Preventive health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns

Abstract

Objective: To review the effectiveness of, and make practice recommendations for, serial clinical examination and ultrasound screening for developmental dysplasia of the hip (DDH) in newborns. The effectiveness of selective screening of high-risk infants with hip and pelvic radiographs and treatment with abduction therapy are also examined.

Options: Screening: serial clinical examination, ultrasound screening, radiographic evaluation.

Treatment: abduction therapy.

Outcomes: Rates of operative intervention, abduction splinting, delayed diagnosis of DDH (beyond 3-6 months), treatment complications and false diagnostic labelling. Long-term functional outcomes were considered important.

Evidence: MEDLINE was searched for relevant English-language articles published from 1966 to November 2000 using the key words "screening," "hip," "dislocation," "dysplasia," "congenital" and "ultrasound." Comparative and descriptive studies and key reviews were retrieved, and their bibliographies were manually searched for further studies.

Benefits, harms and costs: Because most infants will have spontaneous resolution of nonteratologic DDH, early identification and intervention results in unnecessary labelling of newborns as having the problem and unnecessary treatment. Ultrasound screening is a highly sensitive but poorly specific measure of clinically relevant DDH. Abduction splinting is associated with a variety of problems, and its effectiveness in treating DDH is not clearly known. At least 20% of infants requiring operative intervention have had splint therapy. The harms of labelling, repetitive investigations, unnecessary splinting and resource consumption associated with screening are substantial.

Values: The strength of evidence was evaluated using the evidence-based methods of the Canadian Task Force on Preventive Health Care.

Recommendations: There is fair evidence to include serial clinical examination of the hips by a trained clinician in the periodic health examination of all infants until they are walking independently (level II-1 and III evidence; grade B recommendation). There is fair evidence to exclude general ultrasound screening for DDH from the periodic health examination of infants (level II-1 and III evidence; grade D recommendation). There is fair evidence to exclude selective screening for DDH from the periodic health examination of high-risk infants (level II-1 and III evidence; grade D recommendation). There is fair evidence to exclude routine radiographic screening for DDH from the periodic health examination of high-risk infants (level III evidence; grade D recommendation). There is insufficient evidence to evaluate the effectiveness of abduction therapy (level III evidence; grade C recommendation), but good evidence to support a period of close observation for newborns with clinically detected DDH (level I evidence; grade A recommendation). However, there is insufficient evidence to determine the optimal duration of observation (level III evidence; grade C recommendation).

Validation: The members of the Canadian Task Force on Preventive Health Care reviewed the findings of this analysis through an iterative process. The task force sent the final review and recommendations to selected external expert reviewers, and their feedback was incorporated in the final draft of the manuscript.

Sponsors: The Canadian Task Force on Preventive Health Care is funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada.