Cochrane for Clinicians

Putting Evidence into Practice

Screening for Developmental Dysplasia of the Hip in Newborns



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Am Fam Physician. 2013 Jan 1;87(1):10-11.

The clinical content by Drs. Ewald and Kiesel is available for evidence-based continuing medical education (EB CME) credit. See the CME Quiz.

Clinical Question

Does ultrasound screening for developmental dysplasia of the hip (DDH) improve long-term clinical outcomes?

Evidence-Based Answer

Although screening increases the proportion of newborns who are treated for DDH, there is insufficient evidence that targeted or universal ultrasound screening improves long-term orthopedic outcomes. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

DDH is a range of abnormalities of the immature hip in which the femoral head and acetabulum are in improper alignment, grow abnormally, or both. Approximately one in 1,000 children is born with hip dislocation, and 10 in 1,000 children are born with hip subluxation.1 If left untreated, DDH may lead to long-term hip dysplasia and arthritis, requiring hip replacement. Treatment usually includes closed reduction and immobilization. However, abduction splinting has been associated with avascular necrosis of the femoral head, femoral nerve palsy, pressure sores, and parental anxiety. Ultrasonography may be used to screen newborns for DDH. However, the U.S. Preventive Services Task Force has found insufficient evidence to recommend routine screening for DDH to prevent adverse outcomes, noting that spontaneous resolution occurred in 60 to 80 percent of newborn hip abnormalities identified by physical examination and in more than 90 percent of newborn hips identified by ultrasonography as abnormal or suspicious for DDH.2

The authors searched for randomized or quasi-randomized trials evaluating the effects of screening for DDH on the incidence of late presentation of congenital hip dislocation. Two studies compared clinical examination alone, targeted ultrasonography, or universal ultrasonography as an initial screening method for DDH. No statistically significant differences were noted in the rates of late diagnosis of DDH or surgery among these three groups. However, there was a statistically significant increase in the rate of nonsurgical treatment with universal ultrasonography compared with clinical examination alone (relative risk = 1.88; 95% confidence interval, 1.41 to 2.51) or targeted ultrasonography, with one additional child requiring treatment of uncertain benefit for every 100 screened.

A meta-analysis of two studies involving a total of 708 infants found no notable differences in the rates of late diagnosis of DDH, but a marked reduction in treatment rates when using delayed clinical examination and hip ultrasonography with targeted splinting versus early splinting in infants who had clinically unstable hips. Another study compared delayed hip ultrasonography and targeted splinting with immediate splinting in 128 infants with mild hip dysplasia identified on early ultrasonography and found no notable difference in late diagnosis of DDH, but a marked decrease in treatment. No studies compared screening programs with no screening at all.

Thus, the limited evidence in this review suggests that less intensive screening for DDH and delayed treatment of hip abnormalities identified through screening are not associated with worse outcomes than more intensive screening and immediate treatment.

Author disclosure: No relevant financial affiliations to disclose.

Source:

Shorter D, Hong T, Osborn DA. Screening programmes for developmental dysplasia of the hip in newborn infants. Cochrane Database Syst Rev. 2011;(9):CD004595.


The practice recommendations in this activity are available at http://summaries.cochrane.org/CD004595.

REFERENCES

1. Storer SK, Skaggs DL. Developmental dysplasia of the hip. Am Fam Physician. 2006;74(8):1310–1316.

2. U.S. Preventive Services Task Force. Screening for developmental dysplasia of the hip: recommendation statement. Pediatrics. 2006;117(3):898–902.

These brief overviews are summaries of reviews from the Cochrane Library.

The series coordinator for AFP is Kenneth W. Lin, MD, Department of Family Medicine, Georgetown University School of Medicine, Washington, DC.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.


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