Ultrasound in developmental dysplasia of the hip: A screening study in Sardinian newborns

Abstract

KEYWORDSDysplasia of the hip; Ultrasound; Newborn; Screening; DDH.Abstract Introduction: Developmental dysplasia of the hip (DDH) is the most frequent inborn deformity of the locomotor apparatus. Ultrasound screening is frequently used to identify DDH in view of the brevity of the preclinical period during which diagnosis is possible. Appropriate therapeutic intervention during this period can positively affects the evolution of the disorder. Methods: An unselected population of 1158 Sardinian neonates underwent ultrasound examinations of both hips, and findings were classified according to the method described by Graf. Patients were assessed by means of retrospective analysis to reveal cases of congenital dislocation of the hip joint. All cases were classified and treatment outcomes determined. Results: A total of 145 hips requiring treatment were observed in 122 children. Hip dysplasia and/or dislocation were diagnosed between the ages of 14 days and 3 months. One month after diagnosis ultrasound findings were normal in 94% of the infants with at least one hip classified as type 2a. The remaining 6% were classified as types 2b, 2c, D, and 3. All were treated with abduction splints, and normal hip development was observed after one or two months of treatment. Type 4 hips were referred to an orthopedic surgeon for specialist treatment. Conclusions: When performed by skilled operators, ultrasonographic techniques are of considerable value in prescribing treatment for DDH. The satisfactory prognosis associated with early treatment of severe congenital dislocation of the hip joint underlines the advisability of scheduling routine hip screening programs to ensure early diagnosis and effective treatment of the disorder.Sommario Introduzione: La displasia evolutiva dell'anca (DDH) costituisce la deformità più frequente dell'apparato locomotore. Lo screening ecografico è la metodica più utilizzata nell'identificazione della DDH, considerando la brevità del periodo in cui la diagnosi è possibile prima della comparsa dei sintomi clinici. Un intervento terapeutico appropriato precoce può avere un effetto positivo in relazione all'evoluzione di tale patologia. Metodi: L'esame ecografico, la sua valutazione, la classificazione e la tipizzazione delle anche sono stati effettuati secondo il metodo descritto dal Graf. I pazienti sono stati valutati per mezzo di un'analisi retrospettiva volta a identificare i casi di DDH. Tutti i casi sono stati classificati e in base a ciò si è deciso il tipo di trattamento da attuare. Risultati: Complessivamente sono state osservate 145 anche in 122 bambini che presentavano un certo grado di displasia. L'età alla diagnosi variava da 14 a 90 giorni con una media di 52 giorni di vita. Un mese dopo la diagnosi ecografica le anche di tipo 2a, sia bilaterali che unilaterali, sono risultate normali nel 94%. Il restante 6% così come i tipi 2b, 2c, D e 3 sono stati trattati con un divaricatore e la guarigione completa è stata ottenuta dopo due mesi di trattamento. Il tipo 4 è stato monitorato esclusi...

Treatment of Graf Type IIa Hip Dysplasia: A Cutoff Value for Decision Making

“…The high rate of spontaneous improvement reported for DDH (>80%) has led to a considerable dilemma regarding the approach to be used for screening positive infants ( 6 ). It has been argued that ultrasound screening techniques lead to the diagnosis of a higher number of DDH cases compared with a physical examination (Ortolani and Barlow clinical tests) and that this can increase the risk of treatment being prescribed unnecessarily ( 6 ). However, an early diagnosis and treatment of DDH, made possible by ultrasound screening, can lead complete recovery.…”

“…Hip ultrasound, which was described by Graf, has been used to evaluate DDH in children since the early 1980s ( 4 , 5 ). Ultrasound provides detailed visualization of the cartilaginous anatomy of the hip that is not revealed by plain X-rays and allows early detection of DDH ( 6 , 7 ). Hips with a slightly shallow acetabulum and rounded bony rim before 3 months of age are considered developmentally immature and are classified as Graf type IIa ( 5 ).…”

Universal screening may reduce the incidence of late diagnosis of developmental dysplasia of the hip

“…29 Overall, 31 studies were included in the final analysis. Of these, 13 studies reported on universal ultrasound screening, [30][31][32][33][34][35][36][37][38][39][40][41][42] whereas 20 studies reported on selective ultrasound screening. 36,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] Two studies compared universal versus selective screening.…”

“…A total of 13 studies with a total of 115,841 infants described the effect of universal ultrasound screening on the prevalence of late DDH in their population. [30][31][32][33][34][35][36][37][38][39][40][41][42] Of these studies, two were randomized controlled trials (RCTs), 33,36 two were prospective cohort studies, 38,42 six were prospective case series, 30,31,35,37,39,41 and the remaining three studies were retrospective case series. 32,40 Ten of these studies defined late DDH as those diagnosed after three months, two studies defined that as after 12 months, 33,35 and the remaining study after eight months.…”

“…The proportion of universally screened patients who underwent surgical treatment for dysplasia in childhood despite prompt diagnosis of DDH was discussed in eight studies. 30,31,33,35,37,[40][41][42] Of the total of 68 operations performed, only five patients were diagnosed late. These same studies had a total of 18 children with late DDH, of whom 13 were managed nonoperatively with an abduction brace.…”