title: Immediate treatment versus sonographic surveillance for mild hip dysplasia in newborns.
abstract: OBJECTIVE
  We conducted a blinded, randomized, controlled trial to examine whether mildly dysplastic but stable or instable hips would benefit from early treatment, as compared with watchful waiting.
  
  
  METHODS
  A total of 128 newborns with mild hip dysplasia (sonographic inclination angle [alpha angle] of 43 degrees -49 degrees ) and stable or instable but not dislocatable hips were randomly assigned to receive either 6 weeks of abduction treatment (immediate-treatment group) or follow-up alone (active-sonographic-surveillance group). The main outcome measurement was the acetabular inclination angle, measured by radiograph, at 1 year of age.
  
  
  RESULTS
  Both groups included 64 newborns, and there was no loss to follow-up. With the exception of a small but statistically significant excess of girls in the active-sonographic-surveillance group, there were no statistically significant differences in baseline characteristics between the 2 groups. The mean inclination angle at 12 months was 24.2 degrees for both groups (difference: 0.1 [95% confidence interval (CI): -0.8 to 0.9]), and all children had improved and were without treatment. The mean alpha angle was 59.7 degrees in the treatment group and 57.1 degrees in the active-surveillance group for a difference of 2.6 degrees evaluated after 1.5 and 3 months (95% CI: 1.8 to 3.4; P < .001). At 1.5 months of age, the hips had improved in all treated children but not in 5 children under active surveillance (P = .06). Among the sonographic-surveillance group, 47% received treatment after the initial surveillance period of 1.5 months.
  
  
  CONCLUSIONS
  Active-sonographic-surveillance halved the number of children requiring treatment, did not increase the duration of treatment, and yielded similar results at 1-year follow-up. Given a reported prevalence of 1.3% for mildly dysplastic but stable hips, a strategy of active surveillance would reduce the overall treatment rate by 0.6%. Our results may have important implications for families as well as for health care costs.
authors.affiliation: Diagnostic Radiology, Great Ormond Street Hospital for Children, London, United Kingdom. rosenk@gosh.nhs.uk
authors.forename: Karen
authors.initials: K
authors.lastname: Rosendahl
authors.forename: Carol
authors.initials: C
authors.lastname: Dezateux
authors.forename: Kari Røine
authors.initials: KR
authors.lastname: Fosse
authors.forename: Hildegunn
authors.initials: H
authors.lastname: Aase
authors.forename: Stein Magnus
authors.initials: SM
authors.lastname: Aukland
authors.forename: Hallvard
authors.initials: H
authors.lastname: Reigstad
authors.forename: Terje
authors.initials: T
authors.lastname: Alsaker
authors.forename: Dag
authors.initials: D
authors.lastname: Moster
authors.forename: Rolv Terje
authors.initials: RT
authors.lastname: Lie
authors.forename: Trond
authors.initials: T
authors.lastname: Markestad
mesh_terms: D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015915:Motion Therapy, Continuous Passive / Q000379:methods*; D019370:Observation / Q000379:methods*; D011336:Probability; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography