A recent study from Gosford Hospital, Australia, evaluated the effects of different screening programs for DDH on the frequency of late presentation of hip dislocations. Three independent review authors evaluated high quality trials the effectiveness of screening programs for DDH.
Important results include the following:
- One study reported universal ultrasound where every baby has a hip ultrasound study compared to clinical examination alone. Universal ultrasound did not result in a significant reduction in late diagnosed DDH or surgery but universal ultrasound study was associated with a significant increase in treatment of newborn infants.
- One study reported targeted ultrasound of infants at risk 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.
- 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.
Based on the findings of this study Shorter et al have concluded that:
- There is insufficient evidence in literature to give clear recommendations for clinical practice.
- Neither of the ultrasound strategies (universal versus targeted) have been demonstrated to improve clinical outcomes including late diagnosed DDH and surgery. However, 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.
The authors have presented factual data based on a systematic review of literature.
Enforcing universal ultrasound screening in all healthcare systems across the world remains impractical and somewhat controversial. Nevertheless, high-risk patients should have early screening with ultrasound and a good clinical exam. Earlier diagnosis enables the clinician to intervene and reduce the risk of surgery. Treatment of milder cases of dysplasia with harness/ bracing OR continued observation without intervention will continue to be a topic of debate. More prospective studies at a national level involving multiple centers may offer insights in future.