Female-Inclusive Selective Versus Universal Neonatal Hip Ultrasonography Screening for Developmental Dysplasia of the Hip

Objectives: The objective of this study was to compare outcomes of universal versus female-inclusive selective ultrasonography screening for developmental dysplasia of the hip (DDH) in a neonatal population. Methods: This prospective cohort study evaluated two consecutive screening strategies at a single institution: a universal ultrasonography program (2019–2020; n = 354) and a selective program (2024–2025; n = 290). The selective protocol included all female neonates, breech presentation, positive family history, or abnormal clinical findings. All examinations were performed by the same operator using the Graf method. The primary outcome was detection of dysplastic hips; secondary outcomes included immature hip distribution, subgroup differences, and screening efficiency. Results: DDH detection rates were identical between cohorts (1.7%). In the universal cohort, six infants had dysplastic hips; in the selective cohort, five infants were affected, all females. Among these, 40% had no major risk factors. The proportions of mature and immature hips were comparable between cohorts. Screening efficiency was similar (number needed to screen: 59 vs. 58), despite a substantially reduced number of scans in the selective program. Conclusions: A selective screening program that includes all female neonates achieved DDH detection rates comparable to universal screening while significantly reducing imaging volume. As all dysplastic cases occurred in girls, this female-inclusive approach captured the highest-risk demographic without relying solely on traditional risk factors. Incorporating sex-based eligibility into selective screening may provide a safe and efficient framework for DDH screening programs in diverse clinical settings.