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Pediatric Radiology
Published in: Pediatric Radiology 4/2014

01-04-2014 | Original Article

Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991–2006

Authors: Lene Bjerke Laborie, Trond Jacob Markestad, Henrik Davidsen, Kari Røine Brurås, Stein Magnus Aukland, John Asle Bjørlykke, Hallvard Reigstad, Kari Indrekvam, Trude Gundersen Lehmann, Ingvild Øvstebø Engesæter, Lars Birger Engesæter, Karen Rosendahl

Published in: Pediatric Radiology | Issue 4/2014

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Abstract

Background

Early treatment is considered essential for developmental dysplasia of the hip (DDH), but the choice of screening strategy is debated.

Objective

We evaluated the effect of a selective ultrasound (US) screening programme.

Materials and methods

All infants born in a defined region during 1991–2006 with increased risk of developmental dysplasia of the hip, i.e. clinical hip instability, breech presentation, congenital foot deformities or a family history of DDH, underwent US screening at age 1–3 days. Severe sonographic dysplasia and dislocatable/dislocated hips were treated with abduction splints. Mild dysplasia and pathological instability, i.e. not dislocatable/dislocated hips were followed clinically and sonographically until spontaneous resolution, or until treatment became necessary. The minimum observation period was 5.5 years.

Results

Of 81,564 newborns, 11,539 (14.1%) were identified as at-risk, of whom 11,190 (58% girls) were included for further analyses. Of the 81,564 infants, 2,433 (3.0%) received early treatment; 1,882 (2.3%) from birth and 551 (0.7%) after 6 weeks or more of clinical and sonographic surveillance. An additional 2,700 (3.3%) normalised spontaneously after watchful waiting from birth. Twenty-six infants (0.32 per 1,000, 92% girls, two from the risk group) presented with late subluxated/dislocated hips (after 1 month of age). An additional 126 (1.5 per 1,000, 83% girls, one from the risk group) were treated after isolated late residual dysplasia. Thirty-one children (0.38 per 1,000) had surgical treatment before age 5 years. Avascular necrosis was diagnosed in seven of all children treated (0.27%), four after early and three after late treatment.

Conclusion

The first 16 years of a standardised selective US screening programme for developmental dysplasia of the hip resulted in acceptable rates of early treatment and US follow-ups and low rates of late subluxated/dislocated hips compared to similar studies.
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Metadata
Title
Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991–2006
Authors
Lene Bjerke Laborie
Trond Jacob Markestad
Henrik Davidsen
Kari Røine Brurås
Stein Magnus Aukland
John Asle Bjørlykke
Hallvard Reigstad
Kari Indrekvam
Trude Gundersen Lehmann
Ingvild Øvstebø Engesæter
Lars Birger Engesæter
Karen Rosendahl
Publication date
01-04-2014
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 4/2014
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-013-2838-3

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