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Meta-Analysis
. 2011 Sep 7;2011(9):CD004595.
doi: 10.1002/14651858.CD004595.pub2.

Screening programmes for developmental dysplasia of the hip in newborn infants

Damon Shorter  1 , Timothy Hong, David A Osborn
Affiliations
Meta-Analysis

Screening programmes for developmental dysplasia of the hip in newborn infants

Damon Shorter et al. Cochrane Database Syst Rev. .

Abstract

Background: Uncorrected developmental dysplasia of the hip (DDH) is associated with long term morbidity such as gait abnormalities, chronic pain and degenerative arthritis.

Objectives: To determine the effect of different screening programmes for DDH on the incidence of late presentation of congenital hip dislocation.

Search strategy: Searches were performed in CENTRAL (The Cochrane Library), MEDLINE and EMBASE (January 2011) supplemented by searches of clinical trial registries, conference proceedings, cross references and contacting expert informants.

Selection criteria: Randomised, quasi-randomised or cluster trials comparing the effectiveness of screening programmes for DDH.

Data collection and analysis: Three independent review authors assessed study eligibility and quality, and extracted data.

Main results: No study examined the effect of screening (clinical and/or ultrasound) and early treatment versus not screening and later treatment.One study reported universal ultrasound compared to clinical examination alone did not result in a significant reduction in late diagnosed DDH or surgery but was associated with a significant increase in treatment.One study reported targeted ultrasound compared to clinical examination alone did not result in a significant reduction in late diagnosed DDH or surgery, with no significant difference in rate of treatment.Meta-analysis of two studies found universal ultrasound compared to targeted ultrasound did not result in a significant reduction in late diagnosed DDH or surgery. There was heterogeneity between studies reporting the effect on treatment rate.Meta-analysis of two studies found delayed ultrasound and targeted splinting compared to immediate splinting of infants with unstable (but not dislocated) hips resulted in no significant difference in the rate of late diagnosed DDH. Both studies reported a significant reduction in treatment with use of delayed ultrasound and targeted splinting.One study reported delayed ultrasound and targeted splinting compared to immediate splinting of infants with mild hip dysplasia on ultrasound resulted in no significant difference in late diagnosed DDH but a significant reduction in treatment. No infants in either group received surgery.

Authors' conclusions: There is insufficient evidence to give clear recommendations for practice. There is inconsistent evidence that universal ultrasound results in a significant increase in treatment compared to the use of targeted ultrasound or clinical examination alone. Neither of the ultrasound strategies have been demonstrated to improve clinical outcomes including late diagnosed DDH and surgery. The studies are substantially underpowered to detect significant differences in the uncommon event of late detected DDH or surgery. For infants with unstable hips or mildly dysplastic hips, use of delayed ultrasound and targeted splinting reduces treatment without significantly increasing the rate of late diagnosed DDH or surgery.

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Conflict of interest statement

None

Figures

Analysis 1.1
Analysis 1.1
Comparison 1 Unselected infants: Clinical examination with universal ultrasound versus clinical examination alone, Outcome 1 Late diagnosed DDH.
Analysis 1.2
Analysis 1.2
Comparison 1 Unselected infants: Clinical examination with universal ultrasound versus clinical examination alone, Outcome 2 Any treatment.
Analysis 1.3
Analysis 1.3
Comparison 1 Unselected infants: Clinical examination with universal ultrasound versus clinical examination alone, Outcome 3 Surgery.
Analysis 2.1
Analysis 2.1
Comparison 2 Unselected infants: Clinical examination with targeted ultrasound versus clinical examination alone, Outcome 1 Late diagnosed DDH.
Analysis 2.2
Analysis 2.2
Comparison 2 Unselected infants: Clinical examination with targeted ultrasound versus clinical examination alone, Outcome 2 Any treatment.
Analysis 2.3
Analysis 2.3
Comparison 2 Unselected infants: Clinical examination with targeted ultrasound versus clinical examination alone, Outcome 3 Surgery.
Analysis 3.1
Analysis 3.1
Comparison 3 Unselected infants: Clinical examination with universal ultrasound versus clinical examination with targeted ultrasound, Outcome 1 Late diagnosed DDH.
Analysis 3.2
Analysis 3.2
Comparison 3 Unselected infants: Clinical examination with universal ultrasound versus clinical examination with targeted ultrasound, Outcome 2 Any treatment.
Analysis 3.3
Analysis 3.3
Comparison 3 Unselected infants: Clinical examination with universal ultrasound versus clinical examination with targeted ultrasound, Outcome 3 Delayed abduction splinting.
Analysis 3.4
Analysis 3.4
Comparison 3 Unselected infants: Clinical examination with universal ultrasound versus clinical examination with targeted ultrasound, Outcome 4 Avascular necrosis or osteoarthritis.
Analysis 3.5
Analysis 3.5
Comparison 3 Unselected infants: Clinical examination with universal ultrasound versus clinical examination with targeted ultrasound, Outcome 5 Surgery.
Analysis 4.1
Analysis 4.1
Comparison 4 Infants with clinically unstable hips: Treatment guided by ultrasound surveillance versus treatment based on clinical assessment alone, Outcome 1 Late diagnosed DDH.
Analysis 4.2
Analysis 4.2
Comparison 4 Infants with clinically unstable hips: Treatment guided by ultrasound surveillance versus treatment based on clinical assessment alone, Outcome 2 Any treatment.
Analysis 4.3
Analysis 4.3
Comparison 4 Infants with clinically unstable hips: Treatment guided by ultrasound surveillance versus treatment based on clinical assessment alone, Outcome 3 Delayed abduction splinting.
Analysis 4.4
Analysis 4.4
Comparison 4 Infants with clinically unstable hips: Treatment guided by ultrasound surveillance versus treatment based on clinical assessment alone, Outcome 4 Avascular necrosis or osteoarthritis.
Analysis 4.5
Analysis 4.5
Comparison 4 Infants with clinically unstable hips: Treatment guided by ultrasound surveillance versus treatment based on clinical assessment alone, Outcome 5 Surgery.
Analysis 4.6
Analysis 4.6
Comparison 4 Infants with clinically unstable hips: Treatment guided by ultrasound surveillance versus treatment based on clinical assessment alone, Outcome 6 Delayed walking.
Analysis 5.1
Analysis 5.1
Comparison 5 Infants with mild hip dysplasia on ultrasound: Treatment guided by ultrasound surveillance versus treatment based on clinical assessment alone, Outcome 1 Late diagnosed DDH.
Analysis 5.2
Analysis 5.2
Comparison 5 Infants with mild hip dysplasia on ultrasound: Treatment guided by ultrasound surveillance versus treatment based on clinical assessment alone, Outcome 2 Surgery.
Analysis 5.3
Analysis 5.3
Comparison 5 Infants with mild hip dysplasia on ultrasound: Treatment guided by ultrasound surveillance versus treatment based on clinical assessment alone, Outcome 3 Any treatment.
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Update of

  • doi: 10.1002/14651858.CD004595

References

References to studies included in this review

    1. Elbourne D, Dezateux C, Arthur R, Clarke NMP, Gray A, King A, et al. Ultrasonography in the diagnosis and management of developmental hip dysplasia (UK Hip Trial): clinical and economic results of a multicentre randomised controlled trial. Lancet 2002;360(9350):2009‐17. - PubMed
    2. Gardner F, Dezateux C, Elbourne D, Gray A, King A, Quinn A. Collaborative Hip Trial Group. The hip trial: psychosocial consequences for mothers of using ultrasound to manage infants with developmental hip dysplasia. Archives of Disease in Childhood Fetal & Neonatal Edition 2005;90(1):F17‐24. - PMC - PubMed
    3. Gray A, Elbourne D, Dezateux C, King A, Quinn A, Gardner F. Economic evaluation of ultrasonography in the diagnosis and management of developmental hip dysplasia in the United Kingdom and Ireland. The Journal of Bone and Joint Surgery 2005;87(11):2472‐9. - PubMed
    1. Gardiner HM, Duncan AW. Radiological assessment of the effects of splinting on early hip development: results from a randomised controlled trial of abduction splinting vs sonographic surveillance. Pediatric Radiology 1992;22(3):159‐62. - PubMed
    2. Gardiner HM, Dunn PM. Controlled trial of immediate splinting versus ultrasonographic surveillance in congenitally dislocatable hips. Lancet 1990;336(8730):1553‐6. - PubMed
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    1. Rosendahl K, Dezateux C, Fosse KR, Aase H, Aukland SM, Reigstad H, et al. Immediate treatment versus sonographic surveillance for mild hip dysplasia in newborns. Pediatrics 2010;125(1):e9‐e16. - PubMed

References to studies excluded from this review

    1. Bache CE, Clegg J, Herron M. Risk factors for developmental dysplasia of the hip: ultrasonographic findings in the neonatal period. Journal of Pediatric Orthopaedics. Part B 2002;11(3):212‐8. - PubMed
    1. Baronciani D, Atti G, Andiloro F, Bartesaghi A, Gagliardi L, Passamonti C, et al. Screening for developmental dysplasia of the hip: from theory to practice. Collaborative Group DDH Project. Pediatrics 1997;99(2):e5. - PubMed
    1. Bloomfield L, Rogers C, Townsend J, Wolke D, Quist‐Thurston E. The quality of routine examinations of the newborn performed by midwives and SHOs; an evaluation using video recordings. Journal of Medical Screening 2003;10(4):176‐80. - PubMed
    1. Clegg J, Bache CE, Raut VV. Financial justification for routine ultrasound screening of the neonatal hip. Journal of Bone and Joint Surgery. British Volume 1999;81(5):852‐7. - PubMed
    1. Finnbogason T, Jorulf H, Soderman E, Rehnberg L. Anterior dynamic ultrasound and Graf's examination in neonatal hip instability. Acta Radiologica 2008;49(2):204‐11. - PubMed
    2. Finnbogason T, Jorulf H, Soderman E, Rehnberg L. Neonatal hip instability: a prospective comparison of clinical examination and anterior dynamic ultrasound. Acta Radiologica 2008;49(2):212‐9. - PubMed

Additional references

    1. Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip. American Academy of Pediatrics. Clinical practice guideline: Early detection of developmental dysplasia of the hip. Pediatrics 2000;105(4 Pt 1):896‐905. - PubMed
    1. Barlow TG. Early diagnosis and treatment of congenital dislocation of the hip. Journal of Bone and Joint Surgery. British Volume 1962;44B:292‐301.
    1. Bialik V, Fishman J, Katzir J, Zelter M. Clinical assessment of hip instability in the newborn by an orthopedic surgeon and a pediatrician. Journal of Pediatric Orthopedics 1986;6(6):703‐5. - PubMed
    1. Bialik V, Bialik GM, Blazer S, Sujov P, Weiner F, Berant M. Developmental dysplasia of the hip: A new approach to incidence. Pediatrics 1999;103(1):93‐9. - PubMed
    1. Bond CD, Hennrikus WL, DellaMaggiore ED. Prospective evaluation of newborn soft‐tissue hip "clicks" with ultrasound. Journal of Pediatric Orthopedics 1997;17(2):199‐201. - PubMed