1. Screening Hips of Newborns In Scotland
Rahul Tyagi, Marcin R Zgoda, Rachel Short
11th Central European Orthopaedic Congress, Prague 2016

2. Screening Options Screening Type Advantages Disadvantages Universal
No missed opportunity
Large number of false positive and unnecessary treatment
Targeted
Low false positive, low unnecessary treatment
Can miss few
No Screening
No Risks of treatment
No Treatment

3. Newborn & Infant Physical Examination across the UK
England
Selective ultrasound examination for babies with specific risk factors
Public Health England, October 2014
Scotland
Not currently a national screening programme but routinely carried out throughout NHS Scotland.
Macpherson K. Screening hips of newborns in Scotland: a Health Technology Assessment scoping report. Glasgow: Quality Improvement Scotland (NHS QIS ). 2006

4. University Hospital Crosshouse, Ayrshire and Arran, Scotland
All newborns are physically examined at birth and at 8 weeks by health professional
Targeted Screening programme for hip dysplasia

5. Targeted Screening Pathway
Follow Up (When Required)
Repeat Scan
Radiograph
Ultrasound Scan
By Trained Sonographer
By radiologist
Referral
Neonatal exam
High Risks

6. Methodology Retrospective review INCLUDED
All newborns who had hip ultrasound scan for first time in 2014 (Jan-Dec 2014)
US graded as per GRAF static method
Any child who had surgery for DDH from January 2014 to June 2015 (18 Months)

7. GRAF classification

8. RESULTS 428 babies (119 abnormal) 856 hip scans (147 Abnormal)
Average age at first scan was 5 weeks (range 3-22)
GRAF A & B- 134
GRAF 2C -10
GRAF 3- 3

9. Results-2 131 Graf 2a: observed Two bilateral graf 2c: Observed
12 babies were treated with a pavlik harness successfully
No complication (femoral nerve palsy or avn)
One late presentation (at age of 3 years)

10. Risk Factors in Abnormal hips

11. Incidence of Hip Dysplasia in Ayrshire and Arran
3618 live births in year 2014
Sonographic hip dysplasia 32.89/1000
Dysplasia requiring treatment 3.31/1000
Late diagnosis/missed hip dysplasia 0.27/1000

12. Incidence of late diagnosis in Glasgow region
: physical examination- 49 cases, 0.84/1000
: ultrasound screening- 29 cases, 0.57/1000
The lack of evidence of the effect of selective ultrasound screening on the incidence of late developmental dysplasia of the hip in the Greater Glasgow Region Kamath s, Mehdi A, Wilson N, Duncan, R
J Pediatr Orthop B 16:189–191 c 2007

13. Conclusion Incidence of late diagnosis can not be reduced to zero
Due to ethical consideration, we will probably never know the outcome of untreated but observed dysplastic hips in a large cohort of newborns
In our experience, selective hip screening by ultrasound scan is useful in avoiding overtreatment and minimising late presentations.

14. Thank you