Should all twins and multiple births undergo ultrasound examination for developmental dysplasia of the hip?

Barr, Lynne; Rehm, Andreas

doi:10.1302/0301-620x.95b1.29927

Cited by 24 publications

(22 citation statements)

References 19 publications

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“…Findings about multiple pregnancy as a risk factor for DDH are also controversial. Some authors did not recommend routine ultrasound screening for twins and triplets [24–26]. In our study, multiple pregnancy (twins or triplets) was found to be a risk factor for DDH.…”

Section: Discussionmentioning

confidence: 41%

Risk Factor Assessment and a Ten-Year Experience of DDH Screening in a Well-Child Population

Kural

Karapinar

Yılmazbaş

et al. 2019

BioMed Research International

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Aim. Risk based screening for developmental dysplasia of the hip (DDH) with ultrasound is common. However, risk factors vary from one country to the other since data are insufficient to give clear recommendations. We aimed to evaluate the risk factors for developmental dysplasia of the hip (DDH). Methods. In this retrospective case-control study, the health records of all children, who were followed up between 2004 and 2014 at a well-child unit, were investigated for the diagnosis of DDH in Turkey. Of 9758 children, 57 children were found to have abnormal ultrasonographic findings (according to Graf classification) and these constituted the case group. As the control group, healthy 228 children who matched the case children in birth months were selected. Two groups were compared for the risk factors. Results. A total of 19516 hips of 9758 children were examined for DDH. 97 hips of 57 children were found to have abnormal ultrasonographic findings. When the two groups were compared, breech presentation, multiple pregnancy, and torticollis were identified as risk factors. The female sex was also found to have a significantly high prevalence among the children in the case group. Limited hip abduction, positive Ortolani, and Barlow signs were important clinical findings in the case group. Conclusion. According to our findings, breech presentation, female sex, torticollis, and multiple pregnancy were found to be the risk factors of this disorder. Infants with these risk factors should be investigated carefully for DDH.

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Section: Discussionmentioning

confidence: 41%

Risk Factor Assessment and a Ten-Year Experience of DDH Screening in a Well-Child Population

Kural

Karapinar

Yılmazbaş

et al. 2019

BioMed Research International

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“…Other suggested findings, such as being the first born or having torticollis, foot abnormalities, or oligohydramnios, have not been proven to increase the risk of "nonsyndromic" DDH. 3,7 Breech presentation may be the most important single risk factor, with DDH reported in 2% to 27% of boys and girls presenting in the breech position. 6 Genetics may contribute more to the risk of DDH than previously considered "packaging effects."…”

Section: Risk Factorsmentioning

confidence: 99%

Evaluation and Referral for Developmental Dysplasia of the Hip in Infants

Shaw¹,

Segal²,

2016

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Developmental dysplasia of the hip (DDH) encompasses a wide spectrum of clinical severity, from mild developmental abnormalities to frank dislocation. Clinical hip instability occurs in 1% to 2% of full-term infants, and up to 15% have hip instability or hip immaturity detectable by imaging studies. Hip dysplasia is the most common cause of hip arthritis in women younger than 40 years and accounts for 5% to 10% of all total hip replacements in the United States. Newborn and periodic screening have been practiced for decades, because DDH is clinically silent during the first year of life, can be treated more effectively if detected early, and can have severe consequences if left untreated. However, screening programs and techniques are not uniform, and there is little evidence-based literature to support current practice, leading to controversy. Recent literature shows that many mild forms of DDH resolve without treatment, and there is a lack of agreement on ultrasonographic diagnostic criteria for DDH as a disease versus developmental variations. The American Academy of Pediatrics has not published any policy statements on DDH since its 2000 clinical practice guideline and accompanying technical report. Developments since then include a controversial US Preventive Services Task Force “inconclusive” determination regarding usefulness of DDH screening, several prospective studies supporting observation over treatment of minor ultrasonographic hip variations, and a recent evidence-based clinical practice guideline from the American Academy of Orthopaedic Surgeons on the detection and management of DDH in infants 0 to 6 months of age. The purpose of this clinical report was to provide literature-based updated direction for the clinician in screening and referral for DDH, with the primary goal of preventing and/or detecting a dislocated hip by 6 to 12 months of age in an otherwise healthy child, understanding that no screening program has eliminated late development or presentation of a dislocated hip and that the diagnosis and treatment of milder forms of hip dysplasia remain controversial.

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“…13,14 Overall, the main cause for DDH seems to be a mechanical, related to the position in the uterus: hyperflexion with adduction and external rotation of hip, which comprises the dislocating posture. It is worth mentioning that prematurity or multiple gestations do not increase the risk for DDH.…”

Section: Other Conditionsmentioning

confidence: 99%