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

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

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

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

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

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)

GRAF classification

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

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)

Risk Factors in Abnormal hips

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

Incidence of late diagnosis in Glasgow region 1992-1996 : physical examination- 49 cases, 0.84/1000 1997-2001 : 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

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.

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