The effectiveness of combined clinical-sonographic screening in the treatment of neonatal hip instability

Objective: The early diagnosis of neonatal hip instability is well recognized in preventing possible late developmental dysplasia of the hip. The optimal scheme of its diagnosis is essential. The role of combined approach of clinical and ultrasonographic evaluation of hip instability in newborns is evaluated in the present study. Methods: Hips of 9030 consecutive neonates were examined independently by clinical and ultrasonographic means, separately by neonatologists and orthopedic surgeons, without initial sharing of information. When hip pathology was diagnosed by one of the modalities and missed by another, re-examination was performed. The rate of initially undiagnosed, clinically or ultrasonographically unstable hips and the 1-year follow up of the effected newborns were recorded. Results: Instability was diagnosed in 1.4% of all hips, but only 63% of unstable hips were diagnosed on the initial clinical examination. In the remainder, the clinical pathology was established on clinical re-examination after the sonographic abnormality was recognized. Similarly, but to a much lesser extent, sonographic pathology was detected only on the re-examination in 5% of the clinically unstable hips. Although the overall initial under-diagnosis rate of hip instability was 0.6% of all hips, the rate for treated hips was 0.1%. Conclusion: These data should be taken into consideration in planning an efficient DDH screening policy.