Published online March 1, 2006
PEDIATRICS Vol. 117 No. 3 March 2006, pp. e557-e576 (doi:10.1542/peds.2005-1597)
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REVIEW ARTICLE

Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force

Scott A. Shipman, MD, MPHa, Mark Helfand, MD, MPHb, Virginia A. Moyer, MD, MPHc and Barbara P. Yawn, MD, MScd

a Department of Pediatrics
b Oregon Evidence-Based Practice Center, Oregon Health and Science University, Portland, Oregon
c Department of Pediatrics, University of Texas Health Science Center, Houston, Texas
d Department of Primary Care Research, Olmsted Medical Center, Rochester, Minnesota

BACKGROUND. Developmental dysplasia of the hip (DDH) represents a spectrum of anatomic abnormalities that can result in permanent disability.

OBJECTIVE. We sought to gather and synthesize the published evidence regarding screening for DDH by primary care providers.

METHODS. We performed a systematic review of the literature by using a best-evidence approach as used by the US Preventive Services Task Force. The review focused on screening relevant to primary care in infants from birth to 6 months of age and on interventions used in infants before 1 year of age.

RESULTS. The literature on screening and interventions for DDH suffers from significant methodologic shortcomings. No published trials directly link screening to improved functional outcomes. Clinical examination and ultrasound identify somewhat different groups of newborns who are at risk for DDH. A significant proportion of hip abnormalities identified through clinical examination or ultrasound in the newborn period will spontaneously resolve. Very few studies examine the functional outcomes of patients who have undergone therapy for DDH. Because of the high rate and unpredictable nature of spontaneous resolution of DDH and the absence of rigorous comparative studies, the effectiveness of interventions is not known. All surgical and nonsurgical interventions have been associated with avascular necrosis of the femoral head, the most common and most severe harm associated with all treatments of DDH.

CONCLUSIONS. Screening with clinical examination or ultrasound can identify newborns at increased risk for DDH, but because of the high rate of spontaneous resolution of neonatal hip instability and dysplasia and the lack of evidence of the effectiveness of intervention on functional outcomes, the net benefits of screening are not clear.

Key Words: developmental dysplasia of the hip • DDH • hip dysplasia • mass screening • infants • systematic review

Abbreviations: DDH—developmental dysplasia of the hip • AVN—avascular necrosis • CTFPHC—Canadian Task Force on Preventive Health Care • AAP—American Academy of Pediatrics • RCT—randomized • controlled trial

Accepted Oct 19, 2005.


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