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[Experience with 3-stage screening for detection of congenital hip dysplasia]
Insights
A three-stage infant hip screening program found most hip instability at birth. Later screenings showed few new cases, suggesting early detection is key for treating developmental dysplasia of the hip.
Area of Science:
- Orthopedics
- Pediatric screening
- Developmental hip dysplasia
Context:
- A recently recommended three-stage infant screening program for developmental dysplasia of the hip (DDH) involves examinations at birth, six weeks, and three months.
- Prospective evaluation of 789 infants across all three screening stages.
Purpose:
- To evaluate the efficacy of a three-stage infant screening program for detecting developmental dysplasia of the hip.
- To assess the yield of examinations at six weeks and three months compared to the initial newborn assessment.
Summary:
- Approximately 20% of infants presented with pathological (unstable) hips at birth, primarily lax hips, all of which received immediate treatment.
- Subsequent examinations at six weeks and three months revealed minimal new cases of hip instability or dysplasia.
- A limitation of abduction was observed in about 6% of infants at later stages, often attributed to the moulded baby syndrome rather than true hip dysplasia.
Impact:
- The study suggests that the initial newborn examination is crucial for detecting the majority of pathological hips.
- While not entirely obsolete, the second (six-week) screening may offer limited additional diagnostic value for hip dysplasia.
- Refining the screening schedule, potentially to an earlier three-week assessment focused on hip instability, could improve efficiency.
Abstract:
We report an experience with a three-stage screening programme which has recently been recommended. It comprises the examination of children at three successive periods - at birth, at six weeks and at three months. In a prospective study we evaluated 789 children at all three periods. Pathological (unstable) hips were found at birth in about 20 per cent, the majority being lax hips and all underwent immediate treatment. At six weeks we were unable to detect any sign attributable to hip dysplasia except one instability persisting from birth. A limitation of abduction in one or another hip at six weeks or at three months was present in about 6 per cent; it was explained to be related rather to one of the signs of the moulded baby syndrome than to hip dysplasia. We do not regard the second examination in a three-stage screening programme as obsolete though it did not provide us in this series with additional informations; but our experience shows that three weeks would do better than six weeks, and the examination should be focused mainly on hip instability. We feel, however, that the greatest majority of pathological hips if not all should be detected at the maternity ward by a competent examiner.