Ultrasound in the diagnosis of developmental dysplasia of the hip in newborns. The European approach. A review of methods, accuracy and clinical validity

Abstract

Based on soft evidence that ultrasound screening tends to reduce the rate of late developmental dysplasia of the hip (DDH) and the need for surgical interventions, different screening strategies including universal or selective ultrasound screening have been established in several European countries and centres during the last decade. We performed an extensive search for articles on ultrasound diagnosis of developmental dysplasia of the hip over the last 26 years. A few studies reported an adequate repeatability for the static [Graf, Morin, modified Morin (Terjesen)] and for the combined static/dynamic methods [modified Graf (Rosendahl)], while no such reports were found for the dynamic (Harcke) ultrasound techniques. The effect of newborn ultrasound screening on late DDH have been addressed in two randomised trials (RCTs), both concluding that both selective and universal ultrasound screening tend to reduce the prevalence of subluxed or dislocated DDH, thus without reaching statistical significance. Finally, several observational studies have shown that morphologically normal hips tend to remain normal with or without a co-existing instability, and 97% of sonographically immature hips tend to normalise spontaneously within 3 months. Two studies report on a similar pattern for mildly dysplastic, but stable hips. From the data available we suggest that selective ultrasound screening is worthwhile in areas with a high prevalence of late cases, given a well-organised, high-quality service can be provided.

Screening of selected risk factors in developmental dysplasia of the hip: an observational study

“…Individuals with modified Graf types III and IV were classified as ‘pathological’ (as advocated by Rosendahl16 18) and treated in a Pavlik harness at the time of sonography. Individuals with Graf type II were classified as ‘physiological’ and observed with serial sonography and treated only if they progressed to ‘pathological’ Graf types III and IV or irreducible dislocation.…”

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

“…This discussion has generally compared physical examination screening with universal ultrasonography screening 4,39,42,53,[57][58][59][60][61][62] . Some studies have supported universal screening 10,50,63 , and others have supported physical examination screening with only selective use of ultrasonography 57,64 . While a few investigators have recommended universal screening with ultrasound, the United States Preventive Services Task Force, on the basis of its own systematic review of the literature, could not recommend even clinical examination screening, although developmental dysplasia of the hip is a leading cause of early hip arthritis 6,16 .…”

Ultrasound in developmental dysplasia of the hip: A screening study in Sardinian newborns

“…Indeed, the cost of a mass screening program has to be analyzed in light of the economic burden represented by such cases e in terms of repeated, prolonged hospitalizations, surgery, residual disability, and rehabilitation programs. In Europe, this type of comparative analysis has revealed the advisability of performing mass ultrasound screening in young babies (<3 months) [11], whereas, to date authors in the United States have expressed a contrasting opinion [12].…”