The Effect of Screening Policies on Detection Age and Rates of Surgery in Developmental Dysplasia of the Hip (DDH) - a Bi-National Study

This study aimed to compare 1) the demographic characteristics and method of diagnosis of DDH in two centres from two countries using different diagnostic pathways and 2) the subsequent effect on age at diagnosis. The official criteria for ultrasound (US) referrals in the two countries are equivalent but the early clinical examination is performed by an experienced paediatrician in Israel and by a junior trainee or a midwife in the UK.

A database search identified consecutive primary closed and open reductions performed at two comparable referral centres over a twenty year period (1996-2016): 297 patients were included: 150 from Schneider Children’s Medical Centre in Israel (SCMC) and 147 from St Georges Hospital in UK (SGH). A case note review collected data which included patient demographics, risk factors, age at diagnosis and means of diagnosis: clinical vs US.

There was a significant difference between the means of diagnosis with 94% clinical diagnosis at SGH compared to 47% at SCMC. Age at diagnosis was also significantly different (14 weeks SCMC vs 47 weeks SGH) indicating poor clinical detection after birth in SGH. 95 patients (65%) had an open reduction in SGH compared to 18 (12%) in SCMC. The risk factor distribution was comparable. 59% from SGH and 51% from SCMC did not have any risk factors for DDH.

There was a significant difference in diagnosis age between the two cohorts. The majority of patients had no risk factors and positive clinical examination at a young age was significantly different. This resulted in a later diagnosis age and additional surgical interventions. A change in the approach to screening for DDH should be considered.