Radiological screening for DDH among risky infants in Abha Maternity & Children Hospital from 2019-2021

Abstract

Background: Developmental Dysplasia of the Hip (DDH) is the most common musculoskeletal condition diagnosed in neonates. Different timings and approaches to screening for DDH are used in the orthopedic community. Objectives: To provide evidence that DDH can be screened using sonarograph at the age of 2 months to decrease the risk of misdiagnosed DDH and determine the most common method of treatment regarding the radiological screening the infants underwent. Methods: This is a retrospective observational study that targeted all infants at risk of DDH who were born between 01-01-2019 to 31-12-2020 at Abha Maternity and Children Hospital (AMCH), Abha, Saudi Arabia. Included in the study were newborns who underwent radiological screening for hip with known risk factors for DDH. Demographic and clinical data were collected from the hospital electronic system. These data included subjects' age and sex, documented ultrasonography screening, documented X-ray diagnosis of DDH, and type of treatment. Results: A total of 201 infants (101 female, 100 male) aged from one day to six months (mean age 51.46 days, standard deviation 19.21 days) were included in the study. Ultrasonography screening revealed 40 subjects (19.9%) with positive DDH findings. X-rays done at age 4 to 6 months confirmed 26 (12.9%) DDH cases. Ultrasonography correctly detected 24 (11.9%) and excluded 159 (79.1) patients with DDH. However, two cases (1.0%) were not detected by ultrasonography and were later detected by X-ray, and 16 cases (8.0%) were falsely detected as positive DDH. Twenty-five subjects (12.4%) were treated conservatively, and one subject (0.5%) was treated surgically. Twenty-four cases of DDH showed hip abnormalities on ultrasound, giving a sensitivity rate of 92%. On the other side, 159 subjects who did not have DDH were screened negative with ultrasound (specificity rate 91%). Conclusions: The present study reveals that early US screening for DDH has high sensitivity and specificity and was associated with a lower rate of invasive intervention. Further research is needed to confirm these findings and examine potential factors influencing the accuracy of US-based screening programs in Saudi Arabia. Keywords: DDH; Ultrasound; Radiological screening