The early detection of idiopathic scoliosis has been advocated since the 1950s and '60s, concurrent with the development in the modern era of ambulatory spinal orthoses to treat scoliosis in adolescents. This led to the development of screening programs for specific populations, as evidenced by school screening programs in the United States and public health systems in Europe and Asia. Over time, the value of population screening in terms of optimal health care and economics has been debated in the popular press, by the U.S. Preventive Services Task Force, and by professional societies. Recent studies on the effectiveness of bracing to prevent the progression of scoliosis, improved delineation of "at-risk populations," and refined orthotic management programs with emphasis on the use of compliance monitors have influenced the American Academy of Orthopaedic Surgeons (AAOS), the Scoliosis Research Society (SRS), the Pediatric Orthopaedic Society of North America (POSNA), and the American Academy of Pediatrics (AAP) to update their position on screening for scoliosis and has led to a joint position statement on the topic. AAOS, SRS, POSNA, and AAP Position Statement Screening for the Early Detection of Idiopathic Scoliosis in Adolescents This Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions. The AAOS, SRS, POSNA, and AAP believe that there has been additional useful research in the early detection and management of adolescent idiopathic scoliosis (AIS) since the review performed by the U.S. Preventive Services Task Force (USPSTF) in 2004. This information should be available for use by patients, treating health care providers, and policy makers in assessing the relative risks and benefits of the early identification and management of AIS. The AAOS, SRS, POSNA, and AAP believe that there are documented benefits of earlier detection and non-operative management of AIS, earlier identification of severe deformities that are surgically treated, and incorporation of screening of children for AIS by knowledgeable health care providers as a part of their care.

The life expectancy of patients with Down syndrome has increased significantly in recent years. Hip abnormalities occur in children with this syndrome but little is known about their natural history in later life. In 65 adults with Down syndrome we found hip abnormalities in 28%, and this was statistically correlated with walking ability. A subgroup of 18 patients was followed by serial examination; this showed that hip instabifity occurred in adulthood and became worse with time. In some patients, hip instabifity started after skeletal maturity.

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