What do we screen for in NIPE hips and why?
Dislocated or dislocatable hips, developmental dysplasia of the hips.
1-2 in 1000 need surgery
3-5 need Pavlik harness
Delay in treatment can cause complex surgery or ling term complications with mobility
What are the different types of developmental dysplasia of the hips?
Dislocation - femoral head completely out of acetabulum
Subluxation - femoral head partically out of acetabulum
Dislocatable - femoral head loose within acetabulum at rest, but dislocated with examination manoeuvres (BARLOW)
Subluxatable - femoral head within acetabulum at rest, but partically dislocates / moves with examination manoeuvres (ORTOLANI)
Discuss a+p for NIPE hips
Embryology - femoral head and acetabulum come from same mesochymal cells, hip joint formed at 11 weeks
Utero - femoral head should sit nicely within acetabulum, if acetabulum is shallow, femoral head sits outside acetabulum - this can be cause by oligohydramnous due to lack of room and movement.
PN - baby cannot move from flexion to abduction, future risk of DDH. Do not swaddle, more pressure of femoral hip
Discuss risk factors for NIPE hips
First degree relative of hip problems in at birth or childhood
Breech after 28weeks and during birth
Breech after 36 weeks , even if ECV or born not breech
Twins if 1 or both are breech (both need referral)
Discuss observation element of the NIPE hips
Symmetry of legs length - flatten out straight
Level of knees when hips and knees are flexed - one knee higher than other is positive sign of dislocated
Restricted abduction of hips
Skin creases on buttocks are no longer screened for - baston and durward (2025) says to do so
Discuss palpation of NIPE hips ( ortolani )
Ortolani manoeuvre - discovers already dislocated hip. Supine position with one hand supporting sacrum and pubic symphysis. Other hand with thumb on lesser trochanter and middle finger on greater trochanter. Turn 90 degrees outward. Auditable / palpable clunk as femoural head goes back into acetabulum
Discuss palpation of NIPE hips (Barlow)
Discovers dislocatable hip. Thumb on lesser trochanter and middle finger on greater trochanter. Push posteriorly to see if femoural head can come out of the acetabulum
Discuss negative screening pathway for NIPE hips
No findings. Healthy child programme for 6-8w review with gp
Advise parents - no findings, poor tone, stiffness when changing.
DOCUMENT SMART4NIPE, BADGER AND RED BOOK
Discuss positive screening for NIPE hips and referral
Positive referral needs hip scan referral or NN review if concerned surrounding movement or circulation :
Difference in leg length / knee height
Restriction of unilateral hip abduction (20 degree different between 2 legs)
Restriction of bilateral hip abduction (abductions to 60 degrees)
Palpable chunk with Barlow or ortolani
Risk factors - breech (both twins), first degree relative, breech after 36w, breech born after 28weeks before term
DOCUMENT SMART4NIPE, BADGER AND RED BOOK
When should the USS been conducted and what should happen after for NIPE hips
4-6 week USS for babies born after 34 weeks
For babies born before 34 weeks, USS should be before expected term
USS should be assessed by orthopaedic specialist - baby may need pavlik harness
