Progress in screening strategies for neonatal developmental dysplasia of the hip

Abstract

Developmental dysplasia of the hip (DDH) is the most common congenital disease of the musculoskeletal system in newborns and encompasses a disease spectrum ranging from a stable hip with a mildly dysplastic acetabulum to complete hip dislocation. Systematic screening for infant DDH has been performed for several decades all over the world and has contributed greatly to the early detection, diagnosis and treatment of DDH. However, some cases of delayed diagnosis still occur among the screened population, or conversely, overdiagnosis or overtreatment occasionally occurs. Furthermore, screening strategies for DDH are still controversial. The aim of our study was to analyze the current literature on DDH screening, paying particular attention to DDH screening strategies and their effectiveness. We searched the DDH screening literature from 1958 to 2021 in MEDLINE and other databases using PubMed. In this study, we reviewed the history of DDH screening and the progress of screening strategies and discussed the controversies regarding clinical and ultrasound screening methods with particular emphasis on the current opinions. Given the existing scientific evidence and changes in newborn DDH screening practices, universal ultrasound screening seems to be the best option for preventing late-detected cases and can be recommended as a favorable prevention strategy.

Twelve to Twenty-year Follow-up of Dega Acetabuloplasty in Patients With Developmental Dysplasia of the Hip: Is it as Effective as Expected?

“…There were 15 Severin group Ia (46.8%), 1 Severin group Ib (3.1%), 8 Severin group IIa (25%), 2 Severin group IIb (6.2%), 4 Severin group III (12.5%), and 2 Severin group IVa (6.2%) hips. No hips were rated as Severin group V or VI.…”

“…1,2 As the introduction of clinical and ultrasound screening programs allowed earlier treatment, the frequency of surgical treatment in DDH is gradually decreasing. 3,4 However, studies with long-term follow-up showed that a substantial number of hips develop osteoarthritis earlier than expected, even in well-treated hips. 2,[5][6][7] This highlights the importance of studies with even longer-term follow-up.…”

Developmental dysplasia of the hip in infants and children

“…A 2022 systematic review that excluded non-English language papers also concluded that the rate of late detected DDH, defined as greater than 12 weeks of age, and surgical treatment were not significantly different among different screening strategies 38. Conversely, two systematic reviews both supported universal ultrasound, with one showing favourable results of universal ultrasound in five out of six studies and concluding that universal ultrasound screening is cost effective 3940. A recent systematic review also concluded that universal screening shows a trend towards lower prevalence of late DDH but with increased bracing and without a reduction in surgical procedures 41.…”

Assessment for late developmental hip dysplasia in a cohort of infants with risk factors and normal hip ultrasound

“…The Pavlik harness appears to be the most used brace ( 7 ). According to medical literature, despite the current debate between selective and universal screening ( 8 – 10 ), hip ultrasound is considered the most reliable diagnostic examination for DDH ( 11 , 12 ). Until now, available literature ( 13 – 15 ) did not recommend (even in children with risk factors, including breech presentation) further follow-up after a negative hip ultrasound examination.…”