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Hip instability in newborns in an urban community
A K Gupta1, S Kumari, P L Arora
1Lady Hardinge Medical College and Shrimati Sucheta Kripalani Hospital, New Delhi, India.
Insights
Neonatal hip instability is common in New Delhi, affecting 18.7 per 1000 live births. Early detection through screening programs is recommended to prevent secondary complications in infants.
Area of Science:
- Orthopedics
- Pediatrics
- Neonatal Care
Background:
- Early recognition of congenital dislocation of the hip (CDH) is crucial for effective treatment and prevention of secondary changes.
- Limited data exists on the incidence of CDH in India, necessitating local epidemiological studies.
- A study was conducted in New Delhi to address this data gap.
Purpose of the Study:
- To determine the incidence of neonatal hip instability in New Delhi.
- To identify risk factors associated with neonatal hip instability.
- To evaluate the natural progression and treatment outcomes of neonatal hip instability.
Main Methods:
- A prospective study involving 6,029 consecutive newborns examined by orthopaedic and paediatric specialists.
- Clinical examination for neonatal hip instability was supplemented with X-ray and ultrasonographic imaging.
- Data collection focused on incidence, affected demographics, and hip stability over time.
Main Results:
- Neonatal hip instability was detected in 18.7 per 1000 live births (148 hips in 113 newborns).
- Subluxatable hips occurred in 12.1 per 1000, and dislocated hips in 0.82 per 1000 live births.
- Female infants, breech presentation, and left hip involvement were associated risk factors; most hips stabilized within 20 weeks with conservative management, except in cases with other congenital abnormalities.
Conclusions:
- Neonatal hip instability is a prevalent condition in New Delhi.
- The findings support the initiation of a screening program to assess the incidence across India.
- Early detection and intervention are vital for managing neonatal hip instability.
Background:
It is important to recognize congenital dislocation of the hip early so that it can be treated effectively and secondary changes prevented. There is little data on the incidence of this condition in India and we, therefore, studied this problem in a large maternity and paediatric centre in New Delhi.
Methods:
Six thousand and twenty-nine consecutive newborns were examined for neonatal hip instability by an orthopaedic surgeon and a paediatrician. Clinical examination was supplemented by X-ray and ultrasonographic examination.
Results:
One hundred and forty-eight hips in one hundred and thirteen newborns (18.7 per 1000 live-births) were found to be unstable at first examination. Of these 12.1 per 1000 live-births had subluxatable hips and 0.82 per 1000 had dislocated hips. Those affected were more likely to be females, have involvement of the left hip and have had a breech presentation. One hundred and twenty-eight hips in 97 children had stabilized within 2 weeks, although no definite progress to stability was observed in subluxatable, dislocatable or dislocated hips. Two children who had other congenital abnormalities initially required operation, but the hips in all the other children stabilized within 20 weeks of birth with conservative treatment.
Conclusion:
Neonatal hip instability is common in New Delhi and a screening programme should be initiated to detect its incidence in other parts of India.
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