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Dr. Patel is with the Intensive Ambulatory Care Service, Montreal Children's Hospital and the McGill University Health Centre, Montreal, Que.Members of the Canadian Task Force on Preventive Health Care Chairman: Dr. John W. Feightner, Professor, Department of Family Medicine, University of Western Ontario, London, Ont. Past Chairman: Dr. Richard Goldbloom, Professor, Department of Pediatrics, Dalhousie University, Halifax, NS. Members: Drs. R. Wayne Elford, Professor and Chair of Research, Department of Family Medicine, University of Calgary, Calgary, Alta.; Michel Labrecque, Professor, Unité de médecine familiale, Université Laval, Rimouski, Que.; Robin McLeod, Professor, Department of Surgery, Mount Sinai Hospital and University of Toronto, Toronto, Ont.; Harriet MacMillan, Associate Professor, Departments of Psychiatry and Behavioural Neurosciences and of Pediatrics, Canadian Centre for Studies of Children at Risk, McMaster University, Hamilton, Ont.; Jean-Marie Moutquin, Professor and Director, Département d'obstétrique-gynécologie, Université de Sherbrooke, Sherbrooke, Que.; Christopher Patterson, Professor and Head, Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ont.; and Elaine E.L. Wang, Associate Professor, Departments of Pediatrics and Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, Ont. Resource people: Ms. Nadine Wathen, Coordinator, and Mr. Tim Pauley, Research Assistant, Canadian Task Force on Preventive Health Care, Department of Family Medicine, University of Western Ontario, London, Ont.
Objective: To review the effectiveness of, and make practice recommendations for, serial clinical examination and ultrasound screening for developmental dysplasia of the hip (DDH) in newborns. The effectiveness of selective screening of high-risk infants with hip and pelvic radiographs and treatment with abduction therapy are also examined.
Options: Screening: serial clinical examination, ultrasound screening, radiographic evaluation. Treatment: abduction therapy.
Outcomes: Rates of operative intervention, abduction splinting, delayed diagnosis of DDH (beyond 3–6 months), treatment complications and false diagnostic labelling. Long-term functional outcomes were considered important.
Evidence: MEDLINE was searched for relevant English-language articles published from 1966 to November 2000 using the key words "screening," "hip," "dislocation," "dysplasia," "congenital" and "ultrasound." Comparative and descriptive studies and key reviews were retrieved, and their bibliographies were manually searched for further studies.
Benefits, harms and costs: Because most infants will have spontaneous resolution of nonteratologic DDH, early identification and intervention results in unnecessary labelling of newborns as having the problem and unnecessary treatment. Ultrasound screening is a highly sensitive but poorly specific measure of clinically relevant DDH. Abduction splinting is associated with a variety of problems, and its effectiveness in treating DDH is not clearly known. At least 20% of infants requiring operative intervention have had splint therapy. The harms of labelling, repetitive investigations, unnecessary splinting and resource consumption associated with screening are substantial.
Values: The strength of evidence was evaluated using the evidence-based methods of the Canadian Task Force on Preventive Health Care.
Recommendations: · There is fair evidence to include serial clinical examination of the hips by a trained clinician in the periodic health examination of all infants until they are walking independently (level II-1 and III evidence; grade B recommendation). · There is fair evidence to exclude general ultrasound screening for DDH from the periodic health examination of infants (level II-1 and III evidence; grade D recommendation). · There is fair evidence to exclude selective screening for DDH from the periodic health examination of high-risk infants (level II-1 and III evidence; grade D recommendation). · There is fair evidence to exclude routine radiographic screening for DDH from the periodic health examination of high-risk infants (level III evidence; grade D recommendation). · There is insufficient evidence to evaluate the effectiveness of abduction therapy (level III evidence; grade C recommendation), but good evidence to support a period of close observation for newborns with clinically detected DDH (level I evidence; grade A recommendation). However, there is insufficient evidence to determine the optimal duration of observation (level III evidence; grade C recommendation).
Validation: The members of the Canadian Task Force on Preventive Health Care reviewed the findings of this analysis through an iterative process. The task force sent the final review and recommendations to selected external expert reviewers, and their feedback was incorporated in the final draft of the manuscript.
Sponsors: The Canadian Task Force on Preventive Health Care is funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada.
This article has been cited by other articles:
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  S. T. Mahan, J. N. Katz, and Y.-J. Kim To Screen or Not to Screen? A Decision Analysis of the Utility of Screening for Developmental Dysplasia of the Hip J. Bone Joint Surg. Am., July 1, 2009; 91(7): 1705 - 1719. [Abstract] [Full Text] [PDF]
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 R. W. Paton and Q. Choudry Neonatal foot deformities and their relationship to developmental dysplasia of the hip: AN 11-YEAR PROSPECTIVE, LONGITUDINAL OBSERVATIONAL STUDY J Bone Joint Surg Br, May 1, 2009; 91-B(5): 655 - 658. [Abstract] [Full Text] [PDF]
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 S. A. Shipman Risk Management and Developmental Dysplasia of the Hip: Primum Non Nocere Pediatrics, March 1, 2009; 123(3): e546 - e546. [Full Text] [PDF]
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US Preventive Services Task Force Screening for Developmental Dysplasia of the Hip: Recommendation Statement Pediatrics, March 1, 2006; 117(3): 898 - 902. [Full Text] [PDF]
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S. A. Shipman, M. Helfand, V. A. Moyer, and B. P. Yawn Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force Pediatrics, March 1, 2006; 117(3): e557 - e576. [Abstract] [Full Text] [PDF]
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R. W. Paton, K. Hinduja, and C. D. Thomas The significance of at-risk factors in ultrasound surveillance of developmental dysplasia of the hip: A TEN-YEAR PROSPECTIVE STUDY J Bone Joint Surg Br, September 1, 2005; 87-B(9): 1264 - 1266. [Abstract] [Full Text] [PDF]
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 N. F Woolacott, M. A Puhan, J. Steurer, and J. Kleijnen Ultrasonography in screening for developmental dysplasia of the hip in newborns: systematic review BMJ, June 18, 2005; 330(7505): 1413. [Abstract] [Full Text] [PDF]
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 F Gardner, C Dezateux, D Elbourne, A Gray, A King, A Quinn, and on behalf of the Collaborative Hip Trial Group The hip trial: psychosocial consequences for mothers of using ultrasound to manage infants with developmental hip dysplasia Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2005; 90(1): F17 - F24. [Abstract] [Full Text] [PDF]
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 C Dezateux, J Brown, R Arthur, J Karnon, and A Parnaby Performance, treatment pathways, and effects of alternative policy options for screening for developmental dysplasia of the hip in the United Kingdom Arch. Dis. Child., September 1, 2003; 88(9): 753 - 759. [Abstract] [Full Text] [PDF]
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J Brown, C Dezateux, J Karnon, A Parnaby, and R Arthur Efficiency of alternative policy options for screening for developmental dysplasia of the hip in the United Kingdom Arch. Dis. Child., September 1, 2003; 88(9): 760 - 766. [Abstract] [Full Text] [PDF]
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D A C Elliman, C Dezateux, and H E Bedford Newborn and childhood screening programmes: criteria, evidence, and current policy Arch. Dis. Child., July 1, 2002; 87(1): 6 - 9. [Full Text] [PDF]
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