Anterior-dynamic ultrasound in the early detection of hip dislocation in newborns

Findings by SBU Alert

Version: 1

Technology and target group

Annually in Sweden around 90 children are born with a hip joint defect in which the femoral head has become either completely or partially displaced from its normal position (hip dislocation), or is at risk for dislocation. Early detection and treatment of this defect is expected to yield better treatment results and require fewer resources than treatment initiated only after symptoms appear. Since the early 1950s, a clinical examination method has been used (Ortolanis or Palmén/Barlows test) to examine the hips of all newborns. Since this test leads to a high rate of false positive findings and does not identify defects in all children who would benefit from treatment, a special type of ultrasonic examination (anterior-dynamic) has been tested on a small scale as an alternative primary screening method. All newborns in Sweden constitute the potential target group, which would mean approximately 90 000 examinations per year.

Patient benefit

An ongoing Swedish study of screening for hip joint dislocation compares Ortolanis test against anterior-dynamic ultrasound examination. Preliminary results in 4430 children show the percentage of positive findings to be 17.8 per thousand with Ortolanis test and 1.8 per thousand with anterior-dynamic ultrasound examination. A positive finding means that the child becomes subject to treatment. The results should be viewed in relation to the incidence of hip dislocation, which averages approximately 1.0 per thousand in Sweden, indicating a high percentage of false positive findings. Despite a substantially lower rate of false positive findings with the anterior-dynamic ultrasound method, there is nothing that indicates that the percentage of false negative findings would be higher than when Ortolanis test is used. The results are uncertain since they are based on a small population for this type of study. Ultrasonic examination has no known risks for complications or side effects in the child.

Economic aspects

There are no scientific studies on the cost effectiveness of the method.

Scientific evidence

There is poor* scientific documentation on the short-term effects of screening with anterior-dynamic ultrasound for early detection of hip joint dislocation. There is currently no* scientific documentation on the long-term effects nor on the cost effectiveness of the method.

*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.

This summary is based on a report prepared at SBU in collaboration with John E Andersson, MD, Blekinge Hospital, Karlskrona. It has been reviewed by Assoc. Prof. Bertil Romanus, Sahlgrenska University Hospital, Göteborg and Lars Öhberg, MD, Norrland University Hospital, Umeå.

The complete report is available in Swedish only.

Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.

References

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