Choosing Wisely:

Don’t order a screening hip ultrasound to rule out developmental hip dysplasia or developmental hip dislocation if the baby has no risk factors and has a clinically stable hip examination.

Rationale and Comments: Hip dysplasia/dislocation is relatively rare, with incidence of approximately 7 per 1,000 births. Studies have shown that universal screening programs for developmental hip instability using ultrasounds to assess otherwise normal appearing hips have a nearly negligible positive yield. There is a substantial false positive rate, with an associated increase in treatment rate, suggesting that babies without hip pathology are being treated. When there are no physical findings or underlying risk factors for hip dysplasia/dislocation in a newborn, a hip ultrasound is costly, time-intensive and the findings may be misleading to parents and physicians. This recommendation is in accordance with the 2016 AAP clinical report regarding the use of ultrasound in early detection of developmental dysplasia of the hip (see reference: “Evaluation and Referral for Developmental Dysplasia of the Hips in Infants”).
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Orthopaedics and the Pediatric Orthopaedic Society of North America
  • Sources:
  • Prospective cohort studies
  • Disciplines:
  • Neonatology
  • Orthopedic
  • References: • Mahan ST, Katz JN, Kim YJ. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am. 2009:91(7):1705-1719.
    • Laborie LB, Markestad TH, Davidsen H. Bruras KR, Aukland SM, Bjorlykke JA, Reigstad H. Indrekvam K, Lehmann TG, Engesaeter IO, Engesaeter LB, Rosendahl K. Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective study during 1991-2006. Pediatri Radiol. 2014;44 (4): 410-424.
    • Shorter D, Hong T, Osborn DA. Cochrane Review: Screening programs for developmental dysplasia of the hip in newborn infants. Evid Based Child Health. 2013;8(1):11-54.
    • Shaw BA, Segal LS, Section on Orthopaedics. Evaluation and referral for developmental dysplasia of the hip in infants. Pediatric 2016;138(6).

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