Developmental dysplasia of the hip. A population‐based comparison of ultrasound and clinical findings

Abstract

Clinical and ultrasound findings were compared in 3613 newborns examined for developmental dysplasia of the hip (DDH) within 48 hours of delivery. Clinical and sonographic hip stability was described as stable, borderline unstable, dislocatable or dislocated, and the morphology on ultrasound as normal, immature or dysplastic. Persistent clinical or sonographic dislocatability or dislocation, major dysplasia or minor dysplasia combined with an unstable femoral head were indications for early treatment. A total of 123 (3.4%) infants were subjected to early treatment, of which 55 (45%) fulfilled the criteria for treatment on both clinical and ultrasound examinations, 52 (42%) were treated on the basis of ultrasound findings alone, and 16 (13%) on the basis of clinical findings alone. Thirty per cent of the infants with clinically dislocated or dislocatable hips were judged to have stable or just borderline unstable hips on the first clinical examination. Of 486 (13.5%) infants with sonographically immature or minor dysplastic but stable hips, 472 (97%) normalized spontaneously, while treatment was initiated in 14 (3%) of them at 1-3 months of age because of lack of sonographic improvement. Only one infant presented with late DDH during an observation period of 3 years. Accepting sonographic dysplasia as a criterion for early splinting may result in a treatment rate which is almost twice the rate based on clinical criteria, but late dislocation may be virtually eliminated.

To Screen or Not to Screen? A Decision Analysis of the Utility of Screening for Developmental Dysplasia of the Hip

“…Physical examination is known to be somewhat unreliable, with some variability in its ability to detect developmental dysplasia of the hip 3,6,12,72 . This variability may be considered to be a weakness of the present study, resulting in false-positive or false-negative results.…”

Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force

“…Table 3 includes studies of population-based or primary care clinic-based cohorts screened by clinical examination as well as ultrasound screening that were published since the 1996 end point of the AAP review. 28,70,72,[80][81][82][83] Despite variation in the reference standards used in these studies, several important findings emerge. First, a high proportion of hips diagnosed with minor findings of dysplasia undergo spontaneous resolution.…”

How Are Outcomes Affected by Combining the Pemberton and Salter Osteotomies?

“…Developmental dysplasia of the hip is one of the most common orthopaedic problems seen during childhood with reported incidences of 1 per 1,000 to 3.4 per 100 [8,21]. Numerous surgical procedures for DDH have been described [5,6,23,30].…”