Selective ultrasound screening is inadequate to identify patients who present with symptomatic adult acetabular dysplasia.

Ernest L Sink,Benjamin F Ricciardi,Katrina Dela Torre,Charles T Price

doi:10.1007/s11832-014-0620-1

Abstract

PurposeOne goal of neonatal screening for developmental dysplasia of the hip (DDH) is the prevention of late surgery. However, the majority of patients with acetabular dysplasia at skeletal maturity are not diagnosed with DDH during infancy. Selective ultrasound screening may identify patients with neonatal hip instability, but may be ineffective for the prevention of dysplasia presenting in adulthood. The purpose of this study is to identify the prevalence of risk factors for DDH that would have warranted selective ultrasound screening in patients with symptomatic acetabular dysplasia after skeletal maturity.MethodsA prospective hip specialty center registry was used to identify 68 consecutive skeletally mature patients undergoing corrective osteotomy for symptomatic acetabular dysplasia. Risk factors for DDH evaluated in all patients included sex, family history of hip osteoarthritis or DDH, breech, method of delivery, previous hip treatments, and birth order. Radiographs [lateral center edge angle (CEA), anterior CEA, Tönnis grade, and Tönnis angle] were measured preoperatively.ResultsSixty-seven females and one male were identified. No patients were previously diagnosed with DDH or received treatment for their hips. The majority of patients (85.3 %) did not meet selective ultrasound screening guidelines following a stable neonatal hip exam and, therefore, would not have been screened in a selective screening program. Of the findings outside of screening guidelines, 98.5 % were females, 52.9 % were first born, and 36.8 % had a family history of hip osteoarthritis.ConclusionsThe majority (85.3 %) of patients with symptomatic acetabular dysplasia at skeletal maturity would not have met current recommendations for selective ultrasound screening in the USA had they been born today.

Highlights

Acetabular dysplasia is a common cause of hip osteoarthritis and the most common cause of hip arthroplasty in women younger than 50 years of age. [1, 2]
The purpose of this study is to identify the prevalence of risk factors for developmental dysplasia of the hip (DDH) that would have warranted selective ultrasound screening in patients with symptomatic acetabular dysplasia after skeletal maturity
The purpose of this study is to identify the prevalence of risk factors for neonatal DDH that would have warranted selective ultrasound screening in a consecutive series of skeletally mature patients with symptomatic acetabular dysplasia

Summary

Introduction

Acetabular dysplasia is a common cause of hip osteoarthritis and the most common cause of hip arthroplasty in women younger than 50 years of age. [1, 2]. Hip instability and acetabular dysplasia affects up to 4 % of newborn infants [3–6]. Untreated or undetected developmental dysplasia of the hip (DDH) may result in abnormal acetabular development during infancy, and this may lead to an increased risk of symptomatic acetabular dysplasia at later ages [7, 8]. Neonatal hip screening protocols, including both physical examination and/or imaging studies, have been implemented in many countries to promote early diagnosis of DDH, allowing for less invasive treatments, and possibly reducing the rate of late open surgery [5–11]. Some centers recommend universal screening to further decrease the burden of hip dysplasia in later life [7, 8]. Serial clinical examination is widely accepted for all newborns to improve early detection of DDH; recommendations for ultrasound screening have considerable regional variation [5, 6, 9]. Selective ultrasound screening in high-risk newborns following a normal

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