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Screening programmes for developmental dysplasia of the hip in newborn infants
Damon Shorter1, Timothy Hong, David A Osborn
1Gosford Hospital, Holden Street, Gosford, NSW, Australia, 2250.
Insights
Screening for developmental dysplasia of the hip (DDH) shows insufficient evidence for clear practice recommendations. Delayed ultrasound and targeted splinting may reduce treatment for some infants without increasing late-diagnosed DDH.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Evidence-Based Medicine
Background:
- Uncorrected developmental dysplasia of the hip (DDH) leads to long-term issues like gait problems, pain, and arthritis.
- Early detection and treatment are crucial to prevent these morbidities.
Purpose of the Study:
- To evaluate the impact of various developmental dysplasia of the hip (DDH) screening programs on the incidence of late-diagnosed congenital hip dislocation.
Main Methods:
- Systematic review and meta-analysis of randomized, quasi-randomized, or cluster trials.
- Searches conducted in CENTRAL, MEDLINE, and EMBASE, supplemented by trial registries and expert consultation.
- Eligibility, quality assessment, and data extraction performed by three independent reviewers.
Main Results:
- No studies compared screening with no screening.
- Universal ultrasound did not significantly reduce late DDH or surgery but increased treatment compared to clinical examination alone.
- Targeted ultrasound showed no significant difference in late DDH or surgery rates compared to clinical examination.
- Universal ultrasound did not significantly reduce late DDH or surgery compared to targeted ultrasound.
- Delayed ultrasound with targeted splinting reduced treatment for unstable hips without increasing late DDH or surgery.
- Delayed ultrasound with targeted splinting reduced treatment for mild hip dysplasia without increasing late DDH.
Conclusions:
- Insufficient evidence exists for definitive practice recommendations regarding DDH screening.
- Ultrasound screening strategies have not demonstrably improved clinical outcomes like late DDH diagnosis or surgical rates.
- Delayed ultrasound and targeted splinting appear to reduce treatment for specific infant hip conditions without compromising detection rates of late DDH or surgery.
Background:
Uncorrected developmental dysplasia of the hip (DDH) is associated with long term morbidity such as gait abnormalities, chronic pain and degenerative arthritis.
Objectives:
To determine the effect of different screening programmes for DDH on the incidence of late presentation of congenital hip dislocation.
Search Strategy:
Searches were performed in CENTRAL (The Cochrane Library), MEDLINE and EMBASE (January 2011) supplemented by searches of clinical trial registries, conference proceedings, cross references and contacting expert informants.
Selection Criteria:
Randomised, quasi-randomised or cluster trials comparing the effectiveness of screening programmes for DDH.
Data Collection And Analysis:
Three independent review authors assessed study eligibility and quality, and extracted data.
Main Results:
No study examined the effect of screening (clinical and/or ultrasound) and early treatment versus not screening and later treatment.One study reported universal ultrasound compared to clinical examination alone did not result in a significant reduction in late diagnosed DDH or surgery but was associated with a significant increase in treatment.One study reported targeted ultrasound compared to clinical examination alone did not result in a significant reduction in late diagnosed DDH or surgery, with no significant difference in rate of treatment.Meta-analysis of two studies found universal ultrasound compared to targeted ultrasound did not result in a significant reduction in late diagnosed DDH or surgery. There was heterogeneity between studies reporting the effect on treatment rate.Meta-analysis of two studies found delayed ultrasound and targeted splinting compared to immediate splinting of infants with unstable (but not dislocated) hips resulted in no significant difference in the rate of late diagnosed DDH. Both studies reported a significant reduction in treatment with use of delayed ultrasound and targeted splinting.One study reported delayed ultrasound and targeted splinting compared to immediate splinting of infants with mild hip dysplasia on ultrasound resulted in no significant difference in late diagnosed DDH but a significant reduction in treatment. No infants in either group received surgery.
Authors' Conclusions:
There is insufficient evidence to give clear recommendations for practice. There is inconsistent evidence that universal ultrasound results in a significant increase in treatment compared to the use of targeted ultrasound or clinical examination alone. Neither of the ultrasound strategies have been demonstrated to improve clinical outcomes including late diagnosed DDH and surgery. The studies are substantially underpowered to detect significant differences in the uncommon event of late detected DDH or surgery. For infants with unstable hips or mildly dysplastic hips, use of delayed ultrasound and targeted splinting reduces treatment without significantly increasing the rate of late diagnosed DDH or surgery.
