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Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A
Lene Bjerke Laborie1, Trond Jacob Markestad, Henrik Davidsen
1Department of Clinical Medicine, University of Bergen, Bergen, Norway, lene.bjerke.laborie@helse-bergen.no.
Insights
Selective ultrasound (US) screening for developmental dysplasia of the hip (DDH) in at-risk infants led to early treatment and low rates of late-diagnosed hip dislocations. This approach proved effective in managing DDH, with minimal cases requiring later intervention.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Public Health Screening
Background:
- Early intervention is crucial for developmental dysplasia of the hip (DDH).
- Debate exists regarding the optimal screening strategy for DDH.
- Selective screening aims to identify infants at higher risk.
Purpose of the Study:
- To evaluate the effectiveness of a selective ultrasound (US) screening program for DDH.
- To assess treatment outcomes and rates of late-diagnosed DDH.
Main Methods:
- A selective US screening program was implemented for at-risk newborns (1991-2006).
- At-risk criteria included clinical instability, breech presentation, foot deformities, or family history.
- Infants underwent US screening within 1-3 days of birth; treatment or follow-up was based on findings.
Main Results:
- Of 81,564 newborns, 11,539 were identified as at-risk.
- 3.0% received early treatment, while 3.3% normalized spontaneously.
- Late subluxated/dislocated hips occurred in 0.32 per 1,000 infants; surgical treatment was needed for 0.38 per 1,000.
Conclusions:
- A standardized selective US screening program for DDH is effective.
- The program achieved acceptable rates of early treatment and follow-ups.
- Low rates of late subluxated/dislocated hips were observed compared to other studies.
Background:
Early treatment is considered essential for developmental dysplasia of the hip (DDH), but the choice of screening strategy is debated.
Objective:
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.
Results:
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.
Conclusion:
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.
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