Preventing Missed Developmental Dysplasia of the Hip: Universal vs. Selective Ultrasound Screening.

BACKGROUND: Developmental dysplasia of the hip (DDH) encompasses a spectrum of hip abnormalities in infants. Early identification enables nonoperative management and improved outcomes. Selective screening uses clinical examination to determine referral for ultrasound (US), whereas universal screening performs routine US in all newborns after birth. Despite widespread use of both strategies, there is no consensus on the optimal approach. METHODS: A systematic review was conducted to evaluate the outcomes of selective vs. universal screening. MEDLINE, Embase, and the Cochrane Library were searched for studies published from 2005 to 2025. The primary outcomes were late diagnosis and surgical intervention rates. Secondary outcomes included screening rates, overall DDH incidence, and nonoperative treatment rates. RESULTS: A total of 819,277 infants were identified. Universal screening had higher US utilization (98.5% vs. 8.7%; p < 0.001). Overall DDH incidence was higher with universal screening (11.86 vs. 4.36 per 1,000; p = 0.025). Both groups had similar rates of late diagnosis (0.25 vs. 0.59 per 1,000; p = 0.243). Nonoperative treatment rates were higher for universal screening (10.07 vs. 3.54 per 1,000; p = 0.039), while surgical treatment rates were similar (0.50 vs. 0.32 per 1,000; p = 0.291). CONCLUSION: Universal US screening had increased detection and rates of nonoperative treatment but did not reduce late diagnosis or surgical intervention. This highlights a tradeoff between increased detection and treatment burden without clear evidence of improved outcomes. LEVEL OF EVIDENCE: Level III evidence (systematic review and meta-analysis of cohort studies). See Instructions for Authors for a complete description of levels of evidence.