Early detection of developmental dysplasia of hip by ultrasound

Abstract

Objective: To assess the effectiveness of early universal ultrasound (US) screening of developmental dysplasia of the hip (DDH). Study design: A prospective study of universal hip screening of all mature neonates was conducted from 2012 to 2013, at the Department of Obstetrics and Gynaecology, University of Szeged; 1636 newborns (3272 hips) had clinical examinations and hip ultrasound by the Graf method within the1st 3 days of life. Prevalence of DDH, risk factors, sensitivity and specificity of clinical examinations were evaluated. Results: At the 1st US, 70 of the examined 3272 hips (2.14%) were found to be positive. According to Graf categories, the following distribution was observed: type II C, 21 hips (30.0%); D, 24 hips (34.28%); III, 24 hips (34.28%); IV, 1 hip (1.44%). Regarding the risk factors, female gender, breech presentation and positive family history proved to be significant. Interestingly, 28 (50.90%) of the 55 newborns with DDH had neither positive physical signs nor any risk factors, except being female. The physical examination was calculated for sensitivity (20.0%) and specificity (98.34%). Conclusions: In our 1-year period study, 50.9% of the newborns with DDH had neither any positive physical signs nor any risk factors, except being a female. In contrast, early universal US screening of the hip facilitated to diagnose all cases with hip dysplasia. Hip sonography is an effective mode of prevention in orthopaedics, however further studies are needed to compare the rates of operative procedures in selective versus universal screening models.

Developmental Dysplasia of the Hip: A Review of Etiopathogenesis, Risk Factors, and Genetic Aspects

“…Female gender In literature female gender shows seven to nine times more frequent DDH diagnosis at birth, than male newborns [19,23].…”

Incidence of Neonatal Developmental Dysplasia of the Hip and Late Detection Rates Based on Screening Strategy

“…A total of 43 studies 5,8,18,[20][21][22][23]28,29,31,[35][36][37][38][39][42][43][44][45][46][47][48][49][50][51][52][53]55,56,[59][60][61]64,65,67,68,72,74,[76][77][78][79][80] treatments per 1000 newborns and the lowest was 0.1 (95% CI, 0.0-0.3) treatments per 1000 newborns (Figure 3). The total pooled incidence estimates were 9.8 (95% CI, 6.7-14.4) treatments per 1000 newborns with universal ultrasonographic screening, 3.1 (95% CI, 2.0-4.8) treatments per 1000 newborns with selective ultrasonographic screening, and 5.4 (95% CI, 2.1-14.0) treatments per 1000 newborns with clinical screening.…”

“…[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] with 7 884 989 newborns used selective screening, and 29 studies1,8,[18][19][20][21][22][23] with 233 609 newborns used universal ultrasonographic screening. The highest reported incidence was 120.3 (95% CI, 110.9-130.5) infants with DDH per 1000 newborns, and the lowest was 0.2 (95% 0.1-0.4) infants with DDH per 1000 newborns (Figure1).…”

Analysis of Risk Factors for Ultrasonographic Graf Type IIA (−) Hips in Developmental Dysplasia: A Hospital-Based Case-Control Study With Follow-Up Outcomes

“…Some study authors have the opinion that routine screening is unnecessary and that it is overdiagnosis and overtreatment. They further point to the majority of infant cases normalizing without treatment (13)(14)(15). On the other hand, other study authors support US screening to identify development of true hip dysplasia early that requires treatment.…”