NEONATAL HIP INSTABILITY IN SAUDI-ARABIA - RESULTS AND COST-EFFECTIVENESS

The benefits of screening hips at birth for congenital dislocation hav e been repeatedly confirmed but doubts have been raised about the need for splinting all positive cases. Experience from an ongoing screenin g program, now in operation for over 11 years, is presented particular ly with reference to cost benefit of screening and early surgical inte rvention. Of 30,651 live born babies screened for congenital dislocati on of the hip (CDH) employing Barlow and Ortolani maneuvers, 132 were found to be positive, giving an incidence of two to six per 1000 live births, averaging 4.3/1000 for the period. The implications of epidemi ologic and clinical observations and of management have been discussed . The cost of screening and of surgical management of cases that would not have stabilized without splinting has been resolved, even assumin g that three of four positive cases might have stabilized without inte rvention. Cost effectiveness of a screening program for CDH was observ ed from this 11 year study, fully justifying a sustained program apart from the human misery an overlooked diagnosis may cause.