# Improving Early Detection of Developmental Dysplasia of the Hip: A Study of Compliance With England’s Screening Programme

## TL;DR

This study examines compliance with hip screening guidelines in England and finds issues with referral accuracy and scan timing that could affect early treatment of hip dysplasia.

## Contribution

The study identifies specific gaps in the DDH screening pathway in England, particularly in referral accuracy and scan timing.

## Key findings

- All infants received a hip exam within 72 hours, with a median of 21 hours.
- 26.5% of hip ultrasounds were performed outside the recommended 4-6 week window.
- The top 25% of examiners performed 66.2% of all hip exams, indicating uneven workload distribution.

## Abstract

Background

In England, the rate of late-diagnosed developmental dysplasia of the hip (DDH) is higher than that in neighbouring countries, suggesting potential gaps in the national screening pathway. This study aimed to evaluate adherence to the NHS Newborn and Infant Physical Examination (NIPE) programme guidelines to identify areas for improvement.

Methods

A retrospective, single-centre evaluation was conducted in a neonatal unit in England for all consecutive neonates born in August 2023. Main outcome measures included compliance with the 72-hour timeframe for the initial hip examination, accuracy of ultrasound (USS) referral decisions, timeliness of USS completion, and the distribution of clinician workload.

Results

All infants (302/302, 100%) received a hip examination within 72 h (median 21.0 h, IQR 13.3-28.0). Guideline-concordant referral decisions were 291/302 (96.4%; 95% CI 93.6-98.0). Under-referral occurred in 2/27 (7.4%) of indicated cases; over-referral was 9/275 (3.3%) among non-indicated infants and constituted 9/34 (26.5%) of all scans. Hip USS was completed in 34/34 (100%) referred infants; 20/34 (58.8%) scans were completed within 4-6 weeks, 5/34 (14.7%) were early (<4 weeks), and 9/34 (26.5%) were late (>6 weeks). Workload was concentrated: the top quartile of examiners (8/32) performed 200/302 (66.2%) examinations.

Conclusion

This evaluation found excellent compliance with the initial newborn hip examination, yet important weaknesses emerged later in the screening pathway. Inaccurate referrals and uneven examiner involvement were observed alongside delays, with a significant number of infants scanned outside the recommended 4-6-week window. These deviations may reduce the opportunity for timely, non-invasive treatment. Strengthening practice locally could include reviewing the referral-to-scan pathway and establishing a consistent group of higher-volume, credentialed examiners to support accuracy and imaging capacity. Further multi-centre work is needed to assess wider applicability and impact on clinical outcomes.