title: Effect of ultrasound screening on the rate of first operative procedures for developmental hip dysplasia in Germany.
abstract: 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.
authors.affiliation: Department for Paediatric Epidemiology, Institute for Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University, Munich, Germany. AG.EPI@LRZ.uni-muenchen.de
authors.forename: Rüdiger
authors.initials: R
authors.lastname: von Kries
authors.forename: Nicola
authors.initials: N
authors.lastname: Ihme
authors.forename: Doris
authors.initials: D
authors.lastname: Oberle
authors.forename: Anette
authors.initials: A
authors.lastname: Lorani
authors.forename: Renee
authors.initials: R
authors.lastname: Stark
authors.forename: Lutz
authors.initials: L
authors.lastname: Altenhofen
authors.forename: Fritz Uwe
authors.initials: FU
authors.lastname: Niethard
mesh_terms: 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