Baby screening programme ‘fails’ to prevent late diagnosis of hip problems

A study found that selective hip screening of babies could be ineffective in preventing late diagnosis of developmental dysplasia of the hip (DDH).

The condition, which happens when the “ball and socket” hip joint does not form properly, can be treated with a removable splint worn for two to three months if it is spotted early in infancy.

But if it is undiagnosed after three months it can lead to mobility problems, hip pain and osteoarthritis later in life.

To test for the condition, babies are given an ultrasound scan only if potential DDH is spotted just after birth, at six to eight weeks, or if they have an underlying risk of having the condition.

In a study of almost 15m patients published in The Bone and Joint Journal, doctors at Southampton Children’s Hospital found the incidence of late-diagnosed DDH remains similar to that recorded 35 years ago, before the introduction of the screening programme.

Alexander Aarvold, a consultant orthopaedic surgeon at the Southamton hospital, said: “Hip dysplasia is a significant public health issue which, untreated, represents the single largest cause for arthritis and total hip replacement in young adults.

“Detection in children over one year of age remains a persistent reason for referral to paediatric orthopaedic units.

“The approach of selective screening appears to have failed to impact on incidence rates of late-diagnosed DDH and it remains a still uncontrolled disability across the country.”

If it is not picked up in infancy by screening, DDH is usually detected after children start walking.

Those children usually need surgery to get the hip into joint and reduce the chance of arthritis in young adulthood instead of a splint being used.

Public health England said giving all babies scans for DDH could lead to complications caused by unnecessary treatment.

Director of Screening Anne Mackie said: “We know that wearing a splint in the crucial early months can affect the bond between mother and baby and can also cause avascular necrosis where the hip ‘dies’. “But we have recently looked in detail at the efficacy of this programme for newborns, having undertaken a national consultation in 2018, and are currently working on implementing the agreed evidence based clinical changes that will improve the overall screening process and subsequent timely treatment.”