Quality improvement report: Clinical screening for developmental dysplasia of the hip in Northern Ireland

Although there is an agreed national protocol for the clinical screening of developmental hip dysplasia (DDH) there are no national guidelines for the use of ultrasound to detect this condition. The increased incidence of babies requiring surgery for this condition across the bay has led us to institute a selective screening programme in line with best clinical practice. This article describes care pathways in primary and hospital care in some detail and will therefore be of direct clinical relevance to the midwive , health visitors, general practitioners, physiotherapists, paediatricians, and orthopaedic surgeons involved in the management of babies at higher risk of DDH. We also outline the physiotherapy and orthopaedic management of children with this condition. Feedback or suggestions relating to the recently introduced screening programme would be welcomed.

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Letters to the Editor

PEDIATRICS ◽

10.1542/peds.95.5.800 ◽

1995 ◽

Vol 95 (5) ◽

pp. 800-800

Author(s):

Karen Rosendahl ◽

Trond Markestadt

Keyword(s):

Developmental Dysplasia ◽

Ultrasound Screening ◽

Letters To The Editor ◽

Clinical Screening ◽

Dysplasia Of The Hip

We thank Drs Harcke and Walter for their valid comments. We agree that ultrasound has an important role in the detection of developmental dysplasia of the hip (DDH), as we also stated in the conclusion of the paper,1 but we are still uncertain with regard to the use of ultrasound in screening for DDH. In our study universal or selective ultrasound screening possibly had an effect in reducing the rate of late DDH as compared with just clinical screening.1

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Should closed reduction of the dislocated hip be attempted after failed Pavlik harness treatment in developmental dysplasia of the hip?

Bone & Joint Open ◽

10.1302/2633-1462.28.bjo-2021-0088.r1 ◽

2021 ◽

Vol 2 (8) ◽

pp. 584-588

Author(s):

Matthew Arneill ◽

Aidan Cosgrove ◽

Elaine Robinson

Keyword(s):

Northern Ireland ◽

Surgical Procedures ◽

Closed Reduction ◽

Developmental Dysplasia ◽

General Anaesthetic ◽

Pavlik Harness ◽

Total Cohort ◽

Clinically Significant ◽

Dysplasia Of The Hip

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):584–588.

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