Screening programmes for developmental dysplasia of the hip in newborn infants

Abstract

BACKGROUND: Uncorrected developmental dysplasia of the hip (DDH) is associated with long term morbidity such as gait abnormalities, chronic pain and degenerative arthritis. OBJECTIVE: To determine the effect of different screening programmes for DDH on the incidence of late presentation of congenital hip dislocation. METHODS:Search methods: Searches were performed in CENTRAL (The Cochrane Library), MEDLINE and EMBASE (January 2011) supplemented by searches of clinical trial registries, conference proceedings, cross references and contacting expert informants. Selection criteria: Randomized, quasi-randomized or cluster trials comparing the effectiveness of screening programmes for DDH. Data collection and analysis: Three independent review authors assessed study eligibility and quality, and extracted data. MAIN RESULTS:No study examined the effect of screening (clinical and/or ultrasound) and early treatment versus not screening and later treatment. AUTHORS' CONCLUSIONS:There is insufficient evidence to give clear recommendations for practice. There is inconsistent evidence that universal ultrasound results in a significant increase in treatment compared to the use of targeted ultrasound or clinical examination alone. Neither of the ultrasound strategies have been demonstrated to improve clinical outcomes including late diagnosed DDH and surgery. The studies are substantially underpowered to detect significant differences in the uncommon event of late detected DDH or surgery. For infants with unstable hips or mildly dysplastic hips, use of delayed ultrasound and targeted splinting reduces treatment without significantly increasing the rate of late diagnosed DDH or surgery.This is the abstract of a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) 2012, issue 11,

Epidemiological investigation and ultrasonographic results of developmental dysplasia of the hip in infants aged 0-6 months

“…DDH is predominantly observed in females, and there has been a long-standing suspicion of a hormonal/endocrine relationship. Consistent with previous research findings, the incidence of DDH in female infants (20.1%) was higher than in male infants (9.8%) in this study [17,18]. This trend could be linked to endocrine factors causing the relaxation of the hip joint capsule and its surrounding ligaments in female infants [19].…”

Epidemiological investigation and ultrasonographic results of developmental dysplasia of the hip in infants aged 0-6 months

“…DDH is predominantly observed in females, and there has been a long-standing suspicion of a hormonal/endocrine relationship. Consistent with previous research findings, the incidence of DDH in female infants (20.1%) was higher than in male infants (9.8%) in this study [17,18]. This trend could be linked to endocrine factors causing the relaxation of the hip joint capsule and its surrounding ligaments in female infants [19].…”

Enhanced detection services for developmental dysplasia of the hip in Scottish children, 1997–2013

“…For example, in a 2011 Cochrane systematic review of randomised and pseudorandomised trials examining screening, only one study was identified which compared clinical examination alone to clinical examination plus targeted and/or universal ultrasound screening. 5 The incidence of late surgery was lower in groups allocated (in a pseudorandomsied design) to ultrasound (RR 0.45; 95% CI 0.04 to 4.93 and 0.22; 95% CI 0.01 to 4.52 for targeted and universal ultrasound, respectively). However, the CIs were extremely wide ranging from a 20-fold protective effect to a fivefold increase in DDH surgery.…”

Screening for developmental dysplasia of the hip in a rural health district: An analysis of practice

“…From this data, it is unclear if there was any adverse effect on outcome for the late diagnosed DDH apart from those two cases that required surgical management from diagnosis. There is evidence for delayed splinting and a period of supervision and repeat ultrasound prior to bracing for infants with clinically detected mild DDH. It is uncertain if this methodology was used by clinicians in their decision making.…”

Epidemiological investigation and ultrasonographic results of developmental dysplasia of the hip in infants aged 0-6 months

“…DDH is predominantly observed in females, and there has been a long-standing suspicion of a hormonal/endocrine relationship. Consistent with previous research findings, the incidence of DDH in female infants (20.1%) was higher than in male infants (9.8%) in this study [17,18]. This trend could be linked to endocrine factors causing the relaxation of the hip joint capsule and its surrounding ligaments in female infants [19].…”

Enhanced detection services for developmental dysplasia of the hip in Scottish children, 1997–2013

“…For example, in a 2011 Cochrane systematic review of randomised and pseudorandomised trials examining screening, only one study was identified which compared clinical examination alone to clinical examination plus targeted and/or universal ultrasound screening. 5 The incidence of late surgery was lower in groups allocated (in a pseudorandomsied design) to ultrasound (RR 0.45; 95% CI 0.04 to 4.93 and 0.22; 95% CI 0.01 to 4.52 for targeted and universal ultrasound, respectively). However, the CIs were extremely wide ranging from a 20-fold protective effect to a fivefold increase in DDH surgery.…”

Screening for developmental dysplasia of the hip in a rural health district: An analysis of practice

“…From this data, it is unclear if there was any adverse effect on outcome for the late diagnosed DDH apart from those two cases that required surgical management from diagnosis. There is evidence for delayed splinting and a period of supervision and repeat ultrasound prior to bracing for infants with clinically detected mild DDH. It is uncertain if this methodology was used by clinicians in their decision making.…”

Epidemiological investigation and ultrasonographic results of developmental dysplasia of the hip in infants aged 0-6 months

“…DDH is predominantly observed in females, and there has been a long-standing suspicion of a hormonal/endocrine relationship. Consistent with previous research findings, the incidence of DDH in female infants (20.1%) was higher than in male infants (9.8%) in this study [17,18]. This trend could be linked to endocrine factors causing the relaxation of the hip joint capsule and its surrounding ligaments in female infants [19].…”

Enhanced detection services for developmental dysplasia of the hip in Scottish children, 1997–2013

“…For example, in a 2011 Cochrane systematic review of randomised and pseudorandomised trials examining screening, only one study was identified which compared clinical examination alone to clinical examination plus targeted and/or universal ultrasound screening. 5 The incidence of late surgery was lower in groups allocated (in a pseudorandomsied design) to ultrasound (RR 0.45; 95% CI 0.04 to 4.93 and 0.22; 95% CI 0.01 to 4.52 for targeted and universal ultrasound, respectively). However, the CIs were extremely wide ranging from a 20-fold protective effect to a fivefold increase in DDH surgery.…”

Screening for developmental dysplasia of the hip in a rural health district: An analysis of practice

“…From this data, it is unclear if there was any adverse effect on outcome for the late diagnosed DDH apart from those two cases that required surgical management from diagnosis. There is evidence for delayed splinting and a period of supervision and repeat ultrasound prior to bracing for infants with clinically detected mild DDH. It is uncertain if this methodology was used by clinicians in their decision making.…”