To Screen or Not to Screen? A Decision Analysis of the Utility of Screening for Developmental Dysplasia of the Hip

Mahan, Susan T.; Katz, Jeffrey N.; Kim, Young-Jo

doi:10.2106/jbjs.h.00122

Cited by 135 publications

(107 citation statements)

References 65 publications

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“…Several authors have emphasized the need for outcome studies at skeletal maturity for the different screening policies. [37][38][39] Our study confirms that in a Norwegian population, all 3 screening programs studied resulted in similar rates of all radiographic findings associated with acetabular dysplasia or early degenerative change at skeletal maturity. Offering universal hip ultrasound, and treating those testing positive, had thus no additional impact at a group level at skeletal maturity.…”

Section: Discussionsupporting

confidence: 80%

Screening Strategies for Hip Dysplasia: Long-term Outcome of a Randomized Controlled Trial

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Only 2 randomized controlled trials have addressed effects of ultrasound screening for developmental hip dysplasia. Both concluded that adding universal or selective ultrasound to routine clinical examination gave a nonsignificant reduction in rates of late presenting cases, but higher treatment rates. WHAT THIS STUDY ADDS:This maturity review assesses long-term outcome of one of these trials. Rates of radiographic findings indicating acetabular dysplasia and degenerative change were similar across the 3 screening groups in young adulthood. Increased treatment rates were not associated with avascular necrosis. abstract 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 populationbased 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. Pediatrics 2013;132:492-501

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Section: Discussionsupporting

confidence: 80%

Screening Strategies for Hip Dysplasia: Long-term Outcome of a Randomized Controlled Trial

et al. 2013

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“…The physical examination is still the most important means of detection [7,34,35] . In a decision analysis model, the lowest probability of developing degenerative disease of the hip by age 60 was by doing a thorough physical examination of the hip in all newborns [36] . Radiography and sonography are used to confirm the suspicion of DDH.…”

Section: Screening For Ddhmentioning

confidence: 99%

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

Kotlarsky

Reuben

Bialik

et al. 2015

WJO

255

244

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“…Many European countries have also adopted universal ultrasound screening to confirm clinical findings [5,16,33,34,37]. In North America, however, selective ultrasound screening is used only for infants with defined risk factors such as breech presentation, family history, or a clinical history of hip instability [25,29,30,34,35]. Screening methods are controversial, and late presentations still occur with both clinical and ultrasound screening programs, although the reported incidence is variable [19,21,22,31,32].…”

Section: Introductionmentioning

confidence: 99%

What Risk Factors and Characteristics Are Associated With Late-presenting Dislocations of the Hip in Infants?

Mulpuri

Schaeffer

Andrade

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Most infants with developmental dysplasia of the hip (DDH) are diagnosed within the first 3 months of life. However, late-presenting DDH (defined as a diagnosis after 3 months of age) does occur and often results in more complex treatment and increased long-term complications. Specific risk factors involved in late-presenting DDH are poorly understood, and clearly defining an associated set of factors will aid in screening, detection, and prevention of this condition. Questions/purposes Using a multicenter database of patients with DDH, we sought to determine whether there were differences in (1) risk factors or (2) the nature of the dislocation (laterality and joint laxity) when comparing patients with early versus late presentation. Methods A retrospective review of prospectively collected data from a multicenter database of patients with dislocated hips was conducted from 2010 to 2014. Baseline demographics for fetal presentation (cephalic/breech), birth presentation (vaginal/cesarean), birth weight, maternal age, maternal parity, gestational age, family history, and swaddling history of patients were compared among nine different sites for patients who were enrolled at age younger than 3 months and those enrolled between 3 and 18 months of age. A total of 392 patients were enrolled at baseline between 0 and 18 months of age with at least one dislocated hip. Of that group, 259 patients were youngerThe contributing members of the IHDI study group are: Pablo Castañeda, Nicholas M. P. Clarke, Bruce K. Foster, José A. HerreraSoto, James R. Kasser, Simon P. Kelley, Young-Jo Kim, Colin F. Moseley, Unni G. Narayanan, Ernest L. Sink, Vidyadhar Upasani, and John H. Wedge. One author (KM) has received funding from the International Hip Dysplasia Institute for REDCap database coordination, maintenance, and support (http://hipdysplasia.org). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Included patients were recruited from all listed sites as well as Centro Médico ABC Santa Fe, Mexico City, Mexico; Hospital for Sick Children, Toronto, Ontario, Canada; and Southampton General Hospital, Southampton, UK. Data analysis and review were carried out at BC Children's Hospital, Vancouver, British Columbia, Canada. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® than 3 months of age and 133 were 3 to 18 months of age. The proportion of patients with DDH who were enrolled and followed at the nine participating centers was 98%. Results A univariate/multivariate analysis was performed comparing key baseline demographics between early-and late-presenting patient...

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To Screen or Not to Screen? A Decision Analysis of the Utility of Screening for Developmental Dysplasia of the Hip

Cited by 135 publications

References 65 publications

Screening Strategies for Hip Dysplasia: Long-term Outcome of a Randomized Controlled Trial

Screening Strategies for Hip Dysplasia: Long-term Outcome of a Randomized Controlled Trial

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

What Risk Factors and Characteristics Are Associated With Late-presenting Dislocations of the Hip in Infants?

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