The significance of at-risk factors in ultrasound surveillance of developmental dysplasia of the hip

Abstract

Of the 34,723 infants born between 1 June 1992 and 31 May 2002, the hips of 2578 with clinical instability or at-risk factors for developmental dysplasia of the hip were imaged by ultrasound. Instability of the hip was present in 77 patients, of whom only 24 (31.2%) had an associated risk factor. From the 'at-risk' groups, the overall risk of type-III dysplasia, instability and irreducibility was 1:15 when family history, 1:27 when breech delivery and 1:33 when foot deformity were considered as risk factors. Of those hips which were ultrasonographically stable, 88 had type-III dysplasia. A national programme of selective ultrasound screening of at-risk factors for the diagnosis of hip dislocation or instability alone cannot be recommended because of its low predictive value (1:88). However, the incidence of type-III dysplasia and hip dislocation or dislocatability in the groups with clinical instability, family history, breech position and possibly postural foot deformity as risk factors could justify a programme of selective ultrasound imaging.

Prevalence of developmental dysplasia of the hip in preterm infants with maternal risk factors

“…Our findings are consistent with recently published long-term studies that were conducted in infants during the neonatal period to evaluate multiple risk factors for DDH [3,[5][6][7][8].…”

The use of X-ray at 5 months in a selective screening programme for developmental dysplasia of the hip

“…Ultrasound has increased screening sensitivity to 97% in comparison with 13-60% for clinical examination [4]. Early diagnosis is important, as the magnitude of treatment increases with age due to increasing soft tissue contractures, bony deformity and reduced remodelling potential [3,5,[8][9][10][11]. Early application of flexion-abduction bracing has been shown to improve the outcome and reduce splintage duration [3,[8][9][10][11].…”

Neonatal foot deformities and their relationship to developmental dysplasia of the hip

“…6,7 The guidelines stated that 60% of cases of DDH originated as a result of these risk factors, although this figure has been disputed. 8,9 Risk factors are currently thought to be associated with 30% to 31% of ultrasonographically-important DDH. 8,9 The National Screening Committee (UK) currently considers abnormalities of the foot to be a risk factor in DDH.…”

“…8,9 Risk factors are currently thought to be associated with 30% to 31% of ultrasonographically-important DDH. 8,9 The National Screening Committee (UK) currently considers abnormalities of the foot to be a risk factor in DDH. 10 In our longitudinal, observational prospective study over 11 years we have assessed neonatal deformities of the foot and their relationship to DDH.…”