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Importance of the clicking hip in screening for congenital dislocation of the hip
1Morrison Hospital, Swansea.
Insights
Identifying risk factors for congenital dislocation of the hip (CDH) in newborns is crucial. Early screening, including clinical examination and ultrasound for high-risk infants, effectively detects CDH and prevents late presentations.
Area of Science:
- Pediatrics
- Orthopedics
- Neonatal Screening
Background:
- Congenital dislocation of the hip (CDH) is a significant developmental condition.
- Early identification and intervention are critical for optimal outcomes.
- Existing risk factors require ongoing validation and refinement.
Purpose of the Study:
- To prospectively investigate risk factors for CDH in a large birth cohort.
- To assess the effectiveness of clinical examination and secondary screening in identifying CDH.
- To evaluate the incidence and clinical significance of identified risk factors.
Main Methods:
- Prospective investigation of 3289 infants over one year.
- Initial examination by paediatric senior house officers to identify risk factors.
- Secondary screening at a specialized clinic for high-risk infants, including ultrasonography.
- Follow-up for up to 4.1 years to monitor for late presentations.
Main Results:
- An incidence of 15.5 per 1000 births for CDH was observed.
- Established risk factors (family history, caesarean section, breech position) were confirmed.
- Clicking hips on initial examination proved clinically significant.
- No late presentations of CDH were noted during the follow-up period.
Conclusions:
- Clinical examination by senior house officers is effective for secondary screening of high-risk infants.
- An extended high-risk group, identified through clinical assessment, may encompass all potentially abnormal hips.
- Ultrasonography is recommended for all infants identified as high-risk in equipped hospitals.
Abstract:
A birth cohort of 3289 babies was investigated prospectively for one year to assess the importance of risk factors for congenital dislocation of the hip (CDH). 426 (13%) babies had an identifiable risk factor when examined by paediatric senior house officers. On further examination in the first week of life at a screening clinic, 51 proved to have CDH, an incidence of 15.5 per 1000 births. The results confirmed the importance of established factors such as family history, caesarean section, and the breech position, and demonstrated the clinical significance of the presence of clicking hips on initial examination. After up to 4.1 years of follow-up there have been no late presentations. By taking into account the clinical examination by senior house officers, secondary screening of babies at high risk of CDH can be very effective. This extended high risk group may contain all potentially abnormal hips. All such babies should be examined by ultrasonography in hospitals where it is available.