Infant Hip US Service

Development Dysplasia of the Hip (DDH) covers a spectrum of hip abnormalities, ranging from hip dysplasia, reducible subluxation/dislocation and irreducible hip dislocation. The term DDH encompasses the range of hip conditions seen within the first year of life. The late diagnosis of DDH leads to more invasive treatment than if it is diagnosed in infancy and is associated with a significant rate of premature degenerative joint disease of the hip in early adulthood.

 

Reported incidence of DDH in the UK is 1.2/1000 live births. There is a 4-fold increase in females due to increased ligamentous laxity caused by circulating hormone, relaxin. The incidence of DDH increases 12-fold in affected first degree relatives. 60% of DDH cases are first born.

 

Please note that infants referred with risk factors for DDH following the new born examinations will be seen within 4-6 weeks of age at the Infant Hip Screening Service.

 

Refer

Infants with the following clinical signs:

• Positive Barlow or Ortolani tests
• Asymmetric Gluteal skin folds
• Leg length discrepancy
• Unequal/tight hip abduction when the hip is flexed to 90 degrees
• Hip clicks
• Plagiocephaly
• Positional and Fixed Talipes
• Torticollis or sternomastoid tumour

 

Risk Factors for referral include:

• Positive family hx of DDH or Hip instability
• Breech or transverse position at delivery between 28 weeks gestation and term
• Breech position at or after 36 weeks of pregnancy (irrespective of presentation at birth or mode of delivery)
• Multiple pregnancy
• Oligohydramnios
• Parental concern

 

Referrals should be sent on ERS to the Referral Management Service. The infant hip screening clinic aims to see all referrals within 4 weeks of the referral date.

 

Infants up to the age of 12 months with clinical signs of DDH should be referred to the screening clinic. Any child older than this must be referred urgently to the Paediatric Orthopaedic Consultant’s clinic.

Urgent Referrals: please refer on ERS and email claire.hawkins11@nhs.net or phone the Orthopaedic Booking Team on 01736758893.

• Unequal/tight hip abduction when fully flexed
• Limping/asymmetry
• Leg shortening (manifesting as tip toe walking on affected side)
• Unstable hips

For any queries regarding appointments please contact the Orthopaedic Booking Office on 01736 758892.

 

Notes:

Babies requiring the application of a Pavlik harness are referred to the Paediatric Orthopaedic Physiotherapy Team and progress monitored with regular ultrasound scans until the child is approximately 1 year old. They will then be referred to the Paediatric Orthopaedic Consultant clinic where they will be reviewed with xray and will have periodic review as indicated.

Those not responding to harness treatment will be referred to the next available Paediatric Orthopaedic Surgical Clinic. 

For further advice, contact Claire Hawkins claire.hawkins11@nhs.net  or phone Trauma and Orthopaedic secretaries 01872 253430

 

Date                           April 2021

Review Date:            April 2022

Author                       Dr S Burns GP

Contributors             Claire Hawkins, Royal Cornwall Hospital Trust

 

Version No.  2.2