Acetabular dysplasia at the age of 1 year in children with neonatal instability of the hip

Abstract

Background and purposeAs much as one-third of all total hip arthroplasties in patients younger than 60 years may be a consequence of developmental dysplasia of the hip (DDH). Screening and early treatment of neonatal instability of the hip (NIH) reduces the incidence of DDH. We examined the radiographic outcome at 1 year in children undergoing early treatment for NIH.Subjects and methodsAll children born in Malmö undergo neonatal screening for NIH, and any child with suspicion of instability is referred to our clinic. We reviewed the 1-year radiographs for infants who were referred from April 2002 through December 2007. Measurements of the acetabular index at 1 year were compared between neonatally dislocated, unstable, and stable hips.ResultsThe incidence of NIH was 7 per 1,000 live births. The referral rate was 15 per 1,000. 82% of those treated were girls. The mean acetabular index was higher in dislocated hips (25.3, 95% CI: 24.6–26.0) than in neonatally stable hips (22.7, 95% CI: 22.3–23.2). Girls had a higher mean acetabular index than boys and left hips had a higher mean acetabular index than right hips, which is in accordance with previous findings.InterpretationEven in children who are diagnosed and treated perinatally, radiographic differences in acetabular shape remain at 1 year. To determine whether this is of clinical importance, longer follow-up will be required.

Early treatment with the von Rosen splint for neonatal instability of the hip is safe regarding avascular necrosis of the femoral head

“…Stable hips in unilateral NIH have higher AI than controls at 1 year despite treatment (Wenger et al. 2013 ), suggesting that they are not entirely normal to begin with. Also, our finding that Ortolani-positive hips had smaller ossific nuclei than Barlow-positive hips supports the idea that slow ossification of the ossific head may be related to the disease per se.…”

ACR Appropriateness Criteria® Developmental Dysplasia of the Hip-Child

“…Unrecognized and untreated subluxation and dislocation inevitably lead to early degenerative joint disease. It is estimated that DDH is the cause of up to a third of all total hip arthroplasties performed in patients <60 years of age, which emphasizes the importance of proper screening, early diagnosis, and appropriate intervention [25].…”

Introductory Chapter: Five-Dimensional Approach to the Developmental Dysplasia of the Hip

“…For that reason, in some medical systems, an ultrasound screening is also mandatory and universal [8], while in others, it is used only in selected, targeted cases [45]. These variations in screening protocol are due to economic, organisational reasons, as well as the concern of over diagnosing and possible unnecessary treatment [46][47][48] Nevertheless, the problem how to discriminate between dysplastic hips and healthy hips still remains-ultrasound is too dependent on examiner's skills, while radiographic criteria are usually biased by pelvic rotation [57]. Effective screening for DDH should be characterised by low percentage of cases that require surgical intervention, and all of those due to failures of nonoperative treatment, rather than due to late detection [49,58].…”