Illustration of an infant in a Pavlik harness, representing hip dysplasia treatment.

Hip Dysplasia Screening: Is Universal Ultrasound Necessary for Infants?

Elliot Brynn in Health & Wellness December 2025 • 4 min read.

"Navigating the controversy around infant hip screening: A balanced look at universal vs. selective ultrasound and what it means for your child's health."

Developmental dysplasia of the hip (DDH) refers to a spectrum of abnormalities in newborn infants where the hip joint, specifically the acetabulum (socket) and the femoral head (ball), doesn't align correctly. If left undetected and untreated, DDH can lead to a lifetime of complications, including limping, pain, and early-onset osteoarthritis, potentially requiring hip replacement surgery in young adulthood.

Because early detection can significantly improve outcomes, screening for DDH has become a routine part of newborn care in many countries. However, the optimal screening strategy remains a topic of debate. Should all infants undergo universal ultrasound screening, or is a more selective approach, targeting only those with risk factors, sufficient? This question has sparked considerable discussion among healthcare professionals, parents, and policymakers alike.

This article aims to explore the current evidence surrounding DDH screening, weighing the pros and cons of universal versus selective ultrasound. We'll delve into the research findings, expert opinions, and practical considerations to provide you with a balanced perspective on this important aspect of infant healthcare. Our goal is to empower parents with the knowledge they need to make informed decisions about their child's well-being.

Universal vs. Selective Ultrasound: Decoding the Debate

Illustration of an infant in a Pavlik harness, representing hip dysplasia treatment.

The core of the debate lies in weighing the benefits of early detection against the potential harms of overdiagnosis and overtreatment. Proponents of universal ultrasound screening argue that it can identify DDH cases that might be missed by clinical examination alone, leading to earlier intervention and better outcomes. They also point out that many infants with DDH don't have identifiable risk factors, making selective screening less effective.

On the other hand, critics of universal ultrasound screening raise concerns about the high rate of false-positive results. Ultrasound can detect mild hip instability that often resolves spontaneously without treatment. Universal screening could lead to unnecessary treatment, such as Pavlik harnesses or abduction braces, which can be uncomfortable for infants and create additional stress for parents. Furthermore, overtreatment carries its own risks, including avascular necrosis of the femoral head, a serious complication that can damage the hip joint.

Universal Ultrasound Screening: Screening all newborns, regardless of risk factors. Aims for early detection but may lead to overtreatment.
Selective Ultrasound Screening: Screening only infants with risk factors (breech birth, family history, etc.) or suspicious clinical findings. Reduces overtreatment but may miss some cases.
Clinical Examination: Physical examination of the hips by a trained healthcare professional. Simple and cost-effective but less sensitive than ultrasound.

Several studies have attempted to compare the effectiveness of universal and selective ultrasound screening. A systematic review published in the Cochrane Database of Systematic Reviews in 2011 found that no ultrasound strategy significantly improved clinical outcomes, including late diagnosis of DDH or the need for surgery. However, the authors noted that the studies were underpowered to detect significant differences due to the rarity of these events.

Making Informed Decisions About Your Baby's Hip Health

The decision of whether to pursue universal or selective ultrasound screening for your infant's hip health is a complex one, best made in consultation with your pediatrician or other healthcare provider. By understanding the potential benefits and risks of each approach, as well as the specific risk factors relevant to your child, you can work together to develop a screening plan that best suits their individual needs. Remember, close monitoring and follow-up are essential, regardless of the initial screening strategy.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4321/s1139-76322012000500011, Alternate LINK

Title: En Lactantes, ¿Es Más Útil La Ecografía Universal Que La Selectiva Para Detectar La Displasia Del Desarrollo De La Cadera?

Subject: Pediatrics, Perinatology and Child Health

Journal: Pediatría Atención Primaria

Publisher: SciELO Espana/Repisalud

Authors: B. Flores Antón, E. Ortega Páez

Published: 2012-12-01

Everything You Need To Know

What is Developmental Dysplasia of the Hip (DDH) and why is it important to screen for it in infants?

Developmental Dysplasia of the Hip (DDH) refers to a spectrum of abnormalities where the hip joint, specifically the acetabulum (socket) and the femoral head (ball), doesn't align correctly in newborn infants. This misalignment, if left untreated, can lead to significant complications throughout life. These complications can include limping, pain, and early-onset osteoarthritis, potentially necessitating hip replacement surgery in young adulthood. Early detection is critical because intervention can dramatically improve outcomes, making screening for DDH a crucial aspect of newborn care.

What are the key differences between Universal Ultrasound Screening and Selective Ultrasound Screening for DDH?

The primary difference lies in the scope of screening. Universal Ultrasound Screening involves screening all newborns, regardless of any risk factors. The aim of this is to identify as many cases of DDH as possible, leading to early intervention. However, it carries the risk of overdiagnosis and overtreatment, potentially leading to unnecessary interventions for conditions that might resolve on their own. Selective Ultrasound Screening, on the other hand, targets only infants with specific risk factors (such as breech birth or a family history of DDH) or those with suspicious clinical findings. This approach reduces the likelihood of overtreatment but might miss some cases of DDH.

What are the potential risks associated with Universal Ultrasound Screening for DDH?

One significant concern is the high rate of false-positive results. The ultrasound can sometimes detect mild hip instability that might resolve naturally without any intervention. Universal screening can lead to unnecessary treatments, such as the use of Pavlik harnesses or abduction braces. These treatments can be uncomfortable for infants and may cause undue stress for parents. Furthermore, overtreatment itself carries risks, including the serious complication of avascular necrosis of the femoral head, which can damage the hip joint.

Besides Ultrasound, what other methods are used to screen for DDH?

Besides Universal and Selective Ultrasound Screening, Clinical Examination is another method for the detection of DDH. This involves a physical examination of the hips performed by a trained healthcare professional. It is a simple and cost-effective method. However, it's less sensitive than ultrasound screening. It may miss some cases of DDH, particularly those that are less obvious or develop later. The choice of screening method often depends on a variety of factors, including the infant's risk factors, the healthcare provider's preferences, and the available resources.

How can parents make informed decisions about DDH screening for their infants?

The decision about whether to pursue universal or selective ultrasound screening is complex and should be made in consultation with a pediatrician or another healthcare provider. Understanding the potential benefits and risks of each approach is critical. Parents should be aware of their child's individual risk factors, such as breech birth or family history. Close monitoring and follow-up are essential, regardless of the chosen screening strategy. Parents should also discuss any concerns they have with their healthcare provider to develop a screening plan tailored to their child's specific needs and circumstances.