Children treated for developmental dysplasia of the hip at birth and with normal acetabular index at 1 year: How many had residual dysplasia at 5 years?

Abstract

Purpose: The purpose of the study was to assess the effect of further follow-up for children treated for developmental dysplasia of the hip, with normal clinical and radiological findings at 1-year time point. The effect was quantified by the number of hips with a pathologic deterioration up to 5 years. Methods: Among 47,289 children born in Sør-Trøndelag county in Norway between 2003 and 2015, 265 children had developmental dysplasia of the hip. Of these, 164 children (239 hips) treated for developmental dysplasia of the hip with normal clinical findings and normal acetabular index at the 1-year time point were included in the study. The number of hips with pathologic acetabular index at the 5-year time point were reported. The diagnostic uncertainty related to radiological measurements was quantified together with the effect of introducing a second radiographic measurement, the center edge angle. Results: A total of 239 treated hips were normal at the 1-year time point. At 5-year time point, 10 (4.2%) hips had a pathologic acetabular index measurement and none classified to have developmental dysplasia of the hip caused by measurement inaccuracy. Eight (3.3%) hips had pathologic center edge angle measurement. Four hips had both pathologic acetabular index and center edge angle measurements, with three later treated with surgery. The intra- and interobserver repeatability coefficients were within 3.1°–6.6°. Conclusion: The repeatability coefficient of the acetabular index measurements was high and no hips could be classified to have developmental dysplasia of the hip at the 5-year time point when taking this repeatability into account. Hips classified as pathologic combining acetabular index and center edge angle measurements were likely to be treated with surgery for residual dysplasia. We recommend further follow-up for these children. Level of evidence: level II.

Defining the Incidence of Residual Acetabular Dysplasia After Successful Reduction With a Harness

“…Of their cohort, 30% with residual dysplasia subsequently went on to have secondary procedures to correct the acetabular dysplasia. 20 This is in line with our observations with 3/14 (21%) of our cohort with residual dysplasia requiring pelvic osteotomies.…”

“…19 However, previous authors have reported the incidence of RAD at longer follow-ups between 3% and 26% despite successful early PH treatment. 1,[8][9][10][11][12]20 These studies unfortunately all used varied definitions of RAD.…”

Children’s orthopaedics

“…Staying on the theme of developmental dysplasia of the hip (DDH), this paper from Trondheim (Norway) asked yet another pertinent and unanswered question. 6 The authors set out to establish what the residual dysplasia rates are at five years of age in those patients treated for DDH at birth, and in whom a normal acetabular index (AI) was achieved at one year. The reason for the interest in this question was the introduction of a selective ultrasound screening service, which included a final examination at age five years, but the team wished to examine if follow-up could be safely ended at age one year, with benefits for healthcare providers and patients alike.…”

A pilot study to assess justification of radiographic evaluation for developmental dysplasia of the hip.

“…A noteworthy fact is that in communities where mothers carry their neonates on their backs with the hips abducted have a lower incidence of DDH. 4,5 Regardless of the factors, it is extremely important to detect DDH as early as possible. By early detection of the condition, non-invasive management options such as the Pavlik Harness may be used.…”

“…It is not unusual for radiographs to be ordered in newborns and infants less than six months of age for assessment of DDH. 4 There is a lack of literature to outline prevalent practices for radiological screening and diagnosis of DDH in our country.…”