Diagnosis and early treatment of hip dysplasia in infancy is important to prevent long-term joint damage. Infant screening based on clinical signs has been standard practice for half a century in some countries; although doubts exist as to the effectiveness of this approach to prevent later developmental problems.
Universal ultrasound imaging has been proposed as an alternative to clinical screening, and was initiated in Germany in 1996. Rudiger von Kries from Ludwig-Maximilians University, Munich, Germany, and colleagues report the effect of five year's of ultrasound screening on the rate of subsequent hip operations.
About 90% of all children were screened. The number of children who required subsequent hip surgery was greater (147) in the first year after screening was introduced, falling to around 80-100 children in the following years.
Developmental hip dysplasia was diagnosed by ultrasound before 6 weeks of age in 272 (55%) of children who required subsequent hip surgery; however screening at the wrong time (after 6 weeks of age) and no screening were significant factors, as only 13% of infants who required hip surgery had normal ultrasound scans during screening. The investigators calculated the incidence of first operative procedures for the rate of hip dysplasia as occurring in around 1 in 4000 births.
Rudiger von Kries comments: "Ultrasound screening seems to prevent many, but not all, operations for developmental hip dysplasia. Rates of timely screening (i.e., before 6 weeks of age) and training of doctors in ultrasound screening need to be improved."
Issue 6 December 2003
Lancet 2003; 362: 1883-87
Contact: Professor Rudiger von Kries, Department für Paediatric Epidemiology, Institute for Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians-Universität, München Heiglhofstr 63, 81377 München, Germany; T) 49-89-7100-9314; F) 49-89-7100-9315; E) ag.epi@LRZ.uni-muenchen.de
Journal
The Lancet