Neonatal screening and selective sonographic imaging in the diagnosis of developmental dysplasia of the hip

Abstract

Aims The aim of this prospective cohort study was to evaluate the effectiveness of the neonatal hip instability screening programme. Patients and Methods The study involved a four-year observational assessment of a neonatal hip screening programme. All newborns were examined using the Barlow or Ortolani manoeuvre within 72 hours of birth; those with positive findings were referred to a ‘one-stop’ screening clinic for clinical and sonographic assessment of the hip. The results were compared with previous published studies from this unit. Results A total of 124 newborns with a positive Barlow or Ortolani manoeuvre, clunk positive, or ‘unstable’ were referred. Five were found to have clinical instability of the hip. Sonographically, 92 newborns had Graf Type I hips, 12 had Graf Type II hips, and 20 had Graf Type IV hips. The positive predictive value (PPV) of clinical screening was 4.0% and the PPV of sonography was 16.1%. This has led to an increased rate of surgery for DDH. Conclusion Compared with previously published ten-year and 15-year studies, there has been a marked deterioration in the PPV in those referred with potential instability of the hip. There appears to be a paradox, with rising referrals and a decreasing PPV combined with an increasing rate of surgery in newborns with developmental dysplasia of the hip. Cite this article: Bone Joint J 2018;100-B:806–10.

Positive predictive values in clinical screening for developmental dysplasia of the hip

“…We defined a positive clinical examination in the broadest pos- We recognise that including potential immature hips lowers the threshold for a true positive clinical examination in definition #1, which could explain why the PPV was higher than previous studies have found. 4 However, this highlights how differing definitions of pathological DDH results in varying rates of DDH diagnosis.…”

Examining the effectiveness of examination at 6–8 weeks for developmental dysplasia: testing the safety net

“…The merits and disadvantages of universal and selective US examination are well documented in the literature,17–21 and there remains no clear consensus on the best model. What is agreed on however is the necessity of examination experience12–14 22 when electing for a programme of selective screening; centres which have reported low rates of late presentation all have a system of experienced examiners performing the initial neonatal examination.…”

Interobserver reliability in the ultrasonic evaluation with graf method of developmental dysplasia of the hip: the importance of education for ultrasonography classification

“…Reliability in the ultrasonography evaluation with Graf method of developmental dysplasia of the hip İ M L E R İ V E T I P D E R G İ S İ head coverage (FHC) at different positions corresponds to different reference values, and they stated Neutral and Flexion Positions (FHC-D) can be used as a quantitative indicator for assessment of hip stability (8). Choudry et al(9) founded the positive predictive value (PPV) of clinical screening was found as 4.0% and the PPV of sonography was found as 16.1%. They evaluated previously published 10 or 15-year studies, and they found a deterioration in the PPV in those with potential instability of the hip.…”