Congenital dislocation of the hip: Optimal screening strategies in 2014

Abstract

A prospective multi-centre nationwide study of patients with congenital dislocation of the hip (CDH) diagnosed after 3 months of age was conducted with support from the French Society for Paediatric Orthopaedics (Société Française d'Orthopédie Pédiatrique [SoFOP]), French Organisation for Outpatient Paediatrics (Association Française de Pédiatrie Ambulatoire [AFPA]), and French-Speaking Society for Paediatric and Pre-Natal Imaging (Société Francophone d'Imagerie Pédiatrique et Prénatale [SFIPP]). The results showed inadequacies in clinical screening for CDH that were patent when assessed quantitatively and probably also present qualitatively. These findings indicate a need for a communication and educational campaign aimed at highlighting good clinical practice guidelines in the field of CDH screening. The usefulness of routine ultrasound screening has not been established. The findings from this study have been used by the authors and French National Health Authority (Haute Autorité de Santé [HAS]) to develop recommendations about CDH screening. There is an urgent need for a prospective randomised multi-centre nationwide study, which should involve primary-care physicians.

Increase in late diagnosed developmental dysplasia of the hip in South Australia: risk factors, proposed solutions

“…The American Academy of Pediatrics recommends routine ultrasound screening at 6 weeks of age for girls born in the breech position, with optional screening for breech boys, as well as for girls with a family history of DDH 7 . Our results support previous findings 8 that selective ultrasound screening fails to prevent the occurrence of late presenting DDH patients, as the majority of babies requiring intervention are not identified by the current criteria.…”

“…An increase in the number of late DDH diagnoses has also been observed in the United Kingdom, North America and France; [8][9][10][11] it has been attributed to external factors, such as swaddling, as well as to reduced clinical expertise in hip examination, and the lack of repeated hip checks of children until walking age. 8 A systematic review has cast doubt on the value of screening for DDH in general, citing a lack of evidence for benefits in long term functional outcomes, as well as the risk of overtreating. 12 This highlights the challenges when making recommendations for screening, with differences in definitions, treatment protocols and outcome measures making conclusions difficult.…”

“…An increase in the number of late DDH diagnoses has also been observed in the United Kingdom, North America and France; 8 ‐ 11 it has been attributed to external factors, such as swaddling, as well as to reduced clinical expertise in hip examination, and the lack of repeated hip checks of children until walking age 8 …”

Developmental Hip Dysplasia: An Epidemiological Nationwide Study in Italy from 2001 to 2016

“…The most effective screening protocol for the early detection of DDH is still debated worldwide. Clinical assessment, selective ultrasound or early universal ultrasound screening are adopted as diagnosis methods in several countries [12][13][14]. However, few studies reported the results between countries, making it challenging to redact universal screening guidelines.…”

Hip hip: no hurray

“…At around £400, it is far cheaper than the high tech simulation devices now in use but in 1993 only 37% of units were using this model. The only mention in the literature since then is in a review from France in 2014 6. Perhaps this is not surprising as the Hippy is made in France.…”