Routine ultrasound screening for neonatal hip instability. Can it abolish late-presenting congenital dislocation of the hip?

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.

Neonatal foot deformities and their relationship to developmental dysplasia of the hip

“…26 The natural history of neonatal instability of the hip and stable acetabular dysplasia is natural resolution in most cases (90%). 11,27,28 Type-II dysplasia is generally thought to represent an immature rather than a pathological condition. In the 614 cases there were only eight of type-IV and one of type-III.…”

Developmental dysplasia of the hip: What has changed in the last 20 years?

“…This allows assessment of the static anatomy of the hip and the stability of the femoral head in the acetabular socket [56] . However, ultrasound screening should not be performed before 3-4 wk of age in infants with clinical signs or risk factors for DDH because of the normal physiologic laxity that resolves spontaneously by 6 wk of age [56][57][58] . Screening of all newborns with ultrasonography led to a high rate of reexaminations and resulted in a large number of hips needlessly treated [59,60] .…”

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

“…2 Similarly, by 2 to 4 weeks of age, Ͼ60% of infants identified at birth by abnormal clinical examination (Barlow or Ortolani tests) have reverted to normal when judged by repeat clinical examination or by ultrasound examination. 10,37,54 Longer prospective studies 28,[53][54][55][56][57][58][59] and a systematic review of observational studies of ultrasound screening 60 demonstrate that in untreated hips, mild dysplasia without frank instability usually (consistently Ͼ90%) resolves spontaneously between 6 weeks and 6 months.…”