A normal screening ultrasound does not provide complete reassurance in infants at risk of hip dysplasia; further follow-up is required

Mulrain, Jill; Hennebry, Jennifer; Condren, James; O'Driscoll, Donal; O’Beirne, Joseph

doi:10.1007/s11845-020-02296-2

Cited by 5 publications

(7 citation statements)

References 14 publications

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“…There is no consensus on the follow-up time of DDH. [34][35][36][37] Some authors recommend six months followup with ultrasound examinations together with clinical controls 35 . In our protocol we have six months sonographic and clinical follow-up, but we do not have a routine x-ray follow-up protocol, after a normal ultrasound examination.…”

Section: Discussionmentioning

confidence: 99%

Positive family history and girl sex might increase the risk of failure of abduction treatment in developmental dysplasia of the hip

Lankinen

Helminen

Bakti

et al. 2023

Preprint

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Background. Mild Barlow positive but Ortolani negative developmental dysplasia of the hip (DDH) has a great spontaneous recovery potential. Despite that, in many cases abduction treatment is needed. Known risk factors of DDH include girl sex, family history and breech presentation. Risks of failure of the abduction treatment are not well established. Material and methods. The Children with DDH diagnosis treated in Tampere University hospital in the years 1998-2018 were retrospectively found. Only the children with early evaluation (under 2 weeks of age) of pediatric surgeon or pediatric surgery resident were included in the analysis. Total of 759 children were included. Results. Girl sex (p=0.008) and family history (p=0.003) were associated with the most sever forms of DDH in dynamic ultrasound at one month of age. Major hip instability in dynamic ultrasound (p=0.016), and not the alpha angles (p=0.426), was associated with the risk of operative and/or casting treatments. Watchful waiting strategy in mild DDH was safe regarding the major hip instability (p= 0.260) and duration of abduction treatment, as treatment duration was shorter in these children (p<0.001). Conclusion. Family history and girl sex increase a risk of more severe form of DDH which increases the risk of failure of the abduction treatment. The observation period of four to six weeks seems safe in clinically diagnosed mild DDH regarding the risk of operative treatment and treatment duration. Level of evidence: Level II Retrospective study

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Section: Discussionmentioning

confidence: 99%

Positive family history and girl sex might increase the risk of failure of abduction treatment in developmental dysplasia of the hip

Lankinen

Helminen

Bakti

et al. 2023

Preprint

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“…Mulrain and colleagues (2021) studied the reliability of initial US screening due to risk factors for DDH, such as a breech presentation or family history, to predict acetabular dysplasia at 6 months. Their results indicate that about 8% of patients who screen normally (Graf I or Graf IIa that normalizes) on an initial US have abnormal findings on the radiograph at 6 months 17. This rate of late diagnosis implies the need for further screening at 6 months for the individuals who are referred for risk factors, regardless of a negative US, early in life.…”

Section: Discussionmentioning

confidence: 99%

“…In rare cases, plain films may be able to identify a subluxed or dislocated hip that was missed on US. 17 One study only considered hips that screened positive on both types of imaging as truly dysplastic. 18 At our institution, USs require advanced scheduling and are technician-dependent, whereas radiographs can be performed point-of-care.…”

Section: Discussionmentioning

confidence: 99%

“…Their results indicate that about 8% of patients who screen normally (Graf I or Graf IIa that normalizes) on an initial US have abnormal findings on the radiograph at 6 months. 17 This rate of late diagnosis implies the need for further screening at 6 months for the individuals who are referred for risk factors, regardless of a negative US, early in life. Mulrain and colleagues emphasize the need for continued assessment of hips with DDH at and after 6 months of age, utilizing both the US and radiograph.…”

Section: Discussionmentioning

confidence: 99%

“…Plain films offer the benefit of being able to observe the ossification of the femoral heads, but US provides better visibility of hip cartilage. In rare cases, plain films may be able to identify a subluxed or dislocated hip that was missed on US 17. One study only considered hips that screened positive on both types of imaging as truly dysplastic 18.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of Late Dysplasia Based on Ultrasound and Plain X-Ray at 6 Months

Salton

Carry

Hadley-Miller

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Developmental dysplasia of the hip represents a spectrum of deformity. Residual dysplasia at 2 years of age is associated with an increased risk for osteoarthritis and functional limitations. We compared the prognostic value of 6-month imaging modalities and aimed to identify optimal diagnostic metrics for the prediction of residual dysplasia. Methods: After IRB approval, patients who underwent Pavlik treatment between 2009 and 2018 with 2-year follow-up were identified. Sonographs [ultrasound (US)] and radiographs (x-ray) were obtained at 6-month and 2-year-old visits. Dysplasia at 2 years was defined as an acetabular index (AI) > 24 degrees. Receiver operating characteristic curves were constructed to quantitatively compare the prognostic ability of US and x-raybased measures at 6 months. Youden's index [(YI) (values range from 0 (poor test) to 1 (perfect test)] was used to evaluate existing cutoffs at 6 months of age (normal measurements: alpha angle (AA) ≥ 60 degrees, femoral head coverage (FHC) ≥ 50%, and AI <30 degrees) relative to newly proposed limits. Results: Fifty-nine patients were included, of which 28.8% of patients (95% CI: 17.3 to 40.4%) had acetabular dysplasia at 2 years. After adjusting for sex, AA [Area under the Curve (AUC): 80] and AI (AUC: 79) at 6 months of age were better tests than FHC (AUC: 0.77). Current diagnostic cutoffs for AA (YI: 0.08), AI (YI: 0.0), and FHC (YI: 0.06) at 6 months had poor ability to predict dysplasia at 2 years. A composite test of all measures based on proposed cutoffs (AA ≥ 73 degrees, FHC > 62% and AI ≤ 24 degrees) was a better predictor of dysplasia at 2 years (Youden's index (YI): 0.63) than any single metric. Conclusions: The rate of residual dysplasia remains concerning. The 6-month x-ray and US both play a role in the ongoing management of the developmental dysplasia of the hip. The prediction of dysplasia is maximized when all metrics are considered collectively. Existing parameters were not accurate; We recommend the following cutoffs: AA ≥ 73 degrees, FHC > 62%, and AI ≤ 24 degrees. These cutoffs must be validated.

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Developmental dysplasia of the hip in infants referred for a combined pediatric orthopedic and radiologic examination – A prospective cohort study

Norlén

Færgemann

2022

Journal of Orthopaedics

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A normal screening ultrasound does not provide complete reassurance in infants at risk of hip dysplasia; further follow-up is required

Cited by 5 publications

References 14 publications

Positive family history and girl sex might increase the risk of failure of abduction treatment in developmental dysplasia of the hip

Positive family history and girl sex might increase the risk of failure of abduction treatment in developmental dysplasia of the hip

Prediction of Late Dysplasia Based on Ultrasound and Plain X-Ray at 6 Months

Developmental dysplasia of the hip in infants referred for a combined pediatric orthopedic and radiologic examination – A prospective cohort study

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