Monitoring of a hip surveillance programme protects infants from radiation and surgical intervention

Abstract

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.

Incidence of Neonatal Developmental Dysplasia of the Hip and Late Detection Rates Based on Screening Strategy

“…A total of 43 studies 5 , 8 , 18 , 20 , 21 , 22 , 23 , 28 , 29 , 31 , 35 , 36 , 37 , 38 , 39 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 55 , 56 , 59 , 60 , 61 , 64 , 65 , 67 , 68 , 72 , 74 , 76 , 77 , 78 , 79 , 80 including 4 488 951 newborns assessed the incidence of nonoperatively treated DDH. Of these, 5 studies 28 , 29 , 31 , 35 , 76 with 457 752 newborns used clinical screening, 20 studies 5 , 36 , 37 , 38 , 39 , 42 , 43 , 44 , 45 , 46 , 47 ,…”

“…A total of 43 studies 6 , 8 , 20 , 21 , 22 , 23 , 28 , 29 , 30 , 31 , 33 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 46 , 48 , 50 , 51 , 52 , 53 , 56 , 57 , 61 , 68 , 72 , 74 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 including 6 913 795 newborns assessed the incidence of late-detected DDH. Of these, 10 studies 28 , 29 , 30 , 31 , 33 , 76 , 81 , 82 , 83 , 84 with 2 126 583 newborns used clinical screening, 21 studies 6 , 36 , 37 , 38 , 40 , 41 ,…”

“…A total of 30 studies 6 , 8 , 20 , 22 , 23 , 29 , 34 , 37 , 38 , 39 , 42 , 43 , 44 , 46 , 47 , 48 , 50 , 52 , 56 , 62 , 63 , 74 , 77 , 79 , 80 , 82 , 85 , 88 , 89 with 6 497 382 newborns assessed the incidence of operatively treated DDH. Of these, 3 studies 29 , 34 , 82 with 64 559 newborns used clinical screening, 16 studies 6 , 37 , 38 , 39 , 42 , 43 , 44 , 46 , 47 , 48 , 50 , 52 , 77 , 79 , 85 , 88 with 855 109 newborns used selective screening, and 11 studies 8 , 20 , 22 , 23 , 56 , 62 , 63 , 74 , 80 , 89 with 5 577 714 newborns use...…”

“…A total of 43 studies 5,8,18,[20][21][22][23]28,29,31,[35][36][37][38][39][42][43][44][45][46][47][48][49][50][51][52][53]55,56,[59][60][61]64,65,67,68,72,74,[76][77][78][79][80] treatments per 1000 newborns and the lowest was 0.1 (95% CI, 0.0-0.3) treatments per 1000 newborns (Figure 3). The total pooled incidence estimates were 9.8 (95% CI, 6.7-14.4) treatments per 1000 newborns with universal ultrasonographic screening, 3.1 (95% CI, 2.0-4.8) treatments per 1000 newborns with selective ultrasonographic screening, and 5.4 (95% CI, 2.1-14.0) treatments per 1000 newborns with clinical screening.…”

Using Z-score to optimize population-specific DDH screening: a retrospective study in Hangzhou, China

“…In patients with early diagnosis, within 3 to 6 months of life, the treatment which is essentially conservative and involves the use of dynamic harness, was reported with good clinical and ultrasonographic outcomes [ 3 , 4 ]. As early and accurate diagnosis of DDH is believed to be the most important factor for satisfactory treatment, hip US (ultrasonography) has become the most commonly used diagnostic tool for DDH during early infancy and has been so for many years [ 5 , 6 ]. The most widely used DDH screening method was developed by Reinhard Graf in the early 1980s [ 7 – 9 ].…”