Ultrasound screening for developmental dysplasia of the hip in the neonate: the effect on treatment rate and prevalence of late cases

Abstract

Objective: To assess the effect of ultrasound screening on primary diagnosis, management, and prevalence of late cases of developmental dysplasia of the hip (DDH).

Design: A randomized, controlled trial, including 11,925 newborn infants who were allocated to receive either general, or selective or no ultrasound screening in addition to the clinical examination. In the selectivity screened group only infants with risk factors or clinical findings of DDH received an ultrasound examination. The infants were at least 27 months old at the conclusion of the study. Those with risk factors for DDH had a radiograph examination of the hips at 4.5 months of age.

Results: The three study groups did not differ in terms of sex distribution or positive Barlow/Ortolani tests. General ultrasound screening resulted in a higher treatment rate than in either the selective or in the no ultrasound screening groups (3.4% vs 2.0% and 1.8%, P < .0001). For infants not subjected to treatment, ultrasound screening resulted in a higher follow-up rate because of nonconclusive early findings (13%, 1.8%, 0%, respectively; P < .0001). The prevalence of late subluxation or dislocation was lower for subjects assigned to general ultrasound screening than for those subjected to selective or no ultrasound screening, but the differences were not statistically significant (0.3, 0.7, 1.3 per 1000, respectively; P = .11, test for trend).

Conclusion: The effect of ultrasound screening in reducing the prevalence of late DDH was at best marginal despite a considerable increase in diagnostic and therapeutic efforts.