Detecting hip dislocations early in life caused by developmental dysplasia of the hip (DDH) is important. All newborn babies should be screened in the early months to identify this problem. Early detection and treatment are the key to a good result.
Doctors are taught how to test babies for this condition. But some physicians lack the skill needed to accurately conduct and assess the results of these tests. And the tests can be difficult to do on a screaming, squirming infant.
Some groups have suggested using ultrasound (US) as a screening test for all infants. This is called universal screening. Universal screening is already being done in many other countries.
Others suggest just using US when there are positive risk factors. This type of screening is called selective screening. Risk factors include positive family history of DDH, breech birth, and foot deformity present at birth.
In this report, orthopedic surgeons present the pros and cons of universal versus selective screening. Universal screening helps identify problems and guide treatment early. It costs more to test everyone but it saves money in the long run by avoiding the cost of surgery for many infants.
But routine screening isn’t always a good thing. Many children with unstable hips at birth outgrow the condition without treatment. Family distress is the downside of early detection for everyone. US can also be difficult to carry out and interpret, so results may not always be accurate.
The authors suggest the best time to do an US hip screening program for DDH may be during the first three to six weeks after birth. This gives the hips a chance to stabilize first before testing.
Follow-up with repeat US is advised in children who have additional risk factors. Serial (repeated) US may not be needed for children with normal, stable hips who don’t have any risk factors. More study is needed to evaluate the cost of universal vs. selective screening for DDH.