Screening for developmental dysplasia of the hip

CONTEXT: Developmental dysplasia of the hip (DDH) can lead to the later development of chronic pain, osteoarthritis, and limitations in activity. Screening for DDH has been practiced for over 40 years, but recommendations from major professional societies differ. OBJECTIVE: To synthesize the evidenc...

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Main Authors: Shipman, Scott, Helfand, Mark (Author), Nygren, Peggy (Author), Bougatsos, Christina (Author)
Corporate Author: United States Agency for Healthcare Research and Quality
Format: eBook
Language:English
Published: Rockville, MD Agency for Healthcare Research and Quality (US) [2006], 2006
Series:Evidence syntheses
Subjects:
Online Access:
Collection: National Center for Biotechnology Information - Collection details see MPG.ReNa
Summary:CONTEXT: Developmental dysplasia of the hip (DDH) can lead to the later development of chronic pain, osteoarthritis, and limitations in activity. Screening for DDH has been practiced for over 40 years, but recommendations from major professional societies differ. OBJECTIVE: To synthesize the evidence on risks and benefits of screening for DDH. DATA SOURCES: MEDLINE (through Sept, 2004), Cochrane CENTRAL, and previous comprehensive literature reviews. STUDY SELECTION: We focused our review on information gaps identified in previous reviews conducted for the American Academy of Pediatrics and the Canadian Task Force on Preventive Health Care. Specifically, we focused on comparative studies of clinical examination vs. ultrasound screening; studies of the effect of nonsurgical and surgical treatments for DDH on functional outcomes; and studies reporting rates of avascular necrosis with different interventions.
Avascular necrosis (AVN) of the hip, the most common and most severe harm of all treatments for DDH, can result in growth arrest of the hip and eventual joint destruction with significant disability. Reported rates of AVN very widely. CONCLUSION: Screening with clinical examination or ultrasound can identify newborns at risk for DDH, but due to the high rate of spontaneous resolution of neonatal hip instability and dysplasia and the lack of evidence of the effectiveness of interventions on functional outcomes, the net benefits of screening are not clear. KEY WORDS: DDH, Hip Dysplasia, mass screening
DATA EXTRACTION: Using present criteria, the authors assessed the quality of included trials and abstracted information about settings, patients, interventions, and outcomes. DATA SYNTHESIS: No published trials directly link screening to improved functional outcomes. Clinical examination and ultrasound identify somewhat different groups of newborns at risk for DDH; the lack of an untreated cohort or definitive gold standard made it impossible to estimate sensitivity and specificity for the different tests. Few studies examine the functional outcomes of patients who have undergone therapy for DDH. Due to the high rate and unpredictable nature of spontaneous resolution of DDH and the absence of comparative studies of intervention vs. no intervention, the effectiveness of interventions is not known.
Item Description:Title from home page. - "March 2006."
Physical Description:1 online resource illustrations