title: Screening programmes for developmental dysplasia of the hip in newborn infants.
abstract: BACKGROUND
  Uncorrected developmental dysplasia of the hip (DDH) is associated with long term morbidity such as gait abnormalities, chronic pain and degenerative arthritis.
  
  
  OBJECTIVE
  To determine the effect of different screening programmes for DDH on the incidence of late presentation of congenital hip dislocation.
  
  
  METHODS
  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.
  
  
  METHODS
  Randomised, quasi-randomised or cluster trials comparing the effectiveness of screening programmes for DDH.
  
  
  METHODS
  Three independent review authors assessed study eligibility and quality, and extracted data.
  
  
  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.
  
  
  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.
authors: Gosford Hospital, Holden Street, Gosford, NSW, Australia, 2250.
authors: Damon
authors: D
authors: Shorter
authors: Timothy
authors: T
authors: Hong
authors: David A
authors: DA
authors: Osborn
mesh_terms: D057210:Delayed Diagnosis / Q000009:adverse effects*; D006618:Hip Dislocation, Congenital / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008403:Mass Screening / Q000379:methods*; D010808:Physical Examination / Q000379:methods; D015397:Program Evaluation; D012075:Remission, Spontaneous; D013165:Splints; D013997:Time Factors; D014463:Ultrasonography