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PURPOSE OF THE STUDY In the Czech Republic a systematic neonatal hip screening has been performed for many decades. Its aim is to prevent, by means of early treatment of hip dysplasia in the newborn period, the development of hip deformities leading to the onset of degenerative hip changes during the adulthood. The study aims to prove the effects of paediatric hip care based on the data analysis of the Czech National Register of Joint Replacement. MATERIAL AND METHODS The National Register of Joint Replacement comprises information on implantation of hip arthroplasties performed over the period of last 15 years, while the screening has been carried out for almost 60 years. An analysis of the patients' data from the register was conducted; the data was sorted by the diagnosis leading to surgery in individual age categories and individual years. The obtained data was correlated with the systems of newborn hip screening at the time when the treated generations of patients were born. RESULTS According to the National Register of Joint Replacement, in the period 2003-2017 a total of 174,515 primary hip joint replacements were performed, 345 total hip arthroplasties (0.19 %) were implanted for complete hip dislocation in dysplasia, 14,139 replacements (8.10%) were performed for postdysplastic hip degeneration. By comparing the periods 2005-2007 and 2015-2017 a decrease almost to a half of the number of implanted endoprostheses for hip dislocation was identified. Moreover, only 8 of 345 dislocated hips in the Register were managed by joint replacement in patients who were born during the systematic screening period. The percentage of endoprostheses implanted for postdysplastic degeneration decreased respectively; in 2005-2007 period 2,692 of 28,525 hip endoprotheses (9.44%) were implanted, whereas in 2015-2017 period 3,285 of 46,228 hips (7.11%) were operated on. This decline is statistically significant (p < 0.001, OR 1.34). DISCUSSION The efficiency and success rate of sonography resulted in Central Europe in such a rapid expansion of neonatal ultrasound hip screening that no comparative studies were carried out to confirm this concept (as is currently requested by evidencebased-medicine). This has later become the source of misunderstanding and subject to criticism primarily in the overseas literature. Those who focus on ultrasound screening feel that conducting prospective randomised studies on (non)treatment in ultrasound detected pathologies is ethically unacceptable today. When seeking another way of confirming the efficiency of universal screening, a detailed analysis of data from the hip joint replacement registry has proven successful. CONCLUSIONS A low number of arthroplasties implanted for hip dislocation in the Czech population is recorded in the National Register of Joint Replacement. This confirms the success of the existing system of neonatal hip screening; the results show that the treatment of hip dislocation in children is successful. The ongoing decline in the share of patients in the population treated by total hip replacement in postdysplastic degeneration has been confirmed. Data evolution will be subject to further research in the upcoming decades, with a positive effect of ultrasound monitoring of treatment to be foreseen. Key words: developmental dysplasia of the hip, screening, register of joint replacements.

Purpose of the Study: Aim of the study was to analyze age structure of the patients with developmental dysplasia of the hip (DDH) at the time of the operation and epidemiological determinants: gender distribution, proportion of left or right hip affection, type of delivery and mode of labor presentation., Material and Methods: The population of 78 children with DDH was evaluated. Three age groups were analyzed: first group younger than 24 months of life, second group between 24 and 48 months and third group older than 48 months of life. Male and female gender was separately evaluated as well as type of delivery and mode of labor presentation. Separately, 2 groups regarding affected hip were analyzed: group with affected left hip and group with affected right hip. Radiographic findings (Collodiaphyseal angle, Hilgenreiner angle and Wibergs center-edge angle) and clinical findings (positive Trendelenburgs sign, reduced flexion angle (<114°), pain in the hip and incomplete crouch) were evaluated regarding: age of the patients, gender, mode of presentation and type of delivery., Results: There was 33.3% of patients in the first age group, 46.2% of patients in second group and 20.5% of patients in third age group, and regarding gender, 17.9% of males and 82.1% of females. Vaginal delivery was predominant mode with distribution of 87.2% as well as head presentation with distribution of 71.8%. Distribution of children with affected left hip was 46.2% and right hip 53.9%., Discussion: Majority of patients in the study were in the age group between 24 and 48 months of life, suggesting delay in on-time diagnostics of DDH. Female gender was more frequently affected by DDH and vaginal delivery as well as head presentation of newborn was significantly frequent in patients with DDH. It is shown that Collodiaphyseal, Hilgenreiner and Wibergs center-edge angles values are in correlation with the age structure of the patients with DDH at the time of diagnosis. Male gender tends more frequently to present with clinical findings. Reduced flexion angle of the hip is the frequent clinical finding for children with DDH that were born by breech presentation or delivered by Caesarean section., Conclusion: Female gender can be taken as one of possible risk factors during clinical examination of newborn regarding diagnostics of DDH, while breech presentation has been shown not to be one of possible risk factors. Early diagnostics and prompt treatment are beneficial in overall outcome for children with DDH. Therefore, there is great need for countinous education of orthopedic surgeons and pediatricians.

Purpose of the Study: To analyze our results of screening for developmental dysplasia of the hip (DDH) in the Liberec region between 1984 and 2005, Material and Methods: The study comprised 30,010 infants screened for DDH without any primary selection between 1984 and 2005.The infants were clinically examined on the basis of a three-step screening system (newborn, at 6 weeks and between 3 and 4 months of age) and by an imaging method. In the period from 1984 to 1991, this was plain radiography of the hip at 3 months of age, and a total of 12,944 infants were assessed. Between 1992 to 2005 ultrasonography (USG) was used at 6 weeks (or earlier when clinical signs were present) and again at 3 to 4 months of age, and a total of 17,066 infants were evaluated. In 16,678 of these infants, the sonogram obtained at 6 weeks was evaluated in detail by the Graf method. The presence of the epiphyseal nucleus of the proximal femur was assessed at 3 months, and from 2000 at 4 months of age. Attention was paid to the occurrence of DDH in general and findings of dislocation, both subluxation and luxation, of the hip, the proportion of right-side, left-side and bilateral findings, gender differences, the presence or absence of ossification of the femoral epiphyseal nucleus in infants between 3 and 4 months of age and, in the 1992-2005 period, the stratification of Graf types at 6 weeks. A question of whether the child's months of birth might have any relation to a possibility of DDH occurrence was also raised., Results: Between 1984 and 1991, DDH was recorded in 10.4% of the infants, usually in a light form responding well to conservative treatment; subluxation was found in 1.99% and luxation in 0.6%. Between 1992 and 2005, DDH (mostly light forms) was recorded in 5.2%, subluxation in 0.5% and luxation in 0.2% of the infants. Right-side, left-side and bilateral findings were seen in 29%, 46% and 25% of the infants, respectively, and there were distinct differences between the genders. In an evaluated group of 453 infants with either subluxation or luxation, 86% of girls and 14% of boys were affected. The month of birth had no effect on DDH occurrence. Of the 9878 infants examined at 3 months, ossification of the femoral epiphyseal nucleus was found only in 37%, and of the 7188 infants examined at 4 months this was recorded in 64%. In a total of 33,356 hips (16,678 infants) evaluated at 6 weeks on the Graf scale, the following Graf types were recorded: Ia, 21%; Ib, 58%; IIa, 20%; IIc, 1%; D/IIIa, 0.19%; and IIIb/IV, 0.08%., Discussion: The occurrence of DDH (formerly congenital dysplasia of the hip), including all forms/grades, is reported to be 3% to 5% in Central Europe. Our recent results obtained by the USG method are in agreement with this, as are our findings of its more frequent occurrence in girls (boys to girls, 1 to 6) and on the left side. Several reasons--medical, statistical or even sociodemographic--can be considered to explain the discrepancies in DDH detection rates obtained with radiography and ultrasonography, i.e., 10.5% vs 5.3%. For instance, the USG detection of DDH at 6 weeks of age initiates early treatment preventing progression of hip dysplasia. Better facilities available for home neonatal care and increased interest in general baby wellness may also play a role., Conclusions: Screening for developmental dysplasia of the hip is fully justified, because DDH prevalence is still high (500 subluxations and 200 luxations per 100,000 population). However, attention should also be paid to reducing factors and conditions that may adversely affect hip development from the baby's prenatal period to spontaneous walking.

Purpose of the Study: Developmental dysplasia of the hip (DDH) is a serious anatomical abnormality. The aims of the study were to compare the current views on general screening for DDH and, in a group of patients diagnosed for DDH both clinically and ultrasonographically, to analyse the results of their treatment with Wagner stockings., Material and Methods: In the years 2000 to 2001, a total of 3,221 children were examined at birth clinically and by ultrasonography using Graf's method. DDH was diagnosed in 137, and Wagner stockings were used for treatment in 127 patients. This Wagner abduction device consists of linen stockings buttoned to a linen baby shirt. It is based on the Pavlik harness treatment of DDH, and enables us to start therapy at neonatal age. The group was followed up, with checkups including clinical examination and AP radiography to evaluate position of the femoral head in relation to avascular necrosis (AVN) by the Salter method. The data obtained was statistically analysed by the SPSS software, version 14 (SPSS Inc., Chicago, USA)., Results: Out of the 127 children, 106 (95 girls and 11 boys) completed the treatment. In 87 (82%) children with Wagner stockings only, the treatment took place for an average of 82 days (range, 28 to 167), with abduction therapy starting on average at 13 days (range, 1 to 76 days). In 19 (18%) children it was necessary to continue abduction therapy and Wagner stockings were replaced by a Pavlik's harness. The total abduction treatment then lasted on average for 152 days (range, 81 to 289). After January 1, 2005, 75 children (follow-up rate, 70.7%) were examined, 33 at regular checkups and the rest at invitation. The average follow-up was 5.9 (3.8-7.5) years. On two early radiograms with left-side findings, proximal femoral lesions met the Salter criteria of AVN diagnosis. The AVN rate was 2.6% or 1.8% when related to either the patients or the affected hips. At the latest follow-up even in these cases the radiographic findings were resolved., Discussion: At present there is no consensus concerning either screening of newborns for DDH or its early therapy. In the Czech Republic the general screening known as three-step examination of infant hips attained a legal frame by the Regulation issued by the Ministry of Health in 1977 and its amendment in 1996. In Austria the general clinical and ultrasonographic screening is regarded as the gold standard. On the other hand, some official bodies such as the U.S. Preventive Services Task Force, American Academy of Pediatrics or Canadian Task Force do not recommend any general screening. The results of this retrospective study were compared with those of treatment with the Pavlik harness or Frejka pillow, which are both based on a passive mechanical mode of therapy. The comparison has shown that the treatment with Wagner stockings is highly effective and has a low AVN rate., Conclusion: This retrospective study has shown that, in DDH, therapy with Wagner stockings is sufficient to provide for physiological development of the hip, while the AVN rate is very low. Early diagnosis and treatment related to general screening are both beneficial. Based on these results we recommend Wagner stockings as a useful aid in the treatment which is initiated early in infancy and is in agreement with the Pavlik method of functional DDH therapy.

The authors present part of their prospective epidemiological study of congenital dysplasia of hip joints within which newborns were examined by ultrasonogram prior to the beginning of the therapy. Apart from the standard examination in the frontal plane after Graf they examined on principle also the ultrasonographic stability by the dynamic test after Schuler as well as by the application of the probe anteriorly with the simultaneous provocation according to Palmén. The authors have processed pathological ultrasonographic findings in 53 newborns (64 hip joints). The technique of the examination by ultrasound from the anterior approach is explained in detail. The comparison of both dynamic tests has shown that the examination from the anterior approach is considerably more sensitive than Schuler's dynamic test and also fully correlates with the clinical finding. It is a fact that the shift of the head in the flexion dorsally represents the most important component of the movement in unstable hip joint during provocation, it is far more noticeable than the lateralization of the head or the shift in the cranial direction. After achieving ultrasonographic stability the classical Graf method is sufficient for the registration of residual changes on the acetabular rim. The follow-up of patients until their complete healing has shown a surprisingly rapid remodellation of hip joints. The whole complex of clinically unstable hip joints has been divided into subgroups according to Graf classification. In type IIc or IId on the basis of ultrasonographic examination from the anterior approach the stable joints from the ultrasonographic viewpoint have been distinguished from unstable ones. The follow-up carried out in short intervals has shown that of longest duration is the remodellation of total dislocation and, on the contrary, of shortest duration is the healing of joints in the IIc or IId type. An absolute majority of affected hip joints have become normal until 3rd month of the age. The complex does not include two patients with teratological dislocation, the incidence of which has been determined in our study by the ratio of 2 cases in 35,550 of timely examined newborns. The role of the factor of spontaneous stabilization cannot be in this part of the study completely discounted. However, herewith we present part of an accomplished epidemiological study where the number of timely diagnosed patients including late diagnoses corresponds to the number of dislocations and subluxations determined within the conventional late diagnosis.

On the basis of the analysis of the examination of hip joints in 1000 newborns the author supports his former statement that of almost the same frequency as the acknowledged symptomatology of unstable hip joint (in 6.5 per cent) is the pathological symptomatic group of increased tension of tendons of the origin of adductors (in 4.7 per cent), sometimes also with reduced abduction, less palpable head of the hip joint and the symptoms presented by him can improve the quality of screen position case of breech presentation. This was found in 5.2 per cent of deliveries. The combination of both symptomatic groups occurs in 1.4 per cent. Out of individual symptoms in the breech presentation of highest frequency--according to the author--is the increased tension of the origin of adductors (in 94.2 per cent), be it isolated form of incidence (in 25 per cent) or in combination with other symptoms. In the examination technique he includes also the symptom of the hyperextensibility of the knee and relates its frequency (82.7 per cent) with the breech presentation and with the increased joint laxicity conditioned hormonally. After the analysis of mechanical effects in the foetal stage of pregnancy he attempts to correlate clinical neonatal symptomatology with the pathological anatomical classification after Ogden. He arrives at the conclusion that only combined identification of symptoms of both the instability of the hip joint and the symptoms presented by him can improve the quality of screening and thus reduce the incidence of unidentified defect of the hip joint in 3rd month of age of the child. Further progress can be made only after the introduction of a purposeful sonographic screening of the newborn and infant hip joints. The author, however, considers for irreplaceable the method of a careful clinical examination of newborns.

The author gives an account of the early diagnosis and treatment of congenital dislocation of the hip joint in Czechoslovakia since 1918. He pays more detailed attention to the period before the Second World War and the period immediately after the war when aids now used on a world-wide scale were introduced into practice such as Hanausek's apparatus, Frejka's cushion and Pavlik's stirrups. At the same time screening of neonates in some areas was started. The author mentions also methods of preventive examinations of the entire population introduced in the fifties. He also pays attention to efforts to reduce the radiation load in X-ray screening of the population.

We report an experience with a three-stage screening programme which has recently been recommended. It comprises the examination of children at three successive periods - at birth, at six weeks and at three months. In a prospective study we evaluated 789 children at all three periods. Pathological (unstable) hips were found at birth in about 20 per cent, the majority being lax hips and all underwent immediate treatment. At six weeks we were unable to detect any sign attributable to hip dysplasia except one instability persisting from birth. A limitation of abduction in one or another hip at six weeks or at three months was present in about 6 per cent; it was explained to be related rather to one of the signs of the moulded baby syndrome than to hip dysplasia. We do not regard the second examination in a three-stage screening programme as obsolete though it did not provide us in this series with additional informations; but our experience shows that three weeks would do better than six weeks, and the examination should be focused mainly on hip instability. We feel, however, that the greatest majority of pathological hips if not all should be detected at the maternity ward by a competent examiner.