MODERATE RECOMMENDATION There is moderate evidence to not do universal screening of all infants for DDH. Two moderate strength studies showed no statistical difference between universal and selective ultrasound screening of the infant hip for diagnosis of late presenting DDH (Holen 2002, Rosendahl 1994). Holen (2002) augmented clinical screening with either universal or selective (risk) ultrasound. The rate of late cases in Holen’s (2002) study was 0.13/1000 with universal ultrasound screening and 0.65/1000 with selective (risk) screening. The difference in late detection was not statistically significant. Rosendahl (1994) used three matched study groups: general ultrasound screening, risk factor screening and only clinical screening. Late cases identified by group were 0.3/1000, 0.7/1000 and 1.3/1000 respectively and these differences were not statistically significant.
Screening of all infants with ultrasound has the potential to lead to over-treatment. Rosendahl’s (1994) study found that general ultrasound screening resulted in a higher treatment rate (3.4%) than either selective ultrasound screening (2.0%) or clinical screening (1.8%). The higher rate with universal screening is statistically significant. Universal ultrasound screening requires considerable diagnostic and therapeutic effort and these studies which involve large numbers of newborns indicate that such a commitment of resources will not significantly impact the prevalence of late cases.
RISKS AND HARMS
There is a potential to miss a case of DDH in an infant with a normal clinical examination and no risk factors. This could lead to a late diagnosis with concerns for a potential of higher rate of treatment complications as a result of late diagnosis.
2022 UPDATE ADDITIONAL EVIDENCE
1. Gokharman, F. D., Aydin, S., Fatihoglu, E., Ergun, E., Kosar, P. N. Optimizing the Time for Developmental Dysplasia of the Hip Screening: Earlier or Later? Ultrasound Q 2019; 2: 130-135
2. Burnett, M., Rawlings, E. L., Reddan, T. An audit of referral time frames for ultrasound screening of developmental hip dysplasia in neonates with a normal antenatal clinical examination. Sonography 2018; 2: 61-66
3. Geertsema, D., Meinardi, J. E., Kempink, D. R. J., Fiocco, M., van de Sande, M. A. J. Screening program for neonates at risk for developmental dysplasia of the hip: comparing first radiographic evaluation at five months with the standard twelve week ultrasound. A prospective cross-sectional cohort study. Int Orthop 2019; 8: 1933-1938
4. Guler, O., Seker, A., Mutlu, S., Cerci, M. H., Komur, B., Mahirogullari, M. Results of a universal ultrasonographic hip screening program at a single institution. Acta Orthop Traumatol Turc 2016; 1: 42-8
5. Gyurkovits, Z., Sohar, G., Baricsa, A., N, G., Orvos, H., Dubs, B. Early detection of developmental dysplasia of hip by ultrasound. Hip Int 2019; 0: 1120700019879687 Kolb, A., Schweiger, N., Mailath-Pokorny, M., Kaider, A., Hobusch, G., Chiari, C., Windhager, R. Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. Int Orthop 2016; 1: 123-7
6. Kolb, A., Schweiger, N., Mailath-Pokorny, M., Kaider, A., Hobusch, G., Chiari, C., Windhager, R. Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. Int Orthop 2016; 1: 123-7
7. Laborie, L. B., Engesaeter, IO, Lehmann, T. G., Eastwood, D. M., Engesaeter, L. B., Rosendahl, K. Screening strategies for hip dysplasia: long-term outcome of a randomized controlled trial. Pediatrics 2013; 3: 492-501
8. Laborie, L. B., Markestad, T. J., Davidsen, H., Bruras, K. R., Aukland, S. M., Bjorlykke, J. A., Reigstad, H., Indrekvam, K., Lehmann, T. G., Engesaeter, I. O., Engesaeter, L. B., Rosendahl, K. Selective ultrasound screening for developmental hip dysplasia: Effect on management and late detected cases. A prospective survey during 1991-2006. Pediatr Radiol 2014; 4: 410-424
9. Munkhuu, B., Essig, S., Renchinnyam, E., Schmid, R., Wilhelm, C., Bohlius, J., Chuluunbaatar, B., Shonkhuuz, E., Baumann, T. Incidence and treatment of developmental hip dysplasia in Mongolia: a prospective cohort study. PLoS One 2013; 10: e79427
10. Olsen, S. F., Blom, H. C., Rosendahl, K. Introducing universal ultrasound screening for developmental dysplasia of the hip doubled the treatment rate. Acta Paediatr 2018; 2: 255-261
11. Tan, S. H. S., Wong, K. L., Lim, A. K. S., Hui, J. H. The earliest timing of ultrasound in screening for developmental dysplasia of the hips. Ultrasonography 2019; 4: 321-326
12. Westacott, D. J., Butler, D., Shears, E., Cooke, S. J., Gaffey, A. Universal versus selective ultrasound screening for developmental dysplasia of the hip: a single-centre retrospective cohort study. J Pediatr Orthop B 2018; 5: 387-390
- Guler, O., Seker, A., Mutlu, S., Cerci, M. H., Komur, B., Mahirogullari, M. Results of a universal ultrasonographic hip screening program at a single institution. Acta Orthop Traumatol Turc 2016; 1: 42-8
- Geertsema, D., Meinardi, J. E., Kempink, D. R. J., Fiocco, M., van de Sande, M. A. J. Screening program for neonates at risk for developmental dysplasia of the hip: comparing first radiographic evaluation at five months with the standard twelve week ultrasound. A prospective cross-sectional cohort study. Int Orthop 2019; 8: 1933-1938
- Burnett, M., Rawlings, E. L., Reddan, T. An audit of referral time frames for ultrasound screening of developmental hip dysplasia in neonates with a normal antenatal clinical examination. Sonography 2018; 2: 61-66
- (2) Rosendahl K, Markestad T, Lie RT. Ultrasound screening for developmental dysplasia of the hip in the neonate: the effect on treatment rate and prevalence of late cases. Pediatrics 1994;94(1):47-52.
- (1) Holen KJ, Tegnander A, Bredland T et al. Universal or selective screening of the neonatal hip using ultrasound? Journal of Bone and Joint Surgery - Series B 2002;84(6):886-890
- Gokharman, F. D., Aydin, S., Fatihoglu, E., Ergun, E., Kosar, P. N. Optimizing the Time for Developmental Dysplasia of the Hip Screening: Earlier or Later?. Ultrasound Q 2019; 2: 130-135
- Gyurkovits, Z., Sohar, G., Baricsa, A., Nemeth, G., Orvos, H., Dubs, B. Early detection of developmental dysplasia of hip by ultrasound. Hip Int 2019; 0: 1120700019879687
- Kolb, A., Schweiger, N., Mailath-Pokorny, M., Kaider, A., Hobusch, G., Chiari, C., Windhager, R. Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. Int Orthop 2016; 1: 123-7
- Laborie, L. B., Markestad, T. J., Davidsen, H., Bruras, K. R., Aukland, S. M., Bjorlykke, J. A., Reigstad, H., Indrekvam, K., Lehmann, T. G., Engesaeter, I. O., Engesaeter, L. B., Rosendahl, K. Selective ultrasound screening for developmental hip dysplasia: Effect on management and late detected cases. A prospective survey during 1991-2006. Pediatr Radiol 2014; 4: 410-424
- Munkhuu, B., Essig, S., Renchinnyam, E., Schmid, R., Wilhelm, C., Bohlius, J., Chuluunbaatar, B., Shonkhuuz, E., Baumann, T. Incidence and treatment of developmental hip dysplasia in Mongolia: a prospective cohort study. PLoS One 2013; 10: e79427
- Olsen, S. F., Blom, H. C., Rosendahl, K. Introducing universal ultrasound screening for developmental dysplasia of the hip doubled the treatment rate. Acta Paediatr 2018; 2: 255-261
- Tan, S. H. S., Wong, K. L., Lim, A. K. S., Hui, J. H. The earliest timing of ultrasound in screening for developmental dysplasia of the hips. Ultrasonography 2019; 4: 321-326
- Westacott, D. J., Butler, D., Shears, E., Cooke, S. J., Gaffey, A. Universal versus selective ultrasound screening for developmental dysplasia of the hip: a single-centre retrospective cohort study. J Pediatr Orthop B 2018; 5: 387-390
- Laborie, L. B., Engesaeter, IO, Lehmann, T. G., Eastwood, D. M., Engesaeter, L. B., Rosendahl, K. Screening strategies for hip dysplasia: long-term outcome of a randomized controlled trial. Pediatrics 2013; 3: 492-501