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

Shipman, Scott A.; Helfand, Mark; Moyer, Virginia A.; Yawn, Barbara P.

doi:10.1542/peds.2005-1597

Cited by 252 publications

(218 citation statements)

References 129 publications

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“…With an incidence of approximately 1.5 to 20 per 1000 births, of which one to two per 10,000 present late, DDH is one of the most common congenital deformities of the lower limb [10,29]. Avascular necrosis of the femoral head is a devastating complication after closed reduction [3,15] potentially resulting in early degenerative joint disease and impaired function [3,9,15,20].…”

Section: Discussionmentioning

confidence: 99%

Does Perfusion MRI After Closed Reduction of Developmental Dysplasia of the Hip Reduce the Incidence of Avascular Necrosis?

Gornitzky

Georgiadis

Seeley

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Gadolinium-enhanced perfusion MRI (pMRI) after closed reduction/spica casting for developmental dysplasia of the hip (DDH) has been suggested as a potential means to identify and avoid avascular necrosis (AVN). To date, however, no study has evaluated the effectiveness of pMRI in clinical practice or compared it with other approaches (such as postreduction CT scan) to show a difference in the proportion of AVN. Questions/purposes (1) Can a pMRI-based protocol be used immediately post closed reduction to minimize the risk that AVN would develop? (2) What are the overall hiprelated outcomes after closed reduction/spica casting using this protocol? (3) Do any patient-specific factors at the time of closed reduction predict future AVN? Methods This was a retrospective cohort study at a large tertiary care children's hospital. Between 2009 and we treated 43 patients with closed reduction/spica casting for DDH, of whom 33 (77%) received a postreduction pMRI. All patients were indicated for pMRI per treating surgeon preference. A convenience sample totaling 25 hips in 22 patients treated with pMRI was then established using the following exclusion criteria: DDH of neuromuscular/ syndromic origin, failed initial closed reduction, less than 1 year of clinical and radiographic followup, and subsequent open reduction. Next, the 40 patients treated with closed reduction between 2004 and 2009 were screened until the chronologically most recent 25 hips (after applying the previously mentioned exclusion criteria) were identified in 21 of the first 34 patients (62%) screened. Although termed the CT group, specific postreduction imaging was not a defined inclusion criterion in this group with the majority (21 of 25 [84%]) receiving postreduction CT and the remainder (four of 25 [16%]) receiving only postreduction radiographs. All hips with globally decreased femoral head perfusion on postreduction pMRI were treated with immediate cast removal followed by repeat closed reduction or open reduction, as per surgeon preference, with two of 33 (6%) requiring such further interventions. Salter criteria were then used to determine the proportion of AVN on radiographs at 1-year and final followup. Secondary outcomes including residual dysplasia and the need for further corrective surgery were ascertained through radiographic and retrospective chart review. 049). No patient with normal perfusionEach author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conform...

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Section: Discussionmentioning

confidence: 99%

Does Perfusion MRI After Closed Reduction of Developmental Dysplasia of the Hip Reduce the Incidence of Avascular Necrosis?

Gornitzky

Georgiadis

Seeley

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Además, la fiabilidad y concordancia (intra e interobservador) de las pruebas de cribado dependen de la experiencia de los profesionales. En el caso de la ecografía sabemos que el índice kappa es alto para las caderas normales, pero moderado-débil para las caderas anormales 12,14 .…”

Section: El Cribado De La Displasia De Desarrollo De Caderas En El Reunclassified

“…Los beneficios dependen de la disminución de las intervenciones quirúrgicas, de la mejoría funcional, y/o del menor número de casos de displasias de diagnóstico tardío (se considera tardío el diagnóstico de displasias entre las 6 semanas y los 20 meses de edad, en un intervalo muy variable aceptado en la literatura al respecto). Lamentablemente, los estudios acerca de la efectividad del tratamiento son de baja calidad y se estima que el principal efecto adverso de la displasia, la necrosis avascular de la cadera, tiene una incidencia muy variable, entre el 0 y el 60% 12 . Aunque hay trabajos sugerentes de mejores resultados conseguidos mediante el diagnóstico precoz, no se puede excluir el sesgo de adelanto diagnóstico que conlleva la identificación de casos de displasia de resolución espontánea, por lo que el mejor resultado se atribuiría equivocadamente al tratamiento precoz.…”

Section: El Cribado De La Displasia De Desarrollo De Caderas En El Reunclassified

“…Los perjuicios tampoco están claramente evaluados y van desde los efectos secundarios de las pruebas de cribado y confirmación del diagnóstico (riesgo potencial del exceso de exposición a radiación, por ejemplo) a los daños que conlleva la intervención precoz, como seguimiento y/o tratamiento innecesarios, y necrosis avascular de cadera asociada a las técnicas médi-cas e intervenciones quirúrgicas (cuya incidencia es también muy variable, entre el 13,5 y el 109 por 1.000 niños sometidos a tratamiento) 11 , pasando por el etiquetado de los casos (lo que conlleva cargas psicosociales y familiares). Los costes han sido valorados en diferentes estudios económi-cos, y ofrecen un beneficio marginal a la ecografía sobre la exploración clínica, pero en cualquier caso ninguno se ha realizado con el oportuno análisis de los años de vida ajustados por calidad 12 .…”

Section: El Cribado De La Displasia De Desarrollo De Caderas En El Reunclassified

“…La información más importante respecto a este cribado procede de dos guías de prác-tica clínica, publicadas en el año 2000 por la American Academy of Pediatrics 11 y en el año 2001 por la Canadian Task Force on Preventive Health Care 13 , así como de la revisión sistemática publicada en el año 2006 por la US Preventive Service Task Force 12 . Los tres informes coinciden en no recomendar el cribado universal por ecografía de las displasias de desarrollo de cadera, cuya implantación podría favorecer el sobre-diagnóstico y el sobre-tratamiento, pero difieren en cuestiones importantes.…”

Section: El Cribado De La Displasia De Desarrollo De Caderas En El Reunclassified

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Problemas prácticos y éticos de la prevención secundaria: A propósito de dos ejemplos en pediatría

Camacho

Fernández

Dios³

2007

Rev. Esp. Salud Publica

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RESUMENLa prevención tiene un aura positiva que a veces confunde, pues no se corresponde con los hechos. Decimos que "más vale prevenir que curar" y en muchos casos no es cierto. Además, las actividades preventivas deberían tener mucho mayor fundamento científico que las curativas, pues aquellas las solemos ofrecer y éstas nos son requeridas.En este texto revisamos dos ejemplos pediátricos de cribado, el del neuroblastoma y el de la displasia de cadera, que sirven para valorar los problemas prácticos de la prevención secundaria. Con ellos se examinan algunas cuestiones generales e importantes en el cribado, como la necesidad de conocer la historia natural de la enfermedad, y el "punto crítico de irreversabilidad" (el tiempo en que es oportuno hacer el diagnós-tico precoz de forma que permita un mejor curso de la enfermedad por la pronta intervención). En síntesis, sólo a veces "más vale curar que prevenir", y en todo caso las actividades preventivas deberían ser vistas por el clínico con la misma exigencia de fundamento científico que las actividades curativas.Palabras clave: Cribado. Diagnóstico precoz. Prevención secundaria. Neuroblastoma. Luxación congénita de cadera. ABSTRACTEthical and practical problems of secondary prevention. Two paediatrics examples

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Screening programmes for developmental dysplasia of the hip in newborn infants

Shorter

Hong

McKechnie³

et al. 2004

Cochrane Database of Systematic Reviews

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BACKGROUND: Uncorrected developmental dysplasia of the hip (DDH) is associated with long term morbidity such as gait abnormalities, chronic pain and degenerative arthritis. OBJECTIVE: To determine the effect of different screening programmes for DDH on the incidence of late presentation of congenital hip dislocation. METHODS:Search methods: Searches were performed in CENTRAL (The Cochrane Library), MEDLINE and EMBASE (January 2011) supplemented by searches of clinical trial registries, conference proceedings, cross references and contacting expert informants. Selection criteria: Randomized, quasi-randomized or cluster trials comparing the effectiveness of screening programmes for DDH. Data collection and analysis: Three independent review authors assessed study eligibility and quality, and extracted data. MAIN RESULTS:No study examined the effect of screening (clinical and/or ultrasound) and early treatment versus not screening and later treatment. AUTHORS' CONCLUSIONS:There is insufficient evidence to give clear recommendations for practice. There is inconsistent evidence that universal ultrasound results in a significant increase in treatment compared to the use of targeted ultrasound or clinical examination alone. Neither of the ultrasound strategies have been demonstrated to improve clinical outcomes including late diagnosed DDH and surgery. The studies are substantially underpowered to detect significant differences in the uncommon event of late detected DDH or surgery. For infants with unstable hips or mildly dysplastic hips, use of delayed ultrasound and targeted splinting reduces treatment without significantly increasing the rate of late diagnosed DDH or surgery.This is the abstract of a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) 2012, issue 11,

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

Abstract: BACKGROUND. Developmental dysplasia of the hip (DDH) represents a spectrum of anatomic abnormalities that can result in permanent disability.

Cited by 252 publications

References 129 publications

Does Perfusion MRI After Closed Reduction of Developmental Dysplasia of the Hip Reduce the Incidence of Avascular Necrosis?

Does Perfusion MRI After Closed Reduction of Developmental Dysplasia of the Hip Reduce the Incidence of Avascular Necrosis?

Problemas prácticos y éticos de la prevención secundaria: A propósito de dos ejemplos en pediatría

Screening programmes for developmental dysplasia of the hip in newborn infants

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