Screening Strategies for Hip Dysplasia: Long-term Outcome of a Randomized Controlled Trial.

Pediatrics. 2013 Aug 19. [Epub ahead of print]
Laborie LB, Engesæter IO, Lehmann TG, Eastwood DM, Engesæter LB, Rosendahl K.

OBJECTIVE:Screening for hip dysplasia is controversial. A previous randomized
controlled trial revealed that adding universal or selective ultrasound to
routine clinical examination gave a nonsignificant reduction in rates of late
presenting cases, but with higher treatment rates. This study assesses
differences in outcome at skeletal maturity for the 3 newborn screening
strategies in terms of radiographic markers of acetabular dysplasia and early
degenerative change and avascular necrosis (AVN) secondary to neonatal
METHODS:From the initial trial including 11 925 newborns, a population-based sample of 3935 adolescents was invited for follow-up at age 18 to 20 years. A standardized weight-bearing anteroposterior view was obtained. The outcomes evaluated were the radiographic findings of dysplasia (center-edge angle, femoral head extrusion-index, acetabular depth-width ratio, Sharp's angle, subjective evaluation of dysplasia) and degenerative change (joint-space width). 
Signs of AVN were documented.
RESULTS: Of the 3935 subjects invited, 2038 (51.8%) attended the maturity review, of which 2011 (58.2% female patients) were included: 551, 665, and 795 subjects from the universal, selective, and clinical  groups, respectively. Rates per group of positive radiographic findings associated with dysplasia or degenerative change varied depending on radiographic marker used. No statistically significant differences were detected between
groups. No AVN was seen.
CONCLUSIONS:Although both selective and universal ultrasound screenings gave a nonsignificant reduction in rates of late cases when compared with expert clinical programs, we were unable to demonstrate any additional reduction in the rates of radiographic findings associated with acetabular dysplasia or degenerative change at maturity. Increased treatmet
rates were not associated with AVN.