Pregnancy is a great time to start planning the best for your baby. There are steps you can take now such as scheduling visits to the well baby clinic to monitor your baby's growth development and planning an ultrasound screening of baby's hip to detect problems as soon as baby arrives to ensure their health and wellness.

Why do babies need a hip screening?
Congenital Dislocation of the Hip (CDH) or Developmental Dysplasia of the Hip (DDH) is one of the most common diseases in newborns and children. It occurs when the baby's hip does not develop properly and can cause problems like mild dysplasia, hip pain or even severe dislocation resulting in a delay in walking, limping and shortening of the leg. If it is untreated, children may develop arthritis or require hip replacement in late adult life.

How are hip problems diagnosed?
Hip deformity can be screened for during neonatal examinations by clinical examinations involving gently moving the hips and feeling for clicks and clunks. Milder cases, however, cannot be picked up by clinical examination, and these hips can get worse, going on to dysplasia or dislocation of the hip.

Why have a hip ultrasound?
The pick up rate of ultrasound screening is 7.7 in 100 versus 2.1 in 100 manually. Routine screening has been introduced in countries like Austria and Germany in which the rate of operation for babies with dislocated hips has been reduced to near zero.

Most hip problems can be corrected by using a special harness for a few weeks rather than surgery if detected and treated early. The harness holds the baby's hips comfortably flexed and keeps the hips stable allowing them to develop normally. Severe problems do need a plaster cast or even surgical treatment.
To make an early diagnosis ultrasound examination is very helpful and has been widely utilized for two decades in the diagnosis and follow-up of developmental dysplasia of the hip due to its ability to visualize the non-ossified femoral head and portions of the acetabulum in neonates, dynamic capabilities, accuracy and lack of ionizing radiation.

What is a neonatal hip ultrasound?
The baby will lie on an examining cradle on his or her side. A specialist will place some warm gel (a lotion) on a transducer and place it on the baby's hip to take pictures of the hips to look for a dislocated or underdeveloped hip. The test usually takes about 10 minutes for each hip. It is best performed in babies of 0-6 months old.

The extent of development and maturity of the hip can be assessed by the appearance and position of the hip bones. The specialist will also measure angles called alpha angle and beta angle to assess the normality of the hip and classify the results into 4 types according to the angles.
- Type I hips are normal
- Type II hips are immature and require monitoring
- Type III & IV hips are displaced and dislocated hips

What about the report and follow up?
A full report will be given to the baby's parent on completion of the scan. If everything is normal (Type I hips), no follow up is required. Parent will be given a report to pass to the baby's doctor.

If findings may be suggestive of hip instability/ immaturity (Type II hips), a follow up ultrasound will be done 6-8 weeks later. Treatment will be needed if no improvement occurs.

If hip dislocation is confirmed (Type III & IV hips), the specialist will discuss with you the details of treatment.

Reference: Paton, Srinivasan and Shah, etal - Ultrasound screening for hips at risk in developmental dysplasia: Is it worth it? Jbone Joint Surg Br 1999. Graf R -The use of ultrasonography in developmental dysplasia of the hip. Acta Orthop Taumatol Turc 2007.