Ultrasound screening for hips at risk in developmental dysplasia

Abstract

Between May 1992 and April 1997, there were 20 452 births in the Blackburn District. In the same period 1107 infants with hip 'at-risk' factors were screened prospectively by ultrasound. We recorded the presence of dislocation and dysplasia detected under the age of six months using Graf's alpha angle. Early dislocation was present in 36 hips (34 dislocatable and 2 irreducible). Of the 36 unstable hips, 30 (83%) were referred as being Ortolani-positive or unstable; 25 (69%) of these had at least one of the risk factors. Only 11 (31%) were identified from the 'at-risk' screening programme alone (0.54 per 1000 live births). Eight cases of 'late' dislocation presented after the age of six months (0.39 per 1000 live births). The overall rate of dislocation was 2.2 per 1000 live births.Only 31% of the dislocated hips belonged to a major 'at-risk' group. Statistical analysis confirmed that the risk factors had a relatively poor predictive value if used as a screening test for dislocation. In infants referred for doubtful clinical instability, one dislocation was detected for every 11 infants screened (95% confidence interval (CI) 8 to 17) whereas in infants referred because of the presence of any of the major 'at-risk' factors the rate was one in 75 (95% CI 42 to 149).Routine ultrasound screening of the 'at-risk' groups on their own is of little value in significantly reducing the rate of 'late' dislocation in DDH, but screening clinically unstable hips alone or associated with 'at-risk' factors has a high rate of detection. [Br] 1999;81-B:255-8. J Bone Joint Surg

Diagnosis of congenital hip dysplasia in the newborn

“…This can be compared with 7.5% in the study by Holen et al (2002) in the group screened by the same process as in our study, and 18% in the study by Paton et al (1999). Thus, from this point of view it may be argued that our rate of delayed diagnosis was not unreasonably high.…”

“…Congenital dislocation of the hip, defined as the application of orthopedic treatment, was diagnosed in 298 infants in our population of 19,820 screened babies (15 per 1,000). In comparison, Paton et al (1999) found a dislocation rate of 2.2 per 1,000, while Holen et al (2002) found 9.3 per 1,000. Rosendahl et al (1994) compared the effect of selective vs. general vs. no ultrasound screening for CDH on treatment rates.…”

“…The greatest effect on the treatment rate might be to delay the orthopedic and ultrasound follow-up for some time after the newborn period, at least in the absence of obvious clinical hip instability at the initial pediatric screening. Thus, in the study by Paton et al (1999), infants with risk factors only were screened at 8-9 weeks of age. The implementation of such a policy will require a well-organized clinic to prevent dropouts and a highly qualified ultrasound examination to be sure that the hips do indeed normalize.…”

Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force

“…Table 3 includes studies of population-based or primary care clinic-based cohorts screened by clinical examination as well as ultrasound screening that were published since the 1996 end point of the AAP review. 28,70,72,[80][81][82][83] Despite variation in the reference standards used in these studies, several important findings emerge. First, a high proportion of hips diagnosed with minor findings of dysplasia undergo spontaneous resolution.…”

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.…”