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A working party of the Medical Research Council is calling for formal evaluation of the UK neonatal screening programme for congenital dislocation of the hip after its research questioned the effectiveness of the current policy.

Is screening babies for hip dislocation justified?

The working party established a national orthopaedic surveillance scheme and found that the incidence of a first operation for congenital dislocation of the hip in the United Kingdom was 0.78 per 1,000 live births. But congenital dislocation of the hip had not been detected by routine screening in 222 (70%) of 318 children reported to the scheme (Lancet 1998;351:1149-52).

Dr Carol Dezateux, a member of the working group, said that the incidence of first time surgery to correct congenital dislocation of the hip was now similar to that reported before universal screening was introduced in 1969. Current practice in Britain is to screen babies three times during the first six weeks of life. "The children who are not detected through the screening programme and who later require surgery represent a failure of screening. The goal of screening is to institute non-surgical treatment at an early stage to prevent the need for surgery," she said.

Dr Dezateux, senior lecturer at the Institute of Child Health, London, said that the 318 children needing surgery represented half of all cases seen in the United Kingdom. "It is estimated that around one in every 1,000 children born in the UK undergoes at least one surgical procedure for dislocated hip."

She said that several factors could explain the apparent lack of success of the screening programme: "It was surprising to find out how weak the scientific basis is to a screening programme that's been in operation for nearly 30 years. The natural history of dislocation is poorly understood. The test may be picking up all children with unstable hips, but there are also children with stable hips whose dislocation only becomes evident when they start crawling or weight bearing. Another reason could be that people are not being trained to do the test properly."

The working party is meanwhile considering other screening approaches. A cost effectiveness analysis of current and alternative strategies for screening, including ultrasound examination--currently used in some European countries--is being undertaken. But Dr Dezateux warned: "We have to proceed with caution. Ultrasound can lead to an epidemic of unnecessary treatment. In some European countries around 40 times the number of children who you would expect to develop a dislocation are being treated non-surgically."