Late presenting developmental dysplasia of the hip after a normal hip ultrasound at 6 weeks of age: A report of two cases

BackgroundDevelopmental dysplasia of the hip (DDH) is a known orthopedic pathology of newborns that, if not diagnosed and treated, can lead to debilitating long-term consequences. Ultrasound has proven to be an effective method for the early diagnosis of this condition. Recently, reports of late DDH in populations at risk (breech presentation) and after negative ultrasound examination have emerged in the literature.AimThe objective of the study was to assess the possible appearance of late DDH in Italian children with risk factors but negative ultrasound screening.Materials and methodsWe selected patients with risk factors for DDH and a negative hip ultrasound from the medical records of children referred to the Hip Ultrasound Clinic (Rome, Italy) from January 2018 to November 2021. To identify possible cases of late DDH, from February 2022 to July 2022, all patients who met the inclusion criteria were submitted to orthopedic follow-up clinical evaluation. In the case of a pathological objective examination, radiography was performed.ResultsFifty-five patients (52.7% female, 52.7% with breech presentation, and 41.8% with a positive family history) met the inclusion criteria. The median age of gait onset was 13 months. The median age of orthopedic follow-up examination was 45 months. Only three patients (5.5%) had a pathological examination, but no x-ray were pathological.ConclusionOur study has not documented cases of late DDH. Considering the small study population and the only clinical follow-up, further studies are needed to clarify the possible late development of this condition.

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“…Pan et al . ( 22 ) also reported two cases of late presenting DDH in breech infant girls after normal hip ultrasound performed at 6 weeks of age.…”

Section: Discussionmentioning

confidence: 94%

“…Recently, literature has highlighted the possibility of a “late DDH” diagnosis after a negative initial ultrasound screening in children with breech presentation ( 16 – 22 ). If this condition were to be confirmed, there would be a group of children for whom current screening programs might not be sufficient.…”

Section: Introductionmentioning

confidence: 99%

Assessment for late developmental hip dysplasia in a cohort of infants with risk factors and normal hip ultrasound

et al. 2023

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“…Thus, universal screening results into overtreatment of hips which would mature normally without any treatment. On the other hand, it has also been shown that some hips seem normal in the initial US examination but later require operative treatment despite the universal ultrasound screening [ 18 ]. These findings challenge the traditional linear pathophysiological model of hip joint development.…”

Section: Natural Progression Of Ddhmentioning

confidence: 99%

“…Before implementation of universal US to wider use, a more rigorous investigation of its benefits is required, as currently, the evidence does not promote the use of it. This can be explained by the extrinsic factor affecting the development of the hip joint after birth and thus initial screening during the early weeks cannot find these cases [ 17 , 18 ]. Also, the late detection and operative treatment rates with universal screening were similar to those among selectively and clinically screened newborns [ 2 ].…”

Section: Costs Effectiveness and Health Care Resourcesmentioning

confidence: 99%

Why all newborn hip screening programs have same results—a mini review

BM,

Pakarinen,

Helenius

et al. 2024

Eur J Pediatr

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All newborns are screened for developmental dysplasia of the hip (DDH), but countries have varying screening practices. The aim of this narrative mini review is to discuss the controversies of the screening and why it seems that all screening programs are likely to have same outcome. Different screening strategies are discussed alongside with other factors influencing DDH in this review. Universal ultrasound (US) has been praised as it finds more immature hips than clinical examination, but it has not been proven to reduce the rates of late-detected DDH or surgical management. Universal US screening increases initial treatment rates, while selective US and clinical screening have similar outcomes regarding late detection rates than universal US. This can be explained by the extrinsic factor affecting the development of the hip joint after birth and thus initial screening during the early weeks cannot find these cases. Conclusion: It seems that DDH screening strategies have strengths and limitations without notable differences in the most severe outcomes (late-detected cases requiring operative treatment). Thus, it is important to acknowledge that the used screening policy is a combination of values and available resources rather than a decision based on clear evidence.

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Is it a missed initial diagnosis or late presenting developmental dysplasia of the hip

Ömeroğlu

2022

J Paediatrics Child Health

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Late presenting developmental dysplasia of the hip after a normal hip ultrasound at 6 weeks of age: A report of two cases

Cited by 3 publications

References 17 publications

Assessment for late developmental hip dysplasia in a cohort of infants with risk factors and normal hip ultrasound

Assessment for late developmental hip dysplasia in a cohort of infants with risk factors and normal hip ultrasound

Why all newborn hip screening programs have same results—a mini review

Is it a missed initial diagnosis or late presenting developmental dysplasia of the hip

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