Ultrasonography in the diagnosis and management of developmental hip dysplasia (UK Hip Trial): clinical and economic results of a multicentre randomised controlled trial

Elbourne, Diana; Dezateux, Carol; Arthur, Rosemary; Clarke, Nicholas; Gray, Alastair; King, Andy J.; Quinn, Anne Marie; Gardner, Frances; Russell, G A

doi:10.1016/s0140-6736(02)12024-1

Cited by 115 publications

(100 citation statements)

References 21 publications

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“…Consequently, the treatment algorithm from screening through diagnosis and management may be distinct from other centers and provide an opportunity to compare whole treatment processes as opposed to individual factors. There are few large, multicenter trials that have prospectively collected data on patients with DDH [8,10,12]. When we examined laterality, the left hip was more commonly affected, consistent with the literature in the field.…”

Section: Discussionsupporting

confidence: 82%

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What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip?

Mulpuri

Schaeffer

Kelley

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Little information exists concerning the variability of presentation and differences in treatment methods for developmental dysplasia of the hip (DDH) in children \ 18 months. The inherent advantages of prospective multicenter studies are well documented, but data from different centers may differ in terms of important variables such as patient demographics, diagnoses, and treatment or management decisions. The purpose of this study was to determine whether there is a difference in baseline data among the nine centers in five countries affiliated with the International Hip Dysplasia Institute to establish the need to consider the center as a key variable in multicenter studies. Questions/purposes (1) How do patient demographics differ across participating centers at presentation? (2) How do patient diagnoses (severity and laterality) differ across centers? (3) How do initial treatment approaches differ across participating centers? Methods A multicenter prospective hip dysplasia study database was analyzed from 2010 to April 2015. Patients younger than 6 months of age at diagnosis were included if at least one hip was completely dislocated, whereas patients between 6 and 18 months of age at diagnosis were included with any form of DDH. Participating centers (academic, urban, tertiary care hospitals) span five countries across three continents. Baseline data (patient demographics, diagnosis, swaddling history, baseline International Hip Dysplasia Institute classification, and initial treatment) were compared among all nine centers. A total of 496 patients were enrolled with site enrolment ranging from 10 to 117. The proportion of eligible patients who were enrolled and followed at the nine participating centers was 98%. Patient enrollment rates were similar across all sites, and data collection/completeness for relevant variables at initial presentation was comparable. 123 Clin Orthop Relat Res (2016) 474:1138-1145 DOI 10.1007/s11999-016-4746-y Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons®Results In total, 83% of all patients were female (410 of 496), and the median age at presentation was 2.2 months (range, 0-18 months). Breech presentation occurred more often in younger (\6 months) than in older (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) Conclusions With the lack of strong prognostic indicators for DDH identified to date, the center is an important variable to include as a potential predictor of treatment success or failure.

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Section: Discussionsupporting

confidence: 82%

“…Breech presentation occurred more often in younger (\ 6 months) patients than in older (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) …”

Section: Patient Demographicsmentioning

confidence: 99%

What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip?

Mulpuri

Schaeffer

Kelley

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Several authors have emphasized the need for outcome studies at skeletal maturity for the different screening policies. [37][38][39] Our study confirms that in a Norwegian population, all 3 screening programs studied resulted in similar rates of all radiographic findings associated with acetabular dysplasia or early degenerative change at skeletal maturity. Offering universal hip ultrasound, and treating those testing positive, had thus no additional impact at a group level at skeletal maturity.…”

Section: Discussionsupporting

confidence: 80%

Screening Strategies for Hip Dysplasia: Long-term Outcome of a Randomized Controlled Trial

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Only 2 randomized controlled trials have addressed effects of ultrasound screening for developmental hip dysplasia. Both concluded that adding universal or selective ultrasound to routine clinical examination gave a nonsignificant reduction in rates of late presenting cases, but higher treatment rates. WHAT THIS STUDY ADDS:This maturity review assesses long-term outcome of one of these trials. Rates of radiographic findings indicating acetabular dysplasia and degenerative change were similar across the 3 screening groups in young adulthood. Increased treatment rates were not associated with avascular necrosis. abstract OBJECTIVE: Screening for hip dysplasia is controversial. A previous randomized controlled trial revealed that adding universal or selective ultrasound to routine clinical examination gave a nonsignificant reduction in rates of late presenting cases, but with higher treatment rates. This study assesses differences in outcome at skeletal maturity for the 3 newborn screening strategies in terms of radiographic markers of acetabular dysplasia and early degenerative change and avascular necrosis (AVN) secondary to neonatal treatment. METHODS:From the initial trial including 11 925 newborns, a populationbased sample of 3935 adolescents was invited for follow-up at age 18 to 20 years. A standardized weight-bearing anteroposterior view was obtained. The outcomes evaluated were the radiographic findings of dysplasia (center-edge angle, femoral head extrusion-index, acetabular depth-width ratio, Sharp' s angle, subjective evaluation of dysplasia) and degenerative change (joint-space width). Signs of AVN were documented. RESULTS:Of the 3935 subjects invited, 2038 (51.8%) attended the maturity review, of which 2011 (58.2% female patients) were included: 551, 665, and 795 subjects from the universal, selective, and clinical groups, respectively. Rates per group of positive radiographic findings associated with dysplasia or degenerative change varied depending on radiographic marker used. No statistically significant differences were detected between groups. No AVN was seen. CONCLUSIONS:Although both selective and universal ultrasound screenings gave a nonsignificant reduction in rates of late cases when compared with expert clinical programs, we were unable to demonstrate any additional reduction in the rates of radiographic findings associated with acetabular dysplasia or degenerative change at maturity. Increased treatment rates were not associated with AVN. Pediatrics 2013;132:492-501

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“…Although there are no trials or comparative studies of a screened to an unscreened population, 2 randomized, controlled trials (RCTs) 78,79 and 1 non-RCT 53 provide some insight into the accuracy of clinical and ultrasound examinations. These trials reported data about test performance of one screening strategy versus another ( Table 2).…”

Section: Use Of Imaging To Screen For Ddhmentioning

confidence: 99%

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

Shipman¹,

et al. 2006

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Ultrasonography in the diagnosis and management of developmental hip dysplasia (UK Hip Trial): clinical and economic results of a multicentre randomised controlled trial

Cited by 115 publications

References 21 publications

What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip?

What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip?

Screening Strategies for Hip Dysplasia: Long-term Outcome of a Randomized Controlled Trial

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

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