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Screening strategies for hip dysplasia: long-term outcome of a randomized controlled trial
Lene B Laborie1, Ingvild Ø Engesæter, Trude G Lehmann
1Department of Clinical Medicine, University of Bergen, Norway. lene.bjerke.laborie@helse-bergen.no
Insights
Ultrasound screening for hip dysplasia in newborns did not show significant long-term benefits in radiographic markers of dysplasia or degenerative changes at skeletal maturity. Despite reduced late cases, increased treatment rates were not linked to avascular necrosis (AVN).
Area of Science:
- Orthopedics
- Radiology
- Pediatric Health
Background:
- Screening for hip dysplasia remains controversial.
- Previous trials showed nonsignificant reductions in late cases with ultrasound screening but increased treatment rates.
- This study evaluates long-term outcomes of different newborn screening strategies.
Purpose of the Study:
- To assess radiographic markers of acetabular dysplasia and degenerative changes at skeletal maturity.
- To evaluate the incidence of avascular necrosis (AVN) secondary to neonatal treatment.
- To compare outcomes between universal ultrasound, selective ultrasound, and clinical examination screening strategies.
Main Methods:
- A cohort of 3935 adolescents (aged 18-20) from an initial trial of 11,925 newborns were followed up.
- Standardized weight-bearing anteroposterior hip X-rays were obtained.
- Radiographic outcomes included measures of dysplasia and joint-space width; AVN signs were documented.
Main Results:
- 2011 adolescents (58.2% female) were included in the final analysis.
- No statistically significant differences in radiographic findings of dysplasia or degenerative changes were detected between the universal ultrasound, selective ultrasound, and clinical examination groups.
- No cases of avascular necrosis (AVN) were observed.
Conclusions:
- Ultrasound screening (universal or selective) did not demonstrate a significant reduction in radiographic markers of hip dysplasia or degenerative changes at skeletal maturity compared to clinical examination alone.
- While ultrasound screening showed a trend towards reducing late-presenting cases, this did not translate to improved long-term radiographic outcomes.
- Increased treatment rates associated with ultrasound screening were not linked to adverse events like AVN.
Objective:
Screening for hip dysplasia is controversial. A previous randomized controlled trial revealed that adding universal or selective ultrasound to routine clinical examination gave a nonsignificant reduction in rates of late presenting cases, but with higher treatment rates. This study assesses differences in outcome at skeletal maturity for the 3 newborn screening strategies in terms of radiographic markers of acetabular dysplasia and early degenerative change and avascular necrosis (AVN) secondary to neonatal treatment.
Methods:
From the initial trial including 11 925 newborns, a population-based sample of 3935 adolescents was invited for follow-up at age 18 to 20 years. A standardized weight-bearing anteroposterior view was obtained. The outcomes evaluated were the radiographic findings of dysplasia (center-edge angle, femoral head extrusion-index, acetabular depth-width ratio, Sharp's angle, subjective evaluation of dysplasia) and degenerative change (joint-space width). Signs of AVN were documented.
Results:
Of the 3935 subjects invited, 2038 (51.8%) attended the maturity review, of which 2011 (58.2% female patients) were included: 551, 665, and 795 subjects from the universal, selective, and clinical groups, respectively. Rates per group of positive radiographic findings associated with dysplasia or degenerative change varied depending on radiographic marker used. No statistically significant differences were detected between groups. No AVN was seen.
Conclusions:
Although both selective and universal ultrasound screenings gave a nonsignificant reduction in rates of late cases when compared with expert clinical programs, we were unable to demonstrate any additional reduction in the rates of radiographic findings associated with acetabular dysplasia or degenerative change at maturity. Increased treatment rates were not associated with AVN.
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