NEONATAL HIP INSTABILITY IN SAUDI-ARABIA - RESULTS AND COST-EFFECTIVENESS

The benefits of screening hips at birth for congenital dislocation have been repeatedly confirmed but doubts have been raised about the need for splinting all positive cases. Experience from an ongoing screening program, now in operation for over 11 years, is presented particularly with reference to cost benefit of screening and early surgical intervention. Of 30,651 live born babies screened for congenital dislocation of the hip (CDH) employing Barlow and Ortolani maneuvers, 132 were found to be positive, giving an incidence of two to six per 1000 live births, averaging 4.3/1000 for the period. The implications of epidemiologic and clinical observations and of management have been discussed. The cost of screening and of surgical management of cases that would not have stabilized without splinting has been resolved, even assuming that three of four positive cases might have stabilized without intervention. Cost effectiveness of a screening program for CDH was observed from this 11 year study, fully justifying a sustained program apart from the human misery an overlooked diagnosis may cause.