Financial justification for routine ultrasound screening of the neonatal hip

We have analysed the patterns of management of developmental dysplasia of t he hip (DDH) in Coventry over a period of 20 years during which three diffe rent screening policies were used. From 1976 to the end of 1985 we relied on clinical examination alone, The m ean surgical cost for the treatment of DDH during this period was pound 511 0 per 1000 live births. This was reduced to pound 3811 after the introducti on of ultrasound for infants with known risk factors. Since June 1989 we ha ve routinely scanned all infants at birth with a mean surgical cost of poun d 468 per 1000 live births. This reduction in cost is a result of the earli er detection of DDH with fewer children requiring surgery. In those who do, fewer and less invasive procedures are needed. The overall rate of treatme nt has not increased and regular review of patients managed in a Pavlik har ness has allowed us to avoid the complication of avascular necrosis, When we add the cost of running the screening programme to the expense of t reating the condition, the overall cost for the management of DDH is compar able for the different screening policies.