UK Hip Trial (DDH ultrasound)

Ultrasonography in the diagnosis and management of developmental hip dysplasia (UK Hip Trial): clinical and economic results of a multicentre randomised controlled trial.

Elbourne D, Dezateux C, Arthur R, et al. Lancet (London, England) 2002 · PMID 12504396 · doi:10.1016/s0140-6736(02)12024-1

Question

In infants with clinically detected hip instability, does ultrasound-guided management improve outcomes compared with clinical assessment alone?

Design

Multicentre randomised controlled trial across UK and Irish centres with clinical and economic evaluation.

Patients

Infants with clinically detected hip instability identified on newborn examination.

Intervention

Ultrasound-based assessment to guide decisions on abduction splinting

Comparison

Management based on clinical examination alone

Primary outcome

Radiographic hip appearance (subluxation, dislocation or acetabular dysplasia) by 2 years of age

Key result

Radiographic abnormality by age 2 was identical in the two arms, while the ultrasound arm needed significantly less abduction splinting; rates of surgical treatment did not differ significantly.

Limitations

Trial was underpowered to detect small differences in the rare outcome of surgical treatment; limited to infants with clinical instability rather than all newborns.

Impact on practice

Underpins the UK selective (targeted) ultrasound approach, in which infants with clinical instability or risk factors are scanned rather than universal ultrasound screening.