Sonographisches Hüftscreening in Deutschland

Abstract

General ultrasound screening programmes to determine DDH are still a matter of discussion due to a lack of evidence. To facilitate further discussions this review gives an overview of the international data and literature concerning the different screening policies taking into account the results of the German evaluation study from 1997 to 2002. General ultrasound screening programmes are established in Germany and Austria. The analysis of the German screening showed 535 cases of DDH with first operative procedure (age 10 weeks to 5 years) that were treated as inpatients: 66% underwent a closed reduction, 11% an open reduction and 23% an osteotomy of the acetabulum/femur. The number of children who had no ultrasound of the hip before diagnosis decreased from 22% in the first year to 8% in the last. The first ultrasound examination was without pathological findings in 12% of the cases. Capture-recapture estimates suggested that 52% of cases were reported, so that the incidence for first operation due to DDH was 0.26 per 1,000 live births in 1997. This is much lower than in other countries and 4/5 less than the time before screening with ultrasound in Germany. At most 42% of the cases might be preventable by an improvement of the screening programme, but at least 51% would not be prevented. The German ultrasound screening programme has proved to be effective. Improvement of economic efficiency is still possible. Therefore, the German programme with different screening times can be recommended.

International Interdisciplinary Consensus Meeting on the Evaluation of Developmental Dysplasia of the Hip

“…Universal US screening has been in place in Germany since 1996. The German language literature supports this position, in terms of reduced late diagnosis and reduced rates of late surgery related to dysplasia [61,63,92].…”

“…The German language literature supports this position. Ihme et al [92] compared the costs of hip surgery due to DDH at two different time periods (patients who received US and a historical group) and demonstrated that the costs of hip US were lower than the costs of hip surgery. This position was further supported by the study by Farr [65].…”

Even Experts Can Be Fooled: Reliability of Clinical Examination for Diagnosing Hip Dislocations in Newborns

“…The Australian screening programme relies more on clinical examination and the Austrian and German programmes involve a universal USS. 5 The lack of a universal definition of DDH makes it difficult to ascertain an exact incidence, however, in the United States it is believed to be around 1 in 1000 live births. 6 In the United Kingdom, the incidence of DDH diagnosed late, that is, above 1 year old, was calculated at 1.28 per 1000 births despite the selective USS screening programme.…”

Postoperative redislocation of the hip in a patient with congenital insensitivity to pain with anhidrosis: A case report and review of literature

“…Two to three-year-old children often undergo nonsurgical treatment, with a closed reduction after the use of frog-shaped gypsum or fixation of subbranches. Some countries such as Germany have universal screening programmes and have seen a decrease in the rates of surgical reduction in DDH[ 6 ]. Patients over 3 years old are treated by surgery.…”