The Pavlik harness (PH) is commonly used to treat infantile dislocated hips. Variability exists in the duration of brace treatment after successful reduction of the dislocated hip. In this study we evaluate the effect of prescribed time in brace on acetabular index (AI) at two years of age using a prospective, international, multicenter database. We retrospectively studied prospectively enrolled infants with at least one dislocated hip that were initially treated with a PH and had a recorded AI at two-year follow-up. Subjects were treated at one of two institutions. Institution 1 used the PH until they observed normal radiographic acetabular development. Institution 2 followed a structured 12-week brace treatment protocol. Hip dislocation was defined as less than 30% femoral head coverage at rest on the pre-treatment ultrasound or IHDI grade III or IV on the pre-treatment radiograph. Fifty-three hips met our inclusion criteria. Hips from Institution 1 were treated with a brace 3x longer than hips from institution 2 (adjusted mean 8.9±1.3 months vs 2.6±0.2 months)(p < 0 .001). Institution 1 had an 88% success rate and institution 2 had an 85% success rate at achieving hip reduction (p=0.735). At 2-year follow-up, we observed no significant difference in AI between Institution 1 (adjusted mean 25.6±0.9˚) compared to Institution 2 (adjusted mean 23.5±0.8˚) (p=0.1). However, 19% of patients from Institution 1 and 44% of patients from Institution 2 were at or below the 50th percentile of previously published age- and sex- matched AI normal data (p=0.049). Also, 27% (7/26) of hips from Institution 1 had significant acetabular dysplasia, compared to a 22% (6/27) from Institution 2 (p=0.691). We found no correlation between age at initiation of bracing and AI at 2-year follow-up (p=0.071). Our findings suggest that prolonged brace treatment does not result in improved acetabular index at age two years. Hips treated at Institution 1 had the same AI at age two years as hips treated at Institution 2, while spending about 1/3 the amount of time in a brace. We recommend close follow-up for all children treated for dislocated hips, as ~1/4 of infants had acetabular index measurements at or above the 90th percentile of normal. Continued follow-up of this prospective cohort will be critical to determine how many children require acetabular procedures during childhood. The PH brace can successfully treat dislocated infant hips, however, prolonged brace treatment was not found to result in improved acetabular development at two-year follow-up

Introduction. The hip hemiarthroplasty in posterior approach is a common surgical procedure at the femoral neck fractures in the elderly patients. However, the postoperative hip precautions to avoid the risk of dislocations are impeditive for early recovery after surgery. We used MIS posterior approach lately known as conjoined tendon preserving posterior (CPP) approach, considering its enhancement of joint stability, and examined the intraoperative and postoperative complications, retrospectively. Methods. We performed hip hemiarthroplasty using CPP approach in 30 patients, and hip hemiarthroplasty using conventional posterior approach in 30 patients, and both group using lateral position with the conventional posterior skin incision. The conjoined tendon (periformis, obturator internus, and superior/inferior gemellus tendon) was preserved and the obturator externus tendon was incised in CPP approach without any hip precautions postoperatively. The conjoined tendon was incised in conventional approach using hip abduction pillow postoperatively. Results. There was no difference between CPP approach group and conventional approach group in the mean age of patients (81.8 years, and 80.3 years, respectively), and in the mean operative time (68.8 minutes, and 64.9 minutes, respectively). In 4 cases of CPP approach, the avulsion fracture at femoral attachment of the conjoined tendon occured during hip reduction manoeuvres. No dislocations occured in both groups in the follow-up period (2 years). Discussion. Lately, the number of hip surgery in muscle sparing approach is increasing. However, in general, MIS approach induces the intraoperative complications, and requires the skillful procedure. The hip reduction manoeuvres would be more difficult in the CPP approach, than in conventional posterior approach, because the preserved conjoined tendon would inhibit hip reduction, considering those avulsion fractures of the femoral attachment. Nevertheless, CPP approach did not require no extended time compared to conventional approach, and no postoperative hip precautions. Due to these results, CPP approach could be a good MIS procedure including early recovery after surgery based on the enhancement of joint stability, excluding the difficulties in hip reduction manoeuvres. We could not show the difference in dislocation rate between two groups, because of small numbers. We are planning to increase the number of patients in the future study

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

Aims. To determine the likelihood of achieving a successful closed reduction (CR) of a dislocated hip in developmental dysplasia of the hip (DDH) after failed Pavlik harness treatment We report the rate of avascular necrosis (AVN) and the need for further surgical procedures. Methods. Data was obtained from the Northern Ireland DDH database. All children who underwent an attempted closed reduction between 2011 and 2016 were identified. Children with a dislocated hip that failed Pavlik harness treatment were included in the study. Successful closed reduction was defined as a hip that reduced in theatre and remained reduced. Most recent imaging was assessed for the presence of AVN using the Kalamchi and MacEwen classification. Results. There were 644 dislocated hips in 543 patients initially treated in Pavlik harness. In all, 67 hips failed Pavlik harness treatment and proceeded to arthrogram (CR) under general anaesthetic at an average age of 180 days. The number of hips that were deemed reduced in theatre was 46 of the 67 (69%). A total of 11 hips re-dislocated and underwent open reduction, giving a true successful CR rate of 52%. For the total cohort of 67 hips that went to theatre for arthrogram and attempted CR, five (7%) developed clinically significant AVN at an average follow-up of four years and one month, while none of the 35 hips whose reduction was truly successful developed clinically significant AVN. Conclusion. The likelihood of a successful closed reduction of a dislocated hip in the Northern Ireland population, which has failed Pavlik harness treatment, is 52% with a clinically significant AVN rate of 7%. As such, we continue to advocate closed reduction under general anaesthetic for the hip that has failed Pavlik harness. Cite this article: Bone Jt Open 2021;2(8):594–598

Purpose. Following closed or open reduction for developmental dysplasia of the hip (DDH), assessment of reduction is essential. With potentially poor accuracy in confirming reduction, the risk of abnormal hip development and ultimately poor outcome exists if reduction is not achieved. Computed tomography (CT) has been used in recent years to assess reduction. The aim of this study was to compare the accuracy in confirming hip reduction following closed or open reduction in children with DDH, using CT and plain radiographs and to decide whether CT scans improved the assessment of reduction. Methods. We retrospectively reviewed 6 patients treated for DDH at an Academic Hospital. The patients were treated with either closed or open reduction. Post operatively radiographs and CT scans were obtained to assess reduction. Reduction was assessed using Shenton's line, medial joint space, a femoral mid-cervical line through the tri-radiate cartilage and a tri-radiate intersectional line on axial CT. The CT scans were analyzed using Osirix on an Apple Macintosh computer. Results. We were able to obtain measurements in all parameters in only one radiograph, whereas in the CT images all parameters were determined. One patient had radiographs in which no values could be measured. The CT scan however confirmed reduction of that hip. In one patient we assessed a hip as reduced using all the parameters, whereas the tri-radiate intersectional line on axial CT and the Shenton's line on the coronal slice showed that in fact the head was posteriorly subluxed. Conclusion. We conclude that although CT scans did not change our management in this small patient series, CT scans did provide a better means of confirming hip reduction than plain radiographs for patients with DDH following closed or open reduction in a hip spica. NO DISCLOSURES

Purpose. To determine the effect of the femoral head ossific nucleus on the development of avascular necrosis (AVN) after reduction of a dislocated hip. We included consecutive patients treated for a dislocated hip secondary to DDH with either closed or open reduction under the age of 30 months (mean, 9.6□4.8) in this retrospective cohort study. 85 patients or 100 hips were included. Radiographs were analysed for the presence of the ossific nucleus at the time of hip reduction, and for the presence of AVN at 9.2□3.4 years after hip reduction by 3 blinded assessors. There was no significant effect of the femoral head ossific nucleus on the development of osteonecrosis, with 16/40 (40%) cases of osteonecrosis in infants with an ossific nucleus absent compared with 18/60 (30%) in the group with an ossific nucleus (adjusted relative risk = 0.83; 95% CI = 0.38 to 1.83; p=0.65). When only radiographic changes of grade II or worse were considered osteonecrosis, the association remained statistically insignificant (adjusted relative risk = 0.84; 95% CI = 0.35 to 2.00; p=0.69). Conclusion. Our study reports the longest follow-up addressing the question of a potential protective effect of the ossific nucleus on the development of AVN. We could not demonstrate such an effect. Strategies aimed at delaying the treatment of a dislocated hip in the absence of the ossific nucleus cannot be recommended as they will not affect the risk for subsequent AVN

Aims. The purpose of this study was to calculate the dislocation rate following open or closed reduction for developmental dysplasia of the hip (DDH) in our unit. In addition we evaluated the posterior neck line as a method of determining hip relocation and assessed the morphology of the dysplastic acetabulum on single slice CT scan. Method. We retrospectively assessed all patients operated on for either open or closed reduction for DDH between August 2007 and August 2009 and evaluated their notes, CT scans and radiographs. The immediate post-operative dislocation rate was calculated, as was the subsequent re-dislocation rate and late subluxation rate. The acetabular morphology was assessed to determine whether the acetabulae were “S” shaped or “C” shaped. A novel method for confirming hip reduction was also appraised. Results. Seventy-five hips were operated on during the study period. The immediate post-operative dislocation rate was 9.3%. There were no subsequent dislocations in any of the patients in whom CT scans had confirmed adequate initial reduction. Two patients went on to develop late subluxation. 98.6% of dysplastic acetabulae displayed an S shaped acetabulum and 1 hip had a virtually flat acetabulum. The posterior neck line test for dislocation had a 85.7% sensitivity and 96.9% specificity. Conclusions. Immediate post-operative CT scan of the hip is a useful investigation following reduction of the hip for DDH. If it can be established that the hip is reduced on the scan it is unlikely to re-dislocate. The S shape of the acetabulum in DDH is consistently present and is a marker of the dysplastic posterior acetabular wall. The posterior neck line is a reliable measure of hip reduction

Introduction. The standard plane imaging of Graf and the dynamic methods of Harcke are well established methods in assessing hip dysplasia but give limited information in the flexed-abducted treatment position used in the Pavlik harness. The femoral head may sit on the edge of the acetabulum in a flexed position and only reduce when the hips are abducted. This may mean that hips, which reduce when abducted in the Pavlik harness, appear subluxed when scanned in neutral abduction. Harness treatment may thereby be abandoned prematurely due to the failure to confirm reduction. This study identifies ultrasound landmarks on an anterior hip scan which could be used to confirm reduction of the hip in Pavlik Harness. Materials and method. Hips of a newborn piglet were scanned, imaged with magnetic resonance and x-rayed both before and after anatomical dissection. Radiographic markers delineated the position of the tri-radiate cartilage and potential ultrasound landmarks identified to help confirm hip reduction in the flexed-abducted position. Porcine imaging was then compared with that of a human newborn. Results. The porcine model corresponded well to human imaging and we were able to establish a landmark, the ‘Ischial Limb’, which corresponds to the ossification front delineating the posterior ischial edge of the tri-radiate cartilage. This could clearly be seen on anterior hip ultrasound of both the porcine and human hip. This landmark can be used to confirm the hip is reduced by reference to the centre of the femoral head. Discussion and conclusion. We would recommend anterior hip scanning using the ‘Ischial Limb’ as a reference point to confirm hip reduction in Pavlik harness. This simple method is a useful adjunct to conventional ultrasound scanning in the harness treatment of hip instability

The standard plane imaging of Graf and the dynamic methods of Harcke are well established methods in assessing hip dysplasia but give limited information in the flexed-abducted treatment position used in the Pavlik harness. The femoral head may sit on the edge of the acetabulum in a flexed position and only reduce when the hips are abducted. This may mean that hips, which reduce when abducted in the Pavlik harness, appear subluxed when scanned in neutral abduction. Harness treatment may thereby be abandoned prematurely due to the failure to confirm reduction. This study identifies ultrasound landmarks on an anterior hip scan which could be used to confirm reduction of the hip in Pavlik Harness. Hips of a newborn piglet were scanned, imaged with magnetic resonance and x-rayed both before and after anatomical dissection. Radiographic markers delineated the position of the tri-radiate cartilage and potential ultrasound landmarks identified to help confirm hip reduction in the flexed-abducted position. Porcine imaging was then compared with that of a human newborn. The porcine model corresponded well to human imaging and we were able to establish a landmark, the “Ischial Limb”, which corresponds to the ossification front delineating the posterior ischial edge of the tri-radiate cartilage. This could clearly be seen on anterior hip ultrasound of both the porcine and human hip. This landmark can be used to confirm the hip is reduced by reference to the centre of the femoral head. We would recommend anterior hip scanning using the “Ischial Limb” as a reference point to confirm hip reduction in Pavlik harness. This simple method is a useful adjunct to conventional ultrasound scanning in the harness treatment of hip instability

Introduction: Thanks to early ultrasound diagnosis of DDH the number of late diagnosed cases decreased in the last ten years. The surgical intervention because of dislocated hip is also reduced to the few cases a year. We still however have in our practice patients after operative treatment of DDH. One of the methods used for proper hip reduction is transiliacal pelvic osteotomy described by Dega. The aim of this study is to evaluate the late results of one stage procedure with Dega transiliacal pelvic osteotomy in the treatment of DDH with dislocation. Material and Methods: In our Institution 256 dislocated hips were treated surgically by means of open hip reduction, femoral directional osteotomy and Dega’s transiliacal osteotomy. From this group 102 patients (91 female and 11 male), presented 144 operated hips were seen for the final follow-up. The left hip was affected in 45 cases, right in 17, and bilateral in 41 patients. The mean age at the surgery was 23,5 months. Mean follow-up was 19.8 years (minimum 15 years after surgery). Patients were evaluated clinically (Barrett modification of McKay classification) and radiologically using Severin classification. All radiograms from whole period of treatment were collected and evaluated. Results: In 90 hips the final result was classify as very good (57%), good in 36 hips (23%), satisfactory in 10 hips and poor in 8 hips. Radiologically very good result (group IA) was seen in 51 hips, good in 65 hips (group IB, IIA, IIB), satisfactory in 24 hips and poor in 4 hips. It was a good correlation between clinical and radiographic classification. Conclusions : The late results after one stage hip reconstruction with Dega’s transiliacal osteotomy gives a long lasting good results and is recommended for operative treatment of DDH with dislocation

Aims

Open reduction in developmental dysplasia of the hip (DDH) is regularly performed despite screening programmes, due to failure of treatment or late presentation. A protocol for open reduction of DDH has been refined through collaboration between surgical, anaesthetic, and nursing teams to allow same day discharge. The objective of this study was to determine the safety and feasibility of performing open reduction of DDH as a day case.

Purpose of Study. To evaluate the results of using external fixation to stabilise femoral derotation osteotomy involved in DDH surgery. Methods and results. A retrospective analysis was performed on 44 patients undergoing 48 femoral osteotomies for DDH surgery between the years 2001 and 2009 by a single surgeon (senior author MC). The external fixator was used either during the primary procedure involving femoral shortening to aid in hip reduction (4 patients) or to correct femoral malrotation in a reduced hip as a secondary procedure(40 patients). As the external fixator frame was within the hip spica it was not a cause of concern to the parents or the child. There was no evidence of any pin tract infection and all patients eventually progressed to satisfactory bony union. One patient had delayed union which was treated successfully with conservative management and one patient had a malunion requiring a further osteotomy and extended treatment with the external fixator. Conclusion. External fixation is a viable alternative for the traditional internal fixation used for femoral osteotomy involving DDH Surgery. Our study has shown that it produces satisfactory results with minimal complications. Apart from minimising tissue scarring in the muscle and subcutaneous planes, it gives a cosmetically better scar. If there is further need for revision surgery it provides healthy tissue planes for dissection. Furthermore it eliminates the need for additional surgery required for removal of plates

Purpose of the study. To report the difference in the rates of avascular necrosis (AVN) of the femoral head following change in the hip abduction angle in the hip spica. Methods. Up until 2002, following closed and medial open reduction of the dislocated hip, the joint was immobilised in a 90° of flexion, 60° of abduction and 10-20° of internal rotation hip spica. The practice was changed after 2002 to 45° of hip abduction in the spica with other parameters remaining same. We audited the rates of radiologic AVN in these two groups of children. Group A, before 2002, had 20 children and in group B, after 2002 till Aug 2007, had 53 children. AVN was quantified on 2 year radiograph by the classification described by Salter and noted its progression on serial radiographs. Results. Twelve children (60%) in group A had radiographic evidence of AVN in the first two years after the procedure compared to 26 children (49%) in group B. This was usually in the form of delayed appearance of the ossific nucleus and delayed development of already appeared nucleus compared to other side. However, on serial radiographs when these patients were followed, at their latest follow-up, the femoral have developed symmetrically in all but 4 patients (20%) in Group A and 6 patients (11.3%) in Group B. Conclusion. Children treated in hip spica after closed or medial open procedure developed transient avascular changes in their femoral head which recovered in most patients. This transient ischemia is further reduced by decreasing the amount of hip abduction angle without compromising the hip reduction achieved

Purpose of the study: From 1999 to 2004, 16 patients (25 hips) aged 2–9 years (average 5±3 years) were treated for spastic hips. The patients were diplegic (n=19 hips, 76%) and tetraplegic (n=6 hips, 24%). Pure pyramidal cerebral palsy patients with no history of seizure. Material and methods: The surgical plan was: femoral osteotomy, periacetabular osteotomy (San Diego), tenotomy of the adductors and psoas, anterior hip reduction as needed. Pain, range of abduction, Reimmer’s index and acetabular index were noted. Results: In the diplegic patients, outcome was good (70%), fair (23%), poor (7%). In tetraplegic patients, outcome was good (20%), fair (20%), poor (60%). Complications were avascular necrosis (n=1) and decubitus lesions (n=2)

Aims

When the present study was initiated, we changed the treatment for late-detected developmental dislocation of the hip (DDH) from several weeks of skin traction to markedly shorter traction time. The aim of this prospective study was to evaluate this change, with special emphasis on the rate of stable closed reduction according to patient age, the development of the acetabulum, and the outcome at skeletal maturity.

Purpose. To document the success rate of closed reduction and soft tissue release in the treatment of bilateral true dislocation in developmental dysplasia of the hip (DDH). Methods. Case-note review of 22 children (44 hips) with idiopathic bilateral hip dislocation referred to a tertiary centre before walking age. The management protocol was as follows: . Examination under general anaesthesia, arthrogram, closed reduction and appropriate soft tissue release (adductors/psoas), application of a ‘frog’ cast. CT scan at 2 weeks to confirm reduction. Change of cast and arthrogram at 6 weeks to confirm improving position and stability. Cast removal at 12 weeks, and application of an abduction brace for 6 weeks. Treatment failure could occur on day 1 (failure of reduction), at week 2 (failure to maintain reduction), at week 6, or after cast removal. Results. Median age at presentation was 3.8m (2w-7.5m). 19/22 were girls. 7 had a caesarean section for breech presentation, 16/22 had had prior Pavlik harness treatment. All hips were Tonnis 2 or more. Mean age at surgery was 7 months (range 3-12m). 9/44 hips failed on day 1. 13/44 hips failed at 2 weeks. 1/44 hip failed at 6 weeks. 8/22 patients had bilateral failure. 7/22 patients maintained a unilateral hip reduction and 7/22 patients maintained a bilateral reduction after treatment. Mean follow-up was 25m (range 6-71m). 1 patient has bilateral AVN. Successful results were not associated with presentation, previous treatment given, the level of dislocation (Tonnis) or patient age at time of treatment. Conclusion. Following a successful initial reduction, this protocol failed to maintain reduction in 13/35 (40%) hips at 2 weeks: significantly worse than our presented results for unilateral dislocation. Significance. With our current protocol, the percentage chance of reducing at least one of bilateral idiopathic dislocated hips is 64% (14/22) but parents should be told that there is only a 1:3 chance of a successful outcome for both hips following closed reduction

Introduction: Leg length discrepancy in general and leg lengthening in particular has emerged as a topic of interest and a common cause for litigation. Theoretical considerations: Painful mobile hip functions in abduction. The load on the hip is reduced by pelvic tilt to the symptomatic side. For this to be possible the proximal lever - the head neck and the acetabulum - must be relatively intact. Methods: A method to identify patients at risk for limb lengthening after total hip arthroplasty by establishing the aetiology of abduction deformity of the osteoar-thritic hip. Clinically: by pelvic tilt to the symptomatic side apparent limb lengthening, restriction of adduction. Radiologically: by a relatively well preserved geometry of the hip and infero-medial femoral “head –drop” osteophyte. Results: In a group of 5000 patients presenting for primary Charnley low-frictional torque arthroplasty: 182 (3.64%) 80 males, 102 females, mean age 63 (20–80) were identified as being at risk for post-operative limb lengthening. Aetiology – Primary: Unilateral 130, Bilateral 10. – Secondary: Post-surgery 23, post-trauma 10, spinal 6, mixed 3. 122 (67%) had apparent limb lengthening – mean 3.2% and in 43 (24%) limb lengths were equal, 91% had a well preserved architecture and the proximal lever system. Discussion: The tell tale signs in patients at risk for limb lengthening after total hip arthroplasty are: pelvic tilt to the symptomatic side with apparent limb lengthening, restricted adduction, history of backache, well preserved hip structure and normal contralateral hip. Conclusion: Awareness of the pattern identifying patients at risk, detailed pre-operative assessment, avoidance of capsule excision and tight hip reduction are essential

Normal acetabular development in developmental dysplasia of the hip (DDH) depends upon early and maintained congruent reduction. Computed tomography is an accepted method for evaluating this and attempts to quantify hip reduction, by various angular and linear measurements, have been reported. The aim of this study was to assess initial CT scans, following open reduction in the older child with DDH, with comparison of outcome to evaluate prognostic value. Method: Thirty consecutive patients underwent open reduction for DDH, with a mean age of 25.9 months at the time of operation. Acetabular morphology and the position of the femoral head were evaluated on the initial CT scan, taken on the first postoperative day, and AP pelvic radiograph taken at the latest follow-up. Results: The acetabulae of the dislocated hips were found to be significantly more anteverted than the normal. The dislocated hips also had significantly increased lateral displacement both initially and at latest follow-up. Posterior displacement of the proximal femoral metaphysis should raise concern due to an association with the need for further surgical intervention. These results did not however correlate with outcome. In conclusion, despite the significant differences noted between DDH and normal hips they did not predict acetabular development or persistent acetabular dysplasia

Purpose: This is a retrospective study, analysing the long term outcome following Chiari osteotomy and varus derotation osteotomy, which was performed as a part of one stage surgical reconstruction for painful subluxed or dislocated hips in cerebral palsy patients. Methods: Between 1986 and 1993, 12 hips in 11 patients underwent the above procedure. Adequate hip reduction was achieved in 11 hips and an acceptable reduction in the other. Immediate pain relief and subsequent improvement in range of movement of the hip, sitting posture and ease of perineal care was recorded in all. Average age at the surgery was 14.1 (9.1–17.8) years. At the recent follow-up, patients were seen along with the parents or carers and reassessed for pain, sitting comfort, mobility and ease of perineal care. Radiographs were obtained and assessed for acetabular cover, degree of femoral head lateralisation, changes in the hip joint including secondary arthritic changes. Results: At an average follow-up of 13.4 years (range 8.1–17.2 years), all patients remain pain free and continue to maintain improved sitting posture and personal hygiene. Improvement to mobility was marginal, but those who were community walkers to begin with benefited the most. No significant progressive arthritic changes or lateral migration were seen in any of the patients except one, in whom only a partial reduction was achieved. Minor joint changes were seen in 2 other patients. Conclusions: Overall, Chiari osteotomy produces lasting benefits and the possible avascular necrosis and secondary arthritic changes in the hip joint appear to be minimal when compared with the long term benefits

Objective: The aim of this study was to show the effect of a universal (all neonates) ultrasound screening in newborns on the incidence of operative treatment of hip dysplasia. Materials: A retrospective study was performed and all newborns of the county Tyrol (Austria) between 1978 and 1998 (8257 births / year ((range: 7766 – 8858)) were reviewed regarding hip dysplasia and following hip surgeries. Between 1978 and 1983 clinical examination alone was performed to detect hip dysplasia. Between 1983 and 1988 an ultrasound screening programme according to Graf was initiated in our county. Between 1988 and 1998 ultrasound screening was performed in all newborns. Hence two observation periods were determined: 1978–1983 and 1993–1998. The time period between 1983 and 1993 was excluded to minimize bias and learning curve regarding the initiation of the ultrasound screening programme. A retrospective comparative analysis of the two observation periods regarding surgical treatment and costs caused by hip dysplasia was performed. During the observation period indication for surgery did not change, however new treatment techniques were introduced. Patients with neuromuscular and Perthes diseases were excluded. According to age dependent surgical procedures three patient samples were determined: Group A: 0–1.5 years, Group B: 1.5–15 years and Group C: 15–35 years. Results: Comparison of the two observation periods showed no influence on the number of interventions for dysplastic hips in group C (pelvic osteotomies and VDROs). In group A, a decrease of hip reductions was seen from 25.6±3.2 to 7.0± 1.4 cases per year. In group B, there was a decrease of operative procedures for dysplastic hips from 18.0±3.2 to 3.4±1.3 interventions per year. Since the introduction of universal hip ultrasound screening the decrease of the total number of interventions for all groups was 78.6%. Comparison of costs of the two observation periods showed an increase of all costs caused by DDH and CDH of 57.000 euro/ year for the time period between 1993 and 1998 which was mainly caused by the ultrasound screening programme. There was a significant reduction of costs regarding operative and non operative treatment for dysplastic hips from 410.000 euro (1978–1983) to 117.00 euro (1993–1998). Conclusion: Initially there were higher costs caused by the screening method, but on the other hand total number and costs for operative and nonoperative treatment of dysplastic hips were significantly reduced by the universal ultrasound screening programme. In our mind patient’s and family distress and pain related to interventions performed for CDH and DDH justify the slight increase of costs caused by the universal screening programme. We therefore recommend universal hip ultrasound screening for neonates