Abstract
Background
Screening for developmental hip dysplasia (DDH) continues to evolve with the use of ultrasound (US) in either selective or universal screening methods. The possibility of delayed evidence of DDH, and thus the need for radiographic follow-up at a later stage of development have been suggested by some authors.
Aims
The aim of this review was to evaluate the number of patients in our hospital network with a normal screening US at 6 weeks with evidence of DDH at the time of radiographic review at 6 months. Secondary aim; to determine the outcomes for these patients.
Methods
A retrospective review was done to infants undergoing DDH ultrasound screening between January and December 2015. Initial US and radiographs at 6 months were reviewed. Patients with normal screening US who had subsequent radiographs were included for analysis.
Results
In total, there were 829 patients included for analysis. Sixty-three patients (8%) had evidence of DDH at 6 months, representing 34% of all DDH diagnoses for the study period. Five of the 63 patients were lost to follow-up. The remaining 58 babies were treated in Boston bracing. Four patients with evidence of persistent DDH were referred for tertiary review. The osteotomy rate in the radiograph diagnosed group was 2%, versus 6% and 3% in the unstable and US diagnosed groups, respectively.
Conclusion
Eight percent of patients with a normal screening US had evidence of DDH at time of radiograph at 6 months, reflecting 34% of all our DDH cases for the year. Based on these findings, patients in our hospital network undergo radiographic evaluation at 6 months even if the initial screening US is normal.
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References
Phelan N, Thoren J, Fox C, O’Daly BJ, O’Beirne J (2015) Developmental dysplasia of the hip: incidence and treatment outcomes in the Southeast of Ireland. Ir J Med Sci 184:411–415. https://doi.org/10.1007/s11845-014-1133-0
Biedermann R, Riccabona J, Giesinger JM, Brunner A, Liebensteiner M, Wansch J, Dammerer D, Nogler M (2018) Results of universal ultrasound screening for developmental dysplasia of the hip. Bone Joint J 100-B:1399–1404. https://doi.org/10.1302/0301-620X.100B10.BJJ-2017-1539.R2
Dunn PM, Evans RE, Thearle MJ, Griffiths HE, Witherow PJ (1985) Congenital dislocation of the hip: early and late diagnosis and management compared. Arch Dis Child 60:407–414. https://doi.org/10.1136/adc.60.5.407
Mulpuri K, Song KM, Goldberg MJ, Sevarino K (2015) Detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age. J Am Acad Orthop Surg 23:202–205. https://doi.org/10.5435/JAAOS-D-15-00006
European Society of Paediatric Radiology’s Task force group on DDH Recommendations on hip screening
Imrie M, Scott V, Stearns P, Bastrom T, Mubarak SJ (2010) Is ultrasound screening for DDH in babies born breech sufficient? J Child Orthop 4:3–8. https://doi.org/10.1007/s11832-009-0217-2
Sarkissian EJ, Sankar WN, Zhu X, Wu CH, Flynn JM (2015) Radiographic follow-up of DDH in infants: are X-rays necessary after a normalized ultrasound? J Pediatr Orthop 35:551–555. https://doi.org/10.1097/BPO.0000000000000326
Osarumwense D, Popple D, Kershaw IF, Kershaw CJ, Furlong AJ (2007) What follow-up is required for children with a family history of developmental dysplasia of the hip? J Pediatr Orthop B 16:399–402. https://doi.org/10.1097/BPB.0b013e3282f05944
Tafazal S, Flowers MJ (2015) Do we need to follow up an early normal ultrasound with a later plain radiograph in children with a family history of developmental dysplasia of the hip? Eur J Orthop Surg Traumatol 25:1171–1175. https://doi.org/10.1007/s00590-015-1668-4
Jellicoe P, Aitken A, Wright K (2007) Ultrasound screening in developmental hip dysplasia: do all scanned hips need to be followed up? J Pediatr Orthop B 16:192–195. https://doi.org/10.1097/BPB.0b013e328014058d
Tonnis D (1976) Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res:39–47. https://doi.org/10.1097/00003086-197609000-00007
Arumilli BRB (2006) Is secondary radiological follow-up of infants with a family history of developmental dysplasia of the hip necessary? J Bone Jt Surg - Br 88-B:1224–1227. https://doi.org/10.1302/0301-620X.88B9.17330
Price KR, Dove R, Hunter JB (2011) The use of X-ray at 5 months in a selective screening programme for developmental dysplasia of the hip. J Child Orthop
Dezateux C, Rosendahl K (2007) Seminar developmental dysplasia of the hip. Seminar:1541–1552. https://doi.org/10.1016/S0140-6736(07)60710-7
Roovers EA, Boere-Boonekamp MM, Geertsma TSA, Zielhuis GA, Kerkhoff AH (2003) Ultrasonographic screening for developmental dysplasia of the hip in infants. Reproducibility of assessments made by radiographers. J Bone Joint Surg (Br) 85:726–730
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Mulrain, J., Hennebry, J., Dicker, P. et al. A normal screening ultrasound does not provide complete reassurance in infants at risk of hip dysplasia; further follow-up is required. Ir J Med Sci 190, 233–238 (2021). https://doi.org/10.1007/s11845-020-02296-2
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DOI: https://doi.org/10.1007/s11845-020-02296-2