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.

Purpose of Study: In light of the proposed abolishment of the health visitor seven month assessment, we examined the treatment pathways for all patients born in the year 2003 in Northern Ireland who were treated for Developmental Dysplasia of the Hip. We wished to identify those patients who had presented late, to determine if they could have been referred earlier to the paediatric orthopaedic service.

Method: All patients treated conservatively and operatively for DDH were identified retrospectively from nurse procedure records and theatre logs. Patient charts were retrieved and data collected.

Results: One hundred and twelve cases were identified (5.17/1000 births). The mean age at diagnosis was 3.9 months. 33% were referred from maternity units. There was a wide variation in the rate of cases identified from each maternity unit (range 0 to 6.2/1000).

Seventy-four patients presented before the age of six months. Of these, fifteen required operative intervention. Of the thirty-eight patients presenting over the age of six months, twenty-four required operative intervention. The incidence of late presentation of DDH was 1.11 per 1000.

Ten of the late referrals had risk factors for DDH. At the seven month assessment the health visitor successfully identified and referred thirteen patients.

Conclusions: Despite routine clinical screening at birth and at eight weeks, children continue to present late with DDH. The wide variation in referral rates from maternity units suggests that the present method of screening should be closely examined. The health visitor plays an invaluable role in detecting DDH in children at the seven month assessment.