Infant hip screening may miss serious problems

25 February 2020

UCLan Honorary Professor among team of orthopaedic surgeons whose research has been published in the British Journal of General Practice

A University of Central Lancashire (UCLan) honorary professor is part of a research team which is calling for a change to current hip health guidelines.

Professor Paton, who was part of the team that initially developed the UCLan Medical School, joined two fellow orthopaedic professionals to evaluate the current hip checks for six to eight-week-old children.

Developmental dysplasia of the hip (DDH) is a common cause of childhood disability with an incidence reportedly as high as 20 in every 1,000 live births.

The newborn and infant screening guidance from Public Health England still recommends a ‘hip check’ at six to eight-weeks after birth, although this is based on guidance produced by the Department of Health more than 30 years ago and is not supported by up-to-date evidence.

"Despite this six to eight-week assessment, in addition to risk factor screening and the neonatal examination, late presenting cases were still identified."

Orthopaedic surgeon Ronnie Davies, paediatric orthopaedic surgeon Chris Talbot and Professor Paton, a consultant orthopaedic surgeon at Royal Blackburn Hospital, have studied hip problems identified in a population of more than 70,000 children in the north of England.

They have reported that the sensitivity and positive predictive value of the six to eight-week screening test are low (16.7% and 3.5% respectively), so that some cases of DDH will be missed, providing false reassurance to parents. During the 15-year study period, 30 children with late presenting DDH were identified.

The authors, whose work has been published today (25 February) in the British Journal of General Practice, recommend a re-think of current guidance, perhaps with the introduction of a second assessment at three to four months. They also recommend that these assessments are performed in primary care but emphasise the importance of training to ensure that they are carried out correctly. 

Professor Paton
Professor Paton

Chris Talbot, one of the authors, said: “Developmental dysplasia of the hip (DDH) is an important childhood condition for which a selective screening programme is employed in the UK.

“The six to eight-week hip check, which is performed as part of the infant assessment, was evaluated in this study. 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 professional at this time point.”

Professor Paton added: “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'.”

A link to the research paper is available here.