Sonographic evolution in screening for developmental dysplasia of the hip in newborns

Abstract

The term developmental dysplasia of the hip (DDH) refers to an abnormal relation between the femoral head and the acetabulum. At birth the femoral head and the acetabulum are mainly cartilaginous, and a normal adult hip joint depends on their correct development. During the newborn period unstable hips are common, but most of these develop normally.1 If subluxation or dislocation persists, anatomic changes develop, and eventually the correct positioning of the femoral head within the acetabulum (reduction) can be achieved only with surgery. Early detection of DDH can enable less invasive and potentially more effective corrective procedures.

Some believe that DDH detected on ultrasonography should be treated very early or should be followed up intensively. The assumption of proponents of ultrasound screening is that untreated cases will have an adverse outcome,7 whereas others believe that the risk of overtreatment is considerable and that the cost-benefit equation for ultrasound screening is not favourable enough.10,12 Consequently, the screening of all newborn infants at birth for DDH using ultrasound imaging is standard practice in some European countries, such as Germany and Switzerland, but has not been accepted in the United Kingdom, the United States, or Scandinavia.13,14 Therefore, we conducted a systematic review to determine the diagnostic accuracy of ultrasonography for detecting DDH in a unselected population of newborns and to assess the impact of ultrasound screening of newborn infants.