title: Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991-2006.
abstract: BACKGROUND
  Early treatment is considered essential for developmental dysplasia of the hip (DDH), but the choice of screening strategy is debated.
  
  
  OBJECTIVE
  We evaluated the effect of a selective ultrasound (US) screening programme.
  
  
  METHODS
  All infants born in a defined region during 1991-2006 with increased risk of developmental dysplasia of the hip, i.e. clinical hip instability, breech presentation, congenital foot deformities or a family history of DDH, underwent US screening at age 1-3 days. Severe sonographic dysplasia and dislocatable/dislocated hips were treated with abduction splints. Mild dysplasia and pathological instability, i.e. not dislocatable/dislocated hips were followed clinically and sonographically until spontaneous resolution, or until treatment became necessary. The minimum observation period was 5.5 years.
  
  
  RESULTS
  Of 81,564 newborns, 11,539 (14.1%) were identified as at-risk, of whom 11,190 (58% girls) were included for further analyses. Of the 81,564 infants, 2,433 (3.0%) received early treatment; 1,882 (2.3%) from birth and 551 (0.7%) after 6 weeks or more of clinical and sonographic surveillance. An additional 2,700 (3.3%) normalised spontaneously after watchful waiting from birth. Twenty-six infants (0.32 per 1,000, 92% girls, two from the risk group) presented with late subluxated/dislocated hips (after 1 month of age). An additional 126 (1.5 per 1,000, 83% girls, one from the risk group) were treated after isolated late residual dysplasia. Thirty-one children (0.38 per 1,000) had surgical treatment before age 5 years. Avascular necrosis was diagnosed in seven of all children treated (0.27%), four after early and three after late treatment.
  
  
  CONCLUSIONS
  The first 16 years of a standardised selective US screening programme for developmental dysplasia of the hip resulted in acceptable rates of early treatment and US follow-ups and low rates of late subluxated/dislocated hips compared to similar studies.
authors: Department of Clinical Medicine, University of Bergen, Bergen, Norway, lene.bjerke.laborie@helse-bergen.no.
authors: Lene Bjerke
authors: LB
authors: Laborie
authors: Trond Jacob
authors: TJ
authors: Markestad
authors: Henrik
authors: H
authors: Davidsen
authors: Kari Røine
authors: KR
authors: Brurås
authors: Stein Magnus
authors: SM
authors: Aukland
authors: John Asle
authors: JA
authors: Bjørlykke
authors: Hallvard
authors: H
authors: Reigstad
authors: Kari
authors: K
authors: Indrekvam
authors: Trude Gundersen
authors: TG
authors: Lehmann
authors: Ingvild Øvstebø
authors: IØ
authors: Engesæter
authors: Lars Birger
authors: LB
authors: Engesæter
authors: Karen
authors: K
authors: Rosendahl
mesh_terms: D057210:Delayed Diagnosis; D005260:Female; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000379:methods; D009664:Norway; D010808:Physical Examination; D015397:Program Evaluation; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography