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Screening for developmental dysplasia of the hip
B Desprechins1, C Ernst, J de Mey
1Dpt of Radiology, AZ VUB, Brussels, Belgium.
Insights
Early diagnosis of developmental dysplasia of the hip (DDH) is crucial for treatment success. Selective screening of infants with risk factors or abnormal exams is most cost-effective and practical.
Area of Science:
- Pediatric Orthopedics
- Developmental Biology
- Medical Imaging
Background:
- Developmental dysplasia of the hip (DDH) prevalence varies in different populations.
- Early diagnosis is vital for effective treatment and prognosis of DDH.
- Current screening methods for DDH include physical examination and ultrasound.
Purpose of the Study:
- To review the prevalence and diagnosis of DDH.
- To evaluate the effectiveness of different screening strategies for DDH.
- To determine the most cost-effective and practical screening approach for DDH.
Main Methods:
- Literature review of studies on DDH prevalence and screening.
- Analysis of data on established dislocation and neonatal hip instability.
- Comparison of universal versus selective sonographic screening approaches.
Main Results:
- Prevalence of established hip dislocation ranges from 0.7 to 1.6 per 1000 children in unscreened white populations.
- Neonatal hip instability occurs in 3 to 30 per 1000 newborns; 0.1-4 per 1000 have established congenital dislocation requiring surgery.
- Selective screening of infants with risk factors or abnormal physical exams is deemed cost-effective and practical.
Conclusions:
- Early diagnosis of DDH is essential for successful treatment outcomes.
- Combined evaluation of hip morphology and stability is recommended.
- Selective sonographic screening is the most practical and cost-effective method for most countries.
Abstract:
The reported prevalence of established dislocation the hip in an unscreened population varies from 0.7 to 1.6 / 1000 children in European and American white populations. In clinically screened populations neonatal hip instability is reported to occur in 3 to 30 / 1000 newborns while established congenital dislocation has a prevalence of 0.1- 4/1000 of which 1/1000 is judged to be in need for surgery. Early diagnosis of DDH is essential for successful treatment and later prognosis of the disorder. Combined procedure including evaluation of both hip morphology and hip stability is currently recommended. Opinions differ about the need for universal versus selective sonographic screening for diagnosis of DDH. Currently selective screening of those infants with recognised risk factors and those with abnormal physical examination would be cost-effective and the only practicable method for most countries.
