Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip

Abstract

Although hip ultrasonography is gaining acceptance as the most effective method for the early diagnosis of developmental dysplasia of the hip, there is still some controversy regarding the use of ultrasonography as a screening method. The purpose of this study was to investigate prospectively the capacity of clinical examination findings and associated risk factors to detect developmental dysplasia of the hip defined ultrasonographically in infants. A total of 3,541 infants underwent clinical examination and hip ultrasonography. Measured against ultrasonography as a standard, the sensitivity and specificity of clinical examination were 97% and 13.68%, respectively. Graf type IIb or more severe developmental dysplasia was found in 167 infants (208 hips), at an overall frequency of 4.71%. Graf type IIa physiological immaturity was encountered in 838 hips, and of these, 15 hips (1.78%) developed Graf type IIb dysplasia and underwent treatment. Patient characteristics that were found to be significant risk factors were swaddling use, female gender, breech delivery and positive family history. Given its low specificity, our findings suggest that clinical examination does not reliably detect ultrasonographically defined developmental dysplasia of the hip in infants being screened for this disease.

Correlation of femoral head coverage and Graf α angle in infants being screened for developmental dysplasia of the hip

“…Graf's method of diagnosing DDH with the use of α and β angles has been widely used [3,6,10,13,14]. Other methods include one described by Morin et al in a study of 171 infants [8].…”

“…Compared to other imaging methods, advantages of ultrasonography in this context include its ease of use, its freedom from ionising radiation, its capacity to reveal nonbony structures, and its capacity for evaluating the progress of therapy [2,3].…”

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

“…This has been reported to be as low as 13-24% in inexperienced hands [3,4], and only improving to 53-60% with experienced examiners [3,5,6]. A noted problem with clinical examination is that, even with experience, there is under-diagnosis of irreducible dislocated hips [4]. The ideal system would comprise of a few experienced examiners performing all examinations in order to improve reliability.…”

“…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].…”

Hip Ultrasonography in the Diagnosis of Developmental Dysplasia of the Hip: Bakırköy Experience

“…YKU, GKD'nin teşhisi ve tedavisinin izlenmesinde invaziv olmayan, radyasyon içermeyen, güvenli bir metot olup tüm dünyada ve ülkemizde kullanımı gittikçe yaygınlaşmaktadır. GKD tanısında YKU, duyarlılığı ve özgüllüğü klinik muayeneye göre daha yüksek bir yöntemdir (16)(17)(18) …”