Hip instability in newborns in an urban community

Abstract

Background: It is important to recognize congenital dislocation of the hip early so that it can be treated effectively and secondary changes prevented. There is little data on the incidence of this condition in India and we, therefore, studied this problem in a large maternity and paediatric centre in New Delhi.

Methods: Six thousand and twenty-nine consecutive newborns were examined for neonatal hip instability by an orthopaedic surgeon and a paediatrician. Clinical examination was supplemented by X-ray and ultrasonographic examination.

Results: One hundred and forty-eight hips in one hundred and thirteen newborns (18.7 per 1000 live-births) were found to be unstable at first examination. Of these 12.1 per 1000 live-births had subluxatable hips and 0.82 per 1000 had dislocated hips. Those affected were more likely to be females, have involvement of the left hip and have had a breech presentation. One hundred and twenty-eight hips in 97 children had stabilized within 2 weeks, although no definite progress to stability was observed in subluxatable, dislocatable or dislocated hips. Two children who had other congenital abnormalities initially required operation, but the hips in all the other children stabilized within 20 weeks of birth with conservative treatment.

Conclusion: Neonatal hip instability is common in New Delhi and a screening programme should be initiated to detect its incidence in other parts of India.