There are wide differences of opinion about the value of screening infants for hip dysplasia. Almost everyone agrees that the newborn examination is important, but even that misses about one in 10 dislocated hips because they may be stuck out of the socket, the exam may be inaccurate, or the hip can come out of the socket later.
Ultrasound screening remains controversial partly because this seems to lead to over-treatment and there are some risks associated with any type of treatment. The United States Preventive Services Task Force recently determined that they could not recommend any screening strategies for developmental dysplasia of the hip.
Some countries like Germany and Austria national health care systems that have implemented ultrasound screening for all newborns.
A study from Children’s hospital of Boston attempted to determine the place of ultrasound screening using a method called “decision analysis of the utility of screening for developmental dysplasia of the hip”.
The purpose of this study was to determine which of the following three strategies leads to the best chance of having a non-arthritic hip by the age of sixty years: (1) no screening for developmental dysplasia of the hip, (2) universal screening of newborns with both physical examination and ultrasonography, or (3) universal screening with physical examination but only selective use of ultrasonography for neonates considered to be at high risk.
Their analytic model indicated that the optimum strategy, associated with the highest probability of having a non-arthritic hip at the age of sixty years, was to screen all newborn babies with a physical examination for hip dysplasia and to use ultrasound studies selectively for infants who are at high risk.
Comments:
This study confirms the current practice in the North American that includes a hip examination of all newborn babies with selective ultrasound exam for the babies who might be at greater risk for hip dysplasia. This can detect most babies with hip instability at birth, but many more people turn up with dysplasia later in life. There is increasing evidence that current medical practice fails to detect over 90% of hip dysplasia that causes arthritis later in life. The International Hip Dysplasia Institute and other researchers in this field are working to find better ways to prevent hip dysplasia. Almost all babies are being screened properly by competent examiners, but another approach may be needed because the effectiveness of current screening methods is in question.
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