Selective Ultrasound Screening for DDH 1991-2006

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Selective Ultrasound Screening for Developmental Hip Dysplasia: Effect on Management and Late Detected Cases. A Prospective Survey During 1991-2006.

Conditions
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Developmental Dysplasia of the Hip

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: born at Haukeland University hospital January 1991-December 2006 Exclusion Criteria: Children with DDH due to neuromuscular syndromes were excluded.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| all newborns born 1991-2006<br>all newborns born 1991-2006 | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| late dislocated or subluxated hips | late detected after 1 month of life, requiring treatment | first 5 years of life | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants who receive ultrasound follow-up for 6 weeks or more | Number of participants who receive ultrasound follow-up (i.e sonographic surveillance) for 6 weeks or more | first months of life | 
| early treatment | abduction treatment for DDH | first months of life | 
| first surgical treatment | the need for a first surgical treatment the first 5 years of life (closed and open reductions, osteotomies) | first five years of life | 
| avascular necrosis of femoral head | avascular necrosis of femoral head as complication to treatment | first five years of life | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Developmental dysplasia of the hip,, DDH,, avascular necrosis,, late detected cases