European Journal of Ultrasound 15 (2002) 55 – 60 The effectiveness of combined clinical-sonographic screening in the treatment of neonatal hip instability N. Rosenberg a, *, V. Bialik b a Department of Orthopedics A, Rambam Medical Center, POB 9602, Haifa 31096, Israel b Pediatric Orthopedics Unit, Rambam Medical Center and Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel Accepted 7 December 2001 Abstract Objectie: The early diagnosis of neonatal hip instability is well recognized in preventing possible late developmen- tal dysplasia of the hip. The optimal scheme of its diagnosis is essential. The role of combined approach of clinical and ultrasonographic evaluation of hip instability in newborns is evaluated in the present study. Methods: Hips of 9030 consecutive neonates were examined independently by clinical and ultrasonographic means, separately by neonatologists and orthopedic surgeons, without initial sharing of information. When hip pathology was diagnosed by one of the modalities and missed by another, re-examination was performed. The rate of initially undiagnosed, clinically or ultrasonographically unstable hips and the 1-year follow up of the effected newborns were recorded. Results: Instability was diagnosed in 1.4% of all hips, but only 63% of unstable hips were diagnosed on the initial clinical examination. In the remainder, the clinical pathology was established on clinical re-examination after the sonographic abnormality was recognized. Similarly, but to a much lesser extent, sonographic pathology was detected only on the re-examination in 5% of the clinically unstable hips. Although the overall initial under-diagnosis rate of hip instability was 0.6% of all hips, the rate for treated hips was 0.1%. Conclusion: These data should be taken into consideration in planning an efficient DDH screening policy. © 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: DDH; Hip instability; Screening; Ultrasonography www.elsevier.com/locate/ejultrasou 1. Introduction The pathological basis of developmental dys- plasia of the hip (DDH) is considered to be a lack of sufficient mutual development of the hip joint components, leading to the inappropriate contain- ment of the femoral head in the acetabulum (Aronsson et al., 1994). Left untreated, this situa- tion can progress to a clinically complicated pro- cess and result in functional disability with pain, which could require extensive surgical treatment (Cooperman et al., 1983; Wedge and Wasylenko, 1979). There are two main pathological pathways con- sidered as responsible for the lack of hip contain- * Corresponding author. Tel.: +972-4-854-2527; fax: + 972-4-854-2022. E-mail address: nahumrosenberg@hotmail.com (N. Rosen- berg). 0929-8266/02/$ - see front matter © 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0929-8266(01)00167-7