Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991–2006
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Early treatment is considered essential for developmental dysplasia of the hip (DDH), but the choice of screening strategy is debated.
We evaluated the effect of a selective ultrasound (US) screening programme.
Materials and methods
All infants born in a defined region during 1991–2006 with increased risk of developmental dysplasia of the hip, i.e. clinical hip instability, breech presentation, congenital foot deformities or a family history of DDH, underwent US screening at age 1–3 days. Severe sonographic dysplasia and dislocatable/dislocated hips were treated with abduction splints. Mild dysplasia and pathological instability, i.e. not dislocatable/dislocated hips were followed clinically and sonographically until spontaneous resolution, or until treatment became necessary. The minimum observation period was 5.5 years.
Of 81,564 newborns, 11,539 (14.1%) were identified as at-risk, of whom 11,190 (58% girls) were included for further analyses. Of the 81,564 infants, 2,433 (3.0%) received early treatment; 1,882 (2.3%) from birth and 551 (0.7%) after 6 weeks or more of clinical and sonographic surveillance. An additional 2,700 (3.3%) normalised spontaneously after watchful waiting from birth. Twenty-six infants (0.32 per 1,000, 92% girls, two from the risk group) presented with late subluxated/dislocated hips (after 1 month of age). An additional 126 (1.5 per 1,000, 83% girls, one from the risk group) were treated after isolated late residual dysplasia. Thirty-one children (0.38 per 1,000) had surgical treatment before age 5 years. Avascular necrosis was diagnosed in seven of all children treated (0.27%), four after early and three after late treatment.
The first 16 years of a standardised selective US screening programme for developmental dysplasia of the hip resulted in acceptable rates of early treatment and US follow-ups and low rates of late subluxated/dislocated hips compared to similar studies.
KeywordsDevelopmental dysplasia of the hip Hip dysplasia Hip ultrasound Paediatric Neonatal screening
The authors would like to acknowledge Dr. Aslak Aslaksen (AA) and Dr. Orri Einarsson (OE) for performing part of the US examinations. We also thank senior analyst M.sc. Alf M Aksland and orthopaedic secretary Siri Hatlem, Haukeland University Hospitall, for their assistance with management of data for this study. We would also like to thank the staff at the maternity unit and the hip outpatient clinic at the Department of Paediatrics and the radiographers at the section for Paediatric Radiology, Haukeland University Hospital, for help and support during the study period.
Conflicts of interest
K.R. chairs the European Society of Paediatric Radiology (ESPR) task force group on developmental dysplasia of the hip. The others declare no conflicts of interest. Regarding funding, two authors (L.B.L. and I.Ø.E.) received doctoral grants from the Western Norway Regional Health Authority. The study received funding from the University of Bergen, Norway, and from the Arthritis Research Campaign (ARC), UK (grant number 18196). The funding sources had no role in study design, data collection, data analysis, data interpretation, or in the writing of the report. None of the authors has a financial relationship with the organization that sponsored the research. All authors have full control of all primary data and agreed to allow the journal to review their data if requested.
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