title: General ultrasound screening reduces the rate of first operative procedures for developmental dysplasia of the hip: a case-control study.
abstract: OBJECTIVE
  To assess the effectiveness of general ultrasound screening to prevent first operative procedures of the hip.
  
  
  METHODS
  We conducted a case-control study in a population in which general ultrasound screening supplementing clinical screening is recommended and offered free of charge for all children. Participation in ultrasound screening before week 7 as recommended in Germany was the exposure of interest. Case ascertainment was based on active surveillance in orthopedic hospitals. The case definition was: first operative procedure for developmental dysplasia of the hip (closed reduction, open reduction, or osteotomy) in children >9 weeks old and <5 years old and born between 1996 and 2001. Control subjects from the same birth cohorts were recruited in telephone surveys.
  
  
  RESULTS
  Cases of first operative procedures for developmental dysplasia of the hip (n = 446) were compared with 1173 control subjects for ultrasound screening. Effectiveness of ultrasound screening to prevent first operative procedures for developmental dysplasia of the hip was estimated as 52% (95% CI, 32-67). Effectiveness did not vary substantially for closed and open reductions and osteotomy.
  
  
  CONCLUSIONS
  General ultrasound screening reduces the rate of operative procedures for developmental dysplasia of the hip; the impact on developmental dysplasia of the hip. Treatment rates and avascular necrosis need further assessment to balance the benefit against potential overtreatment and adverse effects.
authors.affiliation: Division of Epidemiology, Institute for Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University, Munich, Germany. ruediger.kries@med.uni-muenchen.de
authors.forename: Rüdiger
authors.initials: R
authors.lastname: von Kries
authors.forename: Nicola
authors.initials: N
authors.lastname: Ihme
authors.forename: Lutz
authors.initials: L
authors.lastname: Altenhofen
authors.forename: Fritz Uwe
authors.initials: FU
authors.lastname: Niethard
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Krauspe
authors.forename: Simon
authors.initials: S
authors.lastname: Rückinger
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D005858:Germany / Q000453:epidemiology; D006615:Hip / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000601:surgery; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000379:methods*; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D014463:Ultrasonography