No abstract

We have undertaken routine ultrasound screening for neonatal hip instability in Coventry since June 1989. Of the 14 050 babies scanned during the first three years, 847 (6%) had ultrasound abnormalities. A grading system, based on the percentage of femoral head coverage, is presented. The proportion of abnormal hips decreased gradually so that by nine weeks, 90% had normal ultrasound appearances. Abnormality was more common in babies with a family history of CDH and in breech presentations. All babies with clinically abnormal hips had an abnormal first ultrasound examination. Five babies not diagnosed by clinical examination and with no risk factors had abnormal ultrasound appearances and were subsequently found to have clinically abnormal hips. Routine ultrasound screening has detected cases which would otherwise have presented late.

The relationship between ultrasonographic findings at birth and risk factors for developmental dysplasia of the hip have not been prospectively evaluated. Since implementing a routine screening programme for all new-born babies in 1989 we have collected 48 000 sets of data, including family history, birth presentation, mode of delivery and birth weight. Of the 92 babies (three per 1000 live births) with persistent ultrasonographic abnormality at 6 weeks only 20% displayed evidence of clinical instability at the original examination. Female babies without the additional risks of breech birth or positive family history were quantitatively the most significant group, accounting for 75% of cases treated. The majority of babies requiring intervention would not have been identified utilizing present criteria for selective ultrasound screening.

Twenty-nine patients with thirty pseudarthroses after removal of infected total hip prostheses have been reviewed one to six years later. Six hips still had a discharging sinus. Complete removal of all cement was found to be essential for healing, and various points in the technique of its clearance have been made. In this respect radio-opaque cement was a great advantage, and lateral guttering of the femur was most effective. Compared with the situation before replacement considerable relief of pain was obtained in most patients but there was much less improvement in function.