Call for changes to infant hip screening

Orthopaedic experts are calling for the reassessment of national guidelines relating to new-born and infant developmental dysplasia of the hip (DDH) screening, following the findings of a 15-year study.

Orthopaedic surgeon Ronnie Davies and colleagues examined hip problems identified in more than 70,000 children in the north of England and found that the sensitivity and positive predictive value of the six-eight week screening test are low at just 16.7% and 3.5% respectively.

It means that in some cases of DDH are missed, providing false reassurance to parents, they say.

Writing in today’s BJGP (25 February 2020), they call for the introduction of a second assessment at three-four months and also recommend that the assessments are performed in primary care, with thorough training provided.

Study author Chris Talbot said: “Over 70,000 children were included within this arm of the assessment over a period of 15 years. With this part of the assessment yielding a low sensitivity and positive predictive value, there is a concern that DDH will not be identified at this check and parents falsely reassured.

“Assessment of clinical hip instability is a key sign during this assessment, as too limited hip abduction, and must be undertaken by all health professionals at this time point. Despite this six to eight week assessment, in addition to risk factor screening and the neonatal examination, late presenting cases were still identified.

“It is recommended that there is a change in the UK screening programme to mitigate against the high number of late presenting DDH cases, such as an additional assessment at three to four months.

“Moreover, there needs to be more emphasis placed on the training of healthcare professionals performing this assessment, and empowering parents to raise concerns such as those highlighted in the ‘red book’.”

Davies R, Talbot C, Paton R. Evaluation of primary care 6- to 8-week hip check for diagnosis of developmental dysplasia of the hip: a 15-year observational cohort study. BJGP 25 February 2020; doi:

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