Richmond Practice - Early ultrasound screening for congenital dislocation of the hip

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Early ultrasound screening for congenital dislocation of the hip

By Dr Robert Arlt MD, Consultant Paediatrician

Congenital dislocation of the hip is a condition that affects 15% of births. It refers to a spectrum of disease ranging from complete dislocation of the hip, through to some shallowness of the hip joint socket. This is due to an inappropriate alignment of the upper end of the thigh bone (the femur) and the pelvis. One or both hips may be involved. If the condition is not identified early, the child will have an increased risk of lifelong hip problems that will usually require a hip replacement at a young age.

Hip ultrasound is the gold standard for detecting hip problems in children under four months, but is most effective if done before the age of six weeks. There is evidence that ultrasound hip screening may reduce the need of hip surgery by nearly 80%. For example since introduction of routine baby hip screening in Germany the incidence of hip surgery reduced from 1.24 to 0.26 in 1000 live births. Delayed diagnosis often requires surgical treatment but it may also avoid over-treatment.

Whether hip ultrasound done as a general screening process, or only for babies at risk, depends on the health system in different countries. In Austria, Switzerland and Germany, primary care paediatricians screen all babies. In the UK, all newborns are clinically checked for ‘clicky hips’ and asymmetric thigh creases. But even if such features are missing, hip ultrasound screening before six weeks of age should still be done where risk factors are present. These are mainly:
  • Breech position during pregnancy, in which the baby's bottom is down
  • Family history of the disorder
  • Large birth weight (over 4 kg)
  • Other orthopaedic problems that include metatarsus adductus, clubfoot deformity, congenital conditions, and other syndromes

Less specific risk factors are:
  • Being the first child
  • Being female
  • Stiffness in the neck (torticollis)

Ideally congenital hip dysplasia should be diagnosed and treated before other symptoms occur. Symptoms that may occur in a newborn can include:
  • The leg may appear to turn out more
  • Reduced movement on the side of the body with the dislocation
  • Shorter leg on the side with the hip dislocation

After 3 months of age, the affected leg may turn outward or be shorter than the other leg.

Once the child begins walking, symptoms can include:
  • Waddling or limping while walking
  • One shorter leg, so the child walks on their toes on one side and not the other side
  • The child’s lower back is rounded inward

If hip dysplasia is diagnosed in the first few months of life, it can almost always be treated successfully with a positioning device (a brace). In a few cases, surgery is needed to relocate the hip joint. With a later diagnosis, more complex surgery may be needed and the outcome may be quite unsatisfactory.

To book a hip ultrasound with a Consultant Paediatrician at +richmond practice call
020 890 5009 or email us at mail@richmondpractice.co.uk.

 

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