Cases of debilitating hip condition in babies being missed, surgeons warn

Orthopaedic surgeons fear debilitating hip dysplasia is going undiagnosed in children because babies are screened when they are too young.

Under current guidance from Public Health England, babies are screened for developmental dysplasia of the hip (DDH) – a common cause of childhood disability – between six and eight weeks of age.

The condition has an incidence rate of between 1.4 and 20 cases in every 1,000 infants.

But according to a recent paper, cases of DDH are being missed under screening practices.

A study of more than 70,000 babies born at a district general hospital in the north of England between 1996 and 2010 found a significant rate of late-presenting cases.

Of 70,071 babies screened at six to eight weeks, 170 were identified as having a hip problem.

A further 30 cases were later identified in children between the ages of 18 weeks and five years, prompting concern the screening system is providing false reassurance to parents.

All the late cases would have undergone the initial screening from six to 16 weeks.

The surgeons involved in the study want a rethink of the approach to hip assessments and potentially the introduction of a second assessment.

Orthopaedic surgeon Chris Talbot, of Alder Hey Children’s NHS Foundation Trust in Liverpool, said: “It is recommended that there is a change in the UK screening programme to mitigate against the high number of late-presenting DDH cases, such as an additional assessment at three to four months.

“Moreover, there needs to be more emphasis placed on the training of healthcare professionals performing this assessment, and empowering parents to raise concerns.”

The authors said the results were limited by the difficulty of following up on all infants born in the region until a diagnosis of DDH or until skeletal maturity.

The study – called Evaluation of primary care 6 to 8-week hip check for diagnosis of developmental dysplasia of the hip: a 15-year observational cohort study – is published in the British Journal of General Practice.

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