Congenital hip dislocation: an increasing and still uncontrolled disability?

Abstract

A study of 178 cases of congenital dislocation of the hip in babies born between 1965 and 1978 in Southampton health district showed that the incidence had virtually doubled over this period. Established cases (persisting beyond the first birthday) had risen to around two cases per 1000 live births. One-third of these were first diagnosed after the age of 1 year and one-fifth after 18 months. The findings are particularly disappointing as there were opportunities after the neonatal period for earlier diagnosis. Thus, neonatal screening appears to have failed to make a substantial impact on the morbidity of the disease, probably because of a combination of inherent difficulties in the neonatal screening test as well as failure in its proper application. Much greater vigilance is needed during the first year of life if congenital dislocation of the hip is to be detected and treated as early as possible. Perhaps this could be achieved if all health professionals were more aware of the problem and were encouraged to examine hips at every opportunity and. health authorities periodically audited their results.

Developmental dysplasia of the hip: Risk markers, clinical screening and outcome

“…17 -20 The proportion of hip dislocation (31.4%) in the present group exceeded that of other reports, such as 17.9% dislocation reported by Taylor and Clarke. 20 The rate of disability and unstable hips after the age of 2 years was 0.86/1000, similar to the range of 0.7/1000 -2.2/1000 reported by Catford et al 21 Early detection of DDH may lessen the need for surgical intervention and the risk of disability or motor handicap. The present aim was to evaluate whether the timing of screening by the primary care pediatrician was indeed associated with the outcome and type of treatment.…”

Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force

“…[21][22][23] Ascertainment of cases was often flawed, and the studies span several decades, which make it difficult to assess whether the varied results represent artifacts of data quality, secular trends, or differences in local practice styles. 24 These studies are also limited because they typically do not follow the screen-negative population with the same vigilance as the screen-positive population and experience significant loss to follow-up in the screen-positive population that can bias the outcomes.…”

Financial justification for routine ultrasound screening of the neonatal hip

“…The adoption of these methods to identify all infants with abnormality of the hips has not been universally successful, and has failed to eliminate late presentations of subluxation and dislocation for a number of infants who present with an established abnormality. [4][5][6] Such late presentation frequently results in the need for major operations 7 which often have an unsatisfactory long-term outcome with the development of early degenerative changes in the hip and functional morbidity. The pioneering work in ultrasound examination of Graf 8 in Austria and Harcke et al 9 in the USA has revolutionised our understanding of the process of the disease and allowed the identification and early treatment of instability of the hip.…”