Cochrane Review: Screening programmes for developmental dysplasia of the hip in newborn infants

Abstract

Screening methods for dislocated or improperly formed hips in newborn infants The hip joint is a ball and socket joint. Newborns may have hips that are not in their socket (dislocated) or hips that are improperly formed (dysplasia). Risk factors for hip dysplasia include a family history of a similar problem and female infants delivered in the breech position. The hips of most newborns will be examined clinically after birth and during infancy to determine whether they are stable, unstable or dislocated. Screening for hip dysplasia may prevent the need for late treatment, which is associated with long term hip deformity, gait disturbance and arthritis. However, early screening leads to increased treatment. Treatment may be complicated by damage to the hip due to impairment of the blood supply (avascular necrosis). This review found no studies that compared the benefits and costs of early screening versus not screening for hip problems. Studies that compared the addition of ultrasound to clinical examination reported that when ultrasound was performed on all infants, the rate of treatment increased with no significant difference in rate of late detected dysplasia or surgery. Targeted ultrasound to infants at high risk of hip dysplasia did not significantly increase the rate of treatment but also did not significantly reduce the rate of late detected dysplasia or surgery. It is not possible to give clear recommendations for hip screening of newborn infants from the available evidence. Where infants are clinically detected as having unstable but not dislocated hips, or are detected on ultrasound to have mild hip dysplasia, there is evidence that delaying treatment by two to eight weeks reduces the need for treatment without a significant increase in late diagnosed dysplasia or surgery.

Developmental dysplasia of the hip: What has changed in the last 20 years?

“…A Cochrane review of screening programs for DDH in newborns found that studies that compared the addition of ultrasonography to clinical examination reported that, when ultrasonography was performed on all infants, the rate of treatment increased with no significant change in the rate of late detected dysplasia or surgery. Targeted ultrasonography to infants at high risk of hip dysplasia did not significantly increase the rate of treatment but also did not significantly decrease the rate of late detected dysplasia or surgery [63] . Consequently, ultrasonography is the preferred technique for clarifying physical findings, evaluating a high-risk infant, and monitoring DDH as it is followed and treated.…”

“…When complete displacement of the hip joint is noted at birth, initiation of treatment without an observation period is recommended [1,5] . A recent Cochrane review showed that in infants who were identified clinically to have unstable but not dislocated hips, or were identified on ultrasounography to have mild hip dysplasia, postponing treatment by 2 to 8 wk reduces the need for treatment without a significant increase in late diagnosed dysplasia or surgery [63] .…”

Ultrasound for Screening and Management of Developmental Dysplasia of the Hip

“…There was no statistically significant difference between the 2 groups in the prevalence of late detection of hip dysplasia [14].…”

“…However, universal ultrasound screening has not been unanimously accepted. There are concerns about the ability of such screening programs to reduce the incidence of late diagnosis of DDH [12][13][14]. Complicating the issue is the absence of good quality evidence linking ultrasound screen-ing to improved outcomes.…”

“…In a randomized controlled trial conducted by Holen and colleagues [14], 15,529 infants were randomized into 2 groups: one group received universal ultrasound screening for DDH, and the other group received selective ultrasound screening. There was no statistically significant difference between the 2 groups in the prevalence of late detection of hip dysplasia [14].…”