for those with dysplasia, to allow spontaneous resolution to occur and prevent over-treatment [6, 20] This has been widely accepted as being the best use of resources to minimise late presentation and prevent overdiagnosis and treatment. Another factor supporting selective ultrasound screening is cost. We have used this opportunity to assess the adequacy of selective ultrasound screening, the need for an X-ray at 5 months and the features seen at the time of ultrasound that correlate with the need for intervention
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