Effect of ultrasound screening on the rate of first operative procedures for developmental hip dysplasia in Germany

Lancet. 2003 Dec 6;362(9399):1883-7. doi: 10.1016/S0140-6736(03)14957-4.


Background: Ultrasound screening for developmental hip dysplasia and early conservative treatment might prevent later hip operations. A national hip ultrasound-screening programme, undertaken during the first 6 weeks of life, was introduced across Germany in 1996 and was continued for 5 years. We assessed the rate of first operation on the hip during this programme.

Methods: A national active surveillance programme of initial operations for developmental hip dysplasia was started in 1997 and continued for 5 years. Screening participation was assessed by a random digit dialing telephone survey. Cases were children aged between 10 weeks and 5 years at first operation, who had had no underlying disease leading to developmental hip dysplasia. Completeness of case ascertainment was validated with a capture-recapture study in a representative subsample. Calculated incidences were compared with previously established rates.

Findings: About 90% of all children were screened. 147 cases in the first year, and between 81 and 105 for subsequent years were reported. Treatment included closed reductions 353 (66%), open reductions 61 (11%), and osteotomies 121 (23%). Developmental hip dysplasia was diagnosed by ultrasound before 6 weeks of age in 272 (55%) of cases, 64 (13%) were screened at the recommended time but had normal findings, 70 (14%) had delayed screening, and 89 (18%) were not screened. Capture-recapture estimates suggested that 52% of cases were reported. The corrected incidence for first operation was 0.26 per 1000 livebirths (95% CI 0.22-0.32).

Interpretation: Ultrasound screening seems to prevent many, but not all, operations for developmental hip dysplasia. Rates of timely screening (ie, before 6 weeks of age) and training of doctors in ultrasound screening need to be improved.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Child, Preschool
  • Evaluation Studies as Topic
  • Germany / epidemiology
  • Hip Dislocation, Congenital / diagnostic imaging*
  • Hip Dislocation, Congenital / epidemiology
  • Hip Dislocation, Congenital / surgery*
  • Hip Joint / diagnostic imaging*
  • Hip Joint / surgery
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Mass Screening / statistics & numerical data*
  • Neonatal Screening
  • Orthopedic Procedures / statistics & numerical data
  • Population Surveillance
  • Ultrasonography