Developmental dysplasia of the hip: universal or selective ultrasound screening?

Developmental dysplasia of the hip (DDH) is an intriguing condition that evolves during infancy. It would be thus foolhardy to expect a screening tool at birth to be both highly sensitive and specific. Uncertainty regarding an optimal screening method is compounded by a general lack of sound epidemiological data. Clinical screening remains widely used. Some reports estimated that it did not pick up 60% of children who eventually needed surgery. Ultrasonography, it was hoped, would improve detection rates. There are 2 approaches to ultrasound; universal screening, which is adopted by some European countries, or selective screening of high risk infants. The problems with universal ultrasound screening are high false positive rates and high costs. The benefit was a possible 6- to 10-fold reduction in surgery for late DDH. Similar reductions though had also been reported if ultrasound was used selectively for infants with clinical and historical risk factors. A literature review on this topic is presented. There are pros and cons for both screening strategies. This is reflected in the different protocols that exist among various countries. For healthcare systems that are considering their options, universal ultrasound screening is generally not cost-effective and should not be the preferred screening strategy.