The University of Tokyo trial demonstrates that training public health nurses to perform Graf-method ultrasound during routine home visits can achieve near-universal coverage while detecting DDH in 8.7% of infants, many without clinical signs. This observational pilot in three municipalities (2024-2025) used loaned Fujifilm iViz devices but was not randomized and relied on a modest sample, limiting causal claims about reduced late diagnoses. Prior selective screening programs in Japan and North America have consistently missed up to 30% of cases that later cause early osteoarthritis; universal ultrasound programs in Austria and Switzerland reduced late presentations by over 80% in national registries, yet require hospital infrastructure unavailable in rural settings. The Tokyo study uniquely addresses workforce constraints by shifting initial imaging to community nurses, an approach that aligns with findings from a 2023 multicenter cohort in The Lancet Child & Adolescent Health showing nurse-led point-of-care ultrasound maintained diagnostic accuracy above 90% after brief training. Missed elements in the original coverage include long-term cost modeling: preventing even one case of adult hip replacement yields lifetime savings exceeding $50,000 per patient, amplifying the scalability argument beyond immediate detection rates. Disparities in pediatric orthopedic access, already documented in Japanese national surveys, are directly mitigated here, offering a template for other aging, low-fertility nations facing similar specialist shortages.