Late diagnosis of congenital dislocation of the hip and presence of a screening programme: South Australian population-based study

Background The Medical Research Council Working Party on Congenital Disloca tion of the Hip have reported an ascertainment-adjusted incidence of a firs t operative procedure for congenital dislocation of the hip (CDH) of 0.78 p er 1000 livebirths, which is similar to the incidence of CDH before the sta rt of the UK screening programme. The report showed that CDH had not been d etected by routine screening before age 3 months in 70% of children reporte d to the national orthopaedic surveillance scheme. This report raised conce rns about the merit of screening at birth for CDH. We aimed to find out the incidence of an operative procedure for CDH in the first 5 years of life a mong children born in South Australia between 1988 and 1993, and the propor tion of these patients that were detected at age 3 months or older. Methods The state's database for inpatient separations between January, 198 8, and April, 1998 was searched. Case records were examined for the age and circumstances of diagnosis, and type of operative procedures. Prevalence r ates of CDH were obtained from the South Australian Birth Defects Register, which receives notifications from a statutory perinatal data collection of birth defects detected at birth and subsequent voluntary notifications for children up to age 5 years. Findings Of the 55 children born in South Australia between 1988 and 1993 i dentified as having non-teratological CDH and operative procedures, only 22 (40%) had been diagnosed at age 3 months or order. 18 had an open reductio n of the hip joint or osteotomy, or both, and the remainder had arthrograms , closed reductions, and/or tenotomy. The prevalence of non-teratological C DH in children was 7.74 per 1000 livebirths. The incidence of surgery for C DH in the first 5 years of life was 0.46 per 1000 livebirths (95% CI 0.34-0 .59) and only 0.19 per 1000 livebirths (0.11-0.26) for those diagnosed late (age 3 months or older). These children diagnosed late represented 2.4% of ail known cases of CDH. Interpretation Only 2.4% of known cases of CDH in children born in South Au stralia had been detected late and required surgery. These results shaw tha t a screening programme for CDH can be successful, contrary to the findings of the UK Medical Research Council Working Party.