Selective Ultrasound Screening for DDH 1991-2006
Selective Ultrasound Screening for DDH 1991-2006
Early treatment is considered essential for developmental dysplasia of the hip (DDH), but the
 choice of screening strategy is debated. The investigators evaluated the effect of a
 selective ultrasound (US) screening programme.

 All infants born in a defined region during 1991-2006 with increased risk of DDH, i.e.
 clinical hip instability, breech presentation, congenital foot deformities or a family
 history of DDH, were subjected to US screening at age one to three days. Severe sonographic
 dysplasia and/or dislocatable/dislocated hips were treated with abduction splints. Mild
 dysplasia and/or 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.
Of 81564 newborns, 11539 (14,1%) were identified as at risk, of which 11190 (58% girls) were
 included for further analyses. Of the 81564 infants, 2433 (3•0%) received early treatment;
 1882 (2,3%) from birth and 551 (0,7%) after six weeks or more of clinical and sonographic
 surveillance. Another 2700 (3,3%) normalised spontaneously after watchful waiting from birth.
 Twenty-six infants (0,32 per 1000, 92% girls, two from the risk group) presented with late
 subluxated/dislocated hips (after one month of age). Another 126 (1,5 per 1000, 83% girls,
 one from the risk group) were treated after isolated late residual dysplasia. Thirty-one
 children (0,38 per 1000) had surgical treatment before age five years. Avascular necrosis was
 diagnosed in seven of all children treated (0.27%), four after early and three after late
 treatment.

 Interpretation The first 16 years of a standardised selective US screening programme for DDH
 resulted in acceptable rates of early treatment and US follow-ups, and low rates of late
 subluxated/dislocated hips compared to similar studies.
Inclusion Criteria:

 -  born at Haukeland University hospital January 1991-December 2006

 Exclusion Criteria:

 -  Children with DDH due to neuromuscular syndromes were excluded.