Ultrasound screening for hips at risk in developmental dysplasiaIS IT WORTH IT?R. W. Paton, FRCS Orth, Consultant Orthopaedic Surgeon; M. S. Srinivasan, FRCS Orth, Consultant Orthopaedic Surgeon; and B. Shah, MCh Orth, Specialist Registrar in OrthopaedicsDepartment of Orthopaedic Surgery, Blackburn Royal Infirmary, Bolton Road, Blackburn, Lancashire BB2 3LR, UK. S. Hollis, MSc, Lecturer Department of Mathematics and Statistics, Medical Statistics Unit, Lancaster University, Lancaster LA1 4YF, UK. Correspondence should be sent to Mr M. S. Srinivasan. Between May 1992 and April 1997, there were 20 452 births in the Blackburn District. In the same period 1107 infants with hip ‘at-risk’ factors were screened prospectively by ultrasound. We recorded the presence of dislocation and dysplasia detected under the age of six months using Graf’s alpha angle. Early dislocation was present in 36 hips (34 dislocatable and 2 irreducible). Of the 36 unstable hips, 30 (83%) were referred as being Ortolani-positive or unstable; 25 (69%) of these had at least one of the risk factors. Only 11 (31%) were identified from the ‘at-risk’ screening programme alone (0.54 per 1000 live births). Eight cases of ‘late’ dislocation presented after the age of six months (0.39 per 1000 live births). The overall rate of dislocation was 2.2 per 1000 live births. Only 31% of the dislocated hips belonged to a major ‘at-risk’ group. Statistical analysis confirmed that the risk factors had a relatively poor predictive value if used as a screening test for dislocation. In infants referred for doubtful clinical instability, one dislocation was detected for every 11 infants screened (95% confidence interval (CI) 8 to 17) whereas in infants referred because of the presence of any of the major ‘at-risk’ factors the rate was one in 75 (95% CI 42 to 149). Routine ultrasound screening of the ‘at-risk’ groups on their own is of little value in significantly reducing the rate of ‘late’ dislocation in DDH, but screening clinically unstable hips alone or associated with ‘at-risk’ factors has a high rate of detection. This article has been cited by other articles:
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