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Ultrasonography in screening for developmental dysplasia of the hip in newborns: systematic review

BMJ 2005; 330 doi: (Published 16 June 2005) Cite this as: BMJ 2005;330:1413
  1. Nerys F Woolacott, research fellow (Woolacottnw11{at},
  2. Milo A Puhan, research fellow2,
  3. Johann Steurer, director2,
  4. Jos Kleijnen, director1
  1. 1 Centre for Reviews and Dissemination, University of York, York YO10 5DD
  2. 2 Horten Centre, University of Zurich, Zurich, Switzerland
  1. Correspondence to: N F Woolacott
  • Accepted 6 April 2005


Objective To assess the accuracy and effectiveness of the screening of all newborn infants for developmental dysplasia of the hip (DDH) using ultrasound imaging, as is standard practice in some European countries but not in the United Kingdom, the United States, or Scandinavia.

Design Systematic review.

Data sources Twenty three medical, economic, and grey literature databases (to March 2004), with no limitations of design or language; some references were provided by experts.

Selection of studies Only diagnostic accuracy studies and comparative studies conducted in an unselected newborn population were eligible for the review. Two reviewers independently selected the studies and performed the quality assessment.

Results The review identified one diagnostic accuracy study, and this was of limited quality. In this study the reference standard was treatment up to age of 8 months or an abnormal ultrasound finding at age 8 months. Ultrasound screening had a sensitivity of 88.5% (95% confidence interval 84.1% to 92.1%), specificity of 96.7% (96.4% to 97.4%), a positive predictive value of 61.6% and a negative predictive value of 99.4%. Ten studies evaluated the impact of ultrasound in screening, but these too had various methodological weaknesses, limiting the reliability of their findings. Compared with clinical screening, general ultrasound screening in newborns may increase overall treatment rates, but ultrasound screening seems to be associated with shorter and less intrusive treatment.

Conclusions Clear evidence is lacking either for or against general ultrasound screening of newborn infants for DDH. Studies that investigate the natural course of the disorder, the optimal treatment for DDH, and the best strategy for ultrasound screening are needed.


  • Contributors All authors conceived and designed the study. Kate Misso of the Centre for Reviews and Dissemination designed and did the searches of electronic databases. NFW and MAP collected the data. All authors analysed and interpreted the data. NFW and MAP drafted the manuscript, and all authors revised it. JK and JS obtained the funding. JK is the guarantor.

  • Funding This study was funded by Bundesamt für Sozialversicherung (BSV, the Swiss Federal Office for Social Security). The initial proposal for the study was initiated by BSV, and BSV received the full study report on which this manuscript is based. BSV has seen a draft of this manuscript but has made no contribution to its content.

  • Competing interests None declared.

  • Ethical approval Not needed.

  • Accepted 6 April 2005
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