title: Current screening recommendations for developmental dysplasia of the hip may lead to an increase in open reduction.
abstract: Most centres in the United Kingdom adopt a selective screening programme for developmental dysplasia of the hip (DDH) based on repeated clinical examination and selective ultrasound examination. The Newborn Infant Physical Examination protocol implemented in 2008 recommends a first examination at birth and then a second and final examination at six to ten weeks of age. Due to concerns over an increase in late presentations we performed a retrospective review of our 15-year results to establish if late presentation increases treatment requirements. Of children presenting before six weeks of age, 84% were treated successfully with abduction bracing, whereas 86% of children presenting after ten months eventually required open reduction surgery. This equates to a 12-fold increase in relative risk of requiring open reduction following late presentation. Increasing age at presentation was associated with an increase in the number of surgical procedures, which are inevitably more extensive and complex, with a consequent increased in cost per patient. The implementation of an opportunistic examination at three to five months could help to reduce the unintended consequences of the Newborn Infant Physical Examination programme.
authors.affiliation: University Hospital Nottingham, Derby Road, Nottingham NG7 2UH, UK.
authors.forename: K R
authors.initials: KR
authors.lastname: Price
authors.forename: R
authors.initials: R
authors.lastname: Dove
authors.forename: J B
authors.initials: JB
authors.lastname: Hunter
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000639:trends*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000592:standards*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
keywords: DDH; Hip; NIPE; Open reduction; Policy; Screening; Ultrasound