Abstract
Objective: To determine the effectiveness of ultrasound screening for developmental dysplasia of the hip (DDH) after the neonatal period.
Design: Prospective cohort study.
Setting: Child health care centres.
Participants: Infants attending the child health care centres.
Interventions: The intervention group (n = 5170) was screened by ultrasound at 1, 2, and 3 months of age. The control group (n = 2066) was screened by routine physical examination as part of the programme for child health surveillance at the child health care centres (CHC screening). For evaluation of the screening, the children in both the intervention and control group received an ultrasound examination after 6 months of age to detect any abnormality that might have been missed by the screening.
Results: The sensitivity of the ultrasound screening was 88.5%, and the referral rate 7.6%. As a result of the ultrasound screening, 4.6% of the children were treated. The sensitivity of the CHC screening was 76.4%, with a referral rate of 19.2%. The treatment rate was 2.7%. Of the treated children in the ultrasound screening group, 67% were referred before the age of 13 weeks, whereas in the CHC screening group only 29% were referred before this age.
Conclusions: This study shows that ultrasound screening detects more children with DDH than CHC screening and that more of them are detected at an earlier age. To accomplish this, even fewer children have to be referred. However, even general ultrasound screening seems not to eradicate late cases of DDH. The higher treatment rate in the population screened by ultrasound may be a result of overtreatment.
Full Text
The Full Text of this article is available as a PDF (135.2 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bialik V., Bialik G. M., Wiener F. Prevention of overtreatment of neonatal hip dysplasia by the use of ultrasonography. J Pediatr Orthop B. 1998 Jan;7(1):39–42. doi: 10.1097/01202412-199801000-00007. [DOI] [PubMed] [Google Scholar]
- Boere-Boonekamp M. M., Kerkhoff T. H., Schuil P. B., Zielhuis G. A. Early detection of developmental dysplasia of the hip in The Netherlands: the validity of a standardized assessment protocol in infants. Am J Public Health. 1998 Feb;88(2):285–288. doi: 10.2105/ajph.88.2.285. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bon R. A., Exner G. U. Frühdiagnose der Hüftdysplasie--Argumente für ein generelles sonographisches Screening in der Schweiz. Schweiz Rundsch Med Prax. 1992 Apr 14;81(16):519–523. [PubMed] [Google Scholar]
- Castelein R. M. Fysische diagnostiek--de handgreep van Ortolani. Ned Tijdschr Geneeskd. 2002 Jun 8;146(23):1077–1080. [PubMed] [Google Scholar]
- Catterall A. The early diagnosis of congenital dislocation of the hip. J Bone Joint Surg Br. 1994 Jul;76(4):515–516. [PubMed] [Google Scholar]
- Clarke N. M. Diagnosing congenital dislocation of the hip. BMJ. 1992 Aug 22;305(6851):435–436. doi: 10.1136/bmj.305.6851.435. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Donaldson J. S., Feinstein K. A. Imaging of developmental dysplasia of the hip. Pediatr Clin North Am. 1997 Jun;44(3):591–614. doi: 10.1016/s0031-3955(05)70495-8. [DOI] [PubMed] [Google Scholar]
- Graf R. The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg. 1980;97(2):117–133. doi: 10.1007/BF00450934. [DOI] [PubMed] [Google Scholar]
- Grimes David A., Schulz Kenneth F. Uses and abuses of screening tests. Lancet. 2002 Mar 9;359(9309):881–884. doi: 10.1016/S0140-6736(02)07948-5. [DOI] [PubMed] [Google Scholar]
- Günther K. P., Stoll S., Schmitz A., Niethard F. U., Altenhofen L., Melzer C., von Kries R. Erste Ergebnisse aus der Evaluationsstudie des sonographischen Hüftscreenings in der Bundesrepublik Deutschland. Z Orthop Ihre Grenzgeb. 1998 Nov-Dec;136(6):508–512. doi: 10.1055/s-2008-1045178. [DOI] [PubMed] [Google Scholar]
- Hansson G., Jacobsen S. Ultrasonography screening for developmental dysplasia of the hip joint. Acta Paediatr. 1997 Sep;86(9):913–915. doi: 10.1111/j.1651-2227.1997.tb15168.x. [DOI] [PubMed] [Google Scholar]
- Harcke H. T., Kumar S. J. The role of ultrasound in the diagnosis and management of congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1991 Apr;73(4):622–628. [PubMed] [Google Scholar]
- Leck I. An epidemiological assessment of neonatal screening for dislocation of the hip. J R Coll Physicians Lond. 1986 Jan;20(1):56–62. [PMC free article] [PubMed] [Google Scholar]
- Lewis K., Jones D. A., Powell N. Ultrasound and neonatal hip screening: the five-year results of a prospective study in high-risk babies. J Pediatr Orthop. 1999 Nov-Dec;19(6):760–762. [PubMed] [Google Scholar]
- Müller W., Lercher K., DeVaney T. T., Giner F., Graf R. Untersuchungsfehler durch Schallkopfkippung bei der Hüftsonographie nach Graf. Ultraschall Med. 2001 Feb;22(1):48–54. doi: 10.1055/s-2001-11250. [DOI] [PubMed] [Google Scholar]
- Rosendahl K., Markestad T., Lie R. T. Ultrasound screening for developmental dysplasia of the hip in the neonate: the effect on treatment rate and prevalence of late cases. Pediatrics. 1994 Jul;94(1):47–52. [PubMed] [Google Scholar]
- Tönnis D., Brunken D. Eine Abgrenzung normaler und pathologischer Hüftpfannendachwinkel zur Diagnose der Hüftdysplasie. Auswertungen von 2294 Pfannendachwinkeln kindlicher Hüftgelenke. Arch Orthop Unfallchir. 1968;64(3):197–228. doi: 10.1007/BF02171260. [DOI] [PubMed] [Google Scholar]
- Wientroub S., Grill F. Ultrasonography in developmental dysplasia of the hip. J Bone Joint Surg Am. 2000 Jul;82-A(7):1004–1018. doi: 10.2106/00004623-200007000-00012. [DOI] [PubMed] [Google Scholar]
- von ROSEN Diagnosis and treatment of congenital dislocation of the hip hoint in the new-born. J Bone Joint Surg Br. 1962 May;44-B:284–291. doi: 10.1302/0301-620X.44B2.284. [DOI] [PubMed] [Google Scholar]