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In Vivo Quantification of Hip Arthrokinematics during Dynamic Weight-bearing Activities using Dual Fluoroscopy
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Monitoring of a hip surveillance programme protects infants from radiation and surgical intervention
David J Milligan1, Aidan P Cosgrove1
1Musgrave Park Hospital, Belfast, UK.
Insights
Monitoring developmental dysplasia of the hip (DDH) services improved screening protocols, reducing operative procedures and pelvic radiographs in infants. Performance monitoring is crucial for quality DDH care.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Public Health
Background:
- Developmental dysplasia of the hip (DDH) requires effective screening and monitoring.
- Northern Ireland implemented a regional surveillance policy for infant hip health.
Purpose of the Study:
- To evaluate the performance of DDH services in Northern Ireland.
- To identify areas for service improvement and future planning.
Main Methods:
- Prospective observational study of infants treated for DDH (2011-2017).
- Clinical assessment and radiological investigations followed regional policy.
- Regional radiology data analyzed for ultrasound and radiation use.
Main Results:
- Increased ultrasound scans (4,788 to ~7,000) and nurse-led clinics.
- Reduced hip radiographs in infants (<1 year) from 7,381 to 2,208 annually.
- Modest increase in treatment rate (10.9 to 14.3/1,000 live births) but reduced closed hip reductions.
Conclusions:
- Improved adherence to screening protocols reduced surgeries and pelvic radiographs.
- Performance monitoring of DDH screening programs is vital for quality service delivery.
Aims:
To monitor the performance of services for developmental dysplasia of the hip (DDH) in Northern Ireland and identify potential improvements to enhance quality of service and plan for the future.
Methods:
This was a prospective observational study, involving all infants treated for DDH between 2011 and 2017. Children underwent clinical assessment and radiological investigation as per the regional surveillance policy. The regional radiology data was interrogated to quantify the use of ultrasound and ionizing radiation for this population.
Results:
Evidence-based changes were made to the Northern Ireland screening programme, including an increase in ultrasound scanning capacity and expansion of nurse-led screening clinics. The number of infant hip ultrasound scans increased from 4,788 in 2011, to approximately 7,000 in 2013 and subsequent years. The number of hip radiographs on infants of less than one year of age fell from 7,381 to 2,208 per year. There was a modest increase in the treatment rate from 10.9 to 14.3 per 1,000 live births but there was a significant reduction in the number of closed hip reductions. The incidence of infants diagnosed with DDH after one year of age was 0.30 per 1,000 live births over the entire period.
Conclusion:
Improving compliance with the regional infant hip screening protocols led to reduction in operative procedures and reduced the number of pelvic radiographs of infants. We conclude that performance monitoring of screening programmes for DDH is essential to provide a quality service. Cite this article: Bone Joint J 2020;102-B(4):495-500.
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