Effect of ultrasound screening on the rate of first operative procedures for developmental hip dysplasia in Germany.
BACKGROUND
Ultrasound screening for developmental hip dysplasia and early conservative treatment might prevent later hip operations. A national hip ultrasound-screening programme, undertaken during the first 6 weeks of life, was introduced across Germany in 1996 and was continued for 5 years. We assessed the rate of first operation on the hip during this programme.


METHODS
A national active surveillance programme of initial operations for developmental hip dysplasia was started in 1997 and continued for 5 years. Screening participation was assessed by a random digit dialing telephone survey. Cases were children aged between 10 weeks and 5 years at first operation, who had had no underlying disease leading to developmental hip dysplasia. Completeness of case ascertainment was validated with a capture-recapture study in a representative subsample. Calculated incidences were compared with previously established rates.


RESULTS
About 90% of all children were screened. 147 cases in the first year, and between 81 and 105 for subsequent years were reported. Treatment included closed reductions 353 (66%), open reductions 61 (11%), and osteotomies 121 (23%). Developmental hip dysplasia was diagnosed by ultrasound before 6 weeks of age in 272 (55%) of cases, 64 (13%) were screened at the recommended time but had normal findings, 70 (14%) had delayed screening, and 89 (18%) were not screened. Capture-recapture estimates suggested that 52% of cases were reported. The corrected incidence for first operation was 0.26 per 1000 livebirths (95% CI 0.22-0.32).


CONCLUSIONS
Ultrasound screening seems to prevent many, but not all, operations for developmental hip dysplasia. Rates of timely screening (ie, before 6 weeks of age) and training of doctors in ultrasound screening need to be improved.
von Kries
Rüdiger
R
Department for Paediatric Epidemiology, Institute for Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University, Munich, Germany. AG.EPI@LRZ.uni-muenchen.de
Ihme
Nicola
N
Oberle
Doris
D
Lorani
Anette
A
Stark
Renee
R
Altenhofen
Lutz
L
Niethard
Fritz Uwe
FU
D000367:Age Factors; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005858:Germany / Q000453:epidemiology; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008403:Mass Screening / Q000706:statistics & numerical data*; D015997:Neonatal Screening; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D011159:Population Surveillance; D014463:Ultrasonography