Developmental Dysplasia Of The Hip In Infants Research Articles

Screening Accuracy for Developmental Dysplasia of the Hip by Child Health Nurses.

Developmental Dysplasia of the Hip (DDH) describes a spectrum of abnormalities that impact the normal function of the joint. These abnormalities are detectable during infancy using physical assessment, universal ultrasound, or a combination of both. In Australia, child health nurses predominantly screen for this disease using physical assessment. The aim of this study was to determine if child health nurses can accurately screen for DDH using physical assessment. This Australian study estimated the accuracy and utility of child health nurses using physical assessment to screen for DDH by comparing it to a handheld ultrasound device. This study (N = 44) concluded that using a point prevalence study design, child health nurses in Australia are unable to accurately assess for DDH in infants using physical assessment; overall, clinicians had 50.5% sensitivity (95% CI, 15.7 to 84.3), a specificity of 75.0% (95% CI, 57.8 to 87.9), and 71.3% accuracy (95% CI, 55.6 to 83.9). This study suggests that child health nurses cannot screen for DDH using physical assessment. Understanding education, experience and what assessments are used suggests that the utility of nurses performing DDH screening requires further investigation.

Evaluation of Ultrasound Screening Method and Prevalence for Developmental Hip Dysplasia In The Central Anatolia

Objectives:This study aimed to assess the frequency and subsequent results of developmental dysplasia of the hip (DDH) in newborns in Central Anatolia who were admitted to Konya City Hospital and evaluate the efficiency of the existing screening and treatment methods in detecting and managing DDH in infants. Methods: Total of 10,650 infants were evaluated who had Graf USG screening in Konya City Hospital. İnfants born at or after 38 weeks of gestation were included, while premature infants were excluded. Additionally, we included infants who underwent USG screening between 30 and 90 days after birth, and whose hip development physiology was adequately visualized and assessed during the USG examination. Results: The study examined 8,695 term infants (52.5% male, 47.5% female) who underwent USG screening between 2020 and 2022. Participants mean gestational age at the time of the first USG examination was 7.94±2.07 weeks. Graf type 1 was higher in males (%97-96,5) and graf type 2 was higher in females (%7,2-7,8). Radiologists prefer to re-examine after 1 month for type 2a(%84,49-82,02) but orthopaedic consultation for type Type-2B, 2C, and type-3. The majority of infants (93.6%) underwent only one USG screening. No patients who continued regular USG control and treatment required surgical treatment requiring osteotomy. Conclusion: USG is an early diagnostic method for developmental hip dysplasia (DDH), which allows for simple treatment options and prevention of complications. It is a simple, inexpensive, and non-invasive method. Our study supports that regular USG screenings in infants eliminate the need for surgical procedures requiring osteotomy.

The reality of sonography of the infant hip in Brazil: results and recommendations

Since 1980, when Professor Reinhard Graf developed a novel technique, sonography of the infant hip has played a prominent role in the early diagnosis of developmental dysplasia of the hip (DDH). Brazil is a vast country, and disparities exist among regions and between the public and private health systems. In addition, healthcare professionals often have limited knowledge of DDH, and patients need to be referred to larger urban centers for definitive diagnosis and appropriate treatment. These reasons, and more, may hinder the early diagnosis of DDH. Following the successful implementation of similar neonatal screening programs for other conditions in Brazil, developing a screening program for DDH in Brazil is imperative. Such a program should consider training professionals to use Graf’s technique as a diagnostic procedure. It is recommended that more studies be conducted in every region of the country to provide a broader understanding of the current role of sonography in the screening and diagnosis of DDH in infants in Brazil.

The outcome of early screening and treatment of developmental dysplasia of the hip in infants and toddlers in the Northern Guizhou region.

This study is an observation of the early screening and treatment effect of infant developmental dysplasia of the hip (DDH) in an area in China. From January 2016 to December 2017, we selected infants and toddlers with high-risk factors for DDH, such as asymmetric gluteal folds, unequal length of lower limbs, and limited hip joint abduction, who visited the Department of Child Health Care and the Outpatient Clinic of Pediatric Orthopedics at the Affiliated Hospital of Zunyi Medical University. In total, 1485 cases were divided into age groups, examined using Graf ultrasound and X-ray, and the results were analyzed. Meanwhile, early interventions were actively adopted for cases with abnormalities during the screening. The detection rates of DDH were 24.0%, 2.8%, 9.3%, and 12.2% among those with 0 to 6 months, 7 to 12 months, 13 to 18 months, and 19 to 24 months of age, respectively. Early and individualized corrective conservative treatment was considered for children with abnormalities, and the cure rates were 87.0%, 65.7%, 41.0%, and 16.7% among those with 0 to 6 months, 7 to 12 months, 13 to 18 months, and 19 to 24 months of age, respectively. There was a statistically significant difference in the detection and cure rates of DDH in infants and toddlers of different ages (P < .01).

Risk factors of developmental dysplasia of the hip in infants: A meta-analysis based on cohort studies

IntroductionDevelopmental dysplasia of the hip (DDH) is a prevalent condition in children. Currently, the exact etiology of DDH remains uncertain. The objective of this study was to conduct a meta-analysis to investigate the risk factors associated with DDH in infants. The findings would provide a theoretical foundation for targeted early screening and diagnosis. HypothesisSeveral indicators, such as gender, intrauterine position, family history of DDH, gestational age, delivery mode, amniotic fluid levels, swaddling, parity, fetus number, combined musculoskeletal deformities, birth weight, and physical examination results, may serve as risk factors for DDH. Materials and methodsCohort studies investigating the risk factors of DDH in infants through logistic regression analysis were searched in the Wanfang, VIP citation, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc, Excerpta Medica Database (Embase), PubMed, and Cochrane Library databases up to May 2023. After extracting the data from eligible literature and assessing them using the Newcastle-Ottawa Scale (NOS), articles were selected based on pre-established inclusion and exclusion criteria. ResultsA total of eleven literature reports covering 979,757 infants were included in this meta-analysis. The publication bias did not significantly influence the results. The incidence rate of DDH was 47.99‰ among infants with risk factors compared to 3.21‰ in the general population. Risk factors for DDH included being female (OR=6.97, 95% CI: 5.18–9.39, p<0.001), breech delivery (OR=4.14, 95% CI: 3.09–5.54, p<0.001), positive family history (OR=4.07, 95% CI: 2.20–7.52, p<0.001), cesarean section (OR=1.11, 95% CI: 1.01–1.21, p=0.032), oligohydramnios (OR=3.93, 95% CI: 1.29–12.01, p=0.016), swaddling (OR=6.74, 95% CI: 1.25–36.31, p=0.026), firstborn status (OR=1.84, 95% CI: 1.49–2.53, p<0.001), combined musculoskeletal malformations (OR=2.27, 95% CI: 1.58–3.27, p<0.001), and physical signs of DDH (OR=8.71, 95% CI: 2.44–31.07, p=0.001). Premature delivery (OR=0.91, 95% CI: 0.88–0.95, p<0.001) was a protective factor for DDH. The relationship between multiple pregnancies (OR=0.58, 95% CI: 0.33–1.02, p=0.060) and low birth weight (OR=0.62, 95% CI: 0.14–2.76, p=0.529) in relation to DDH remained uncertain. DiscussionThis meta-analysis shows that female, breech delivery, positive family history, cesarean section, firstborn status, oligohydramnios, swaddling and combined musculoskeletal malformations are associated with DDH. Premature delivery appeared to be a protective factor against DDH. Nevertheless, the other factors need more research to reach more conclusive results. Level of evidenceIII; meta-analysis.

Evaluation The Efficacy of Barlow and Ortalani Test in The Diagnosis of Developmental Dysplasia of The Hip in Infant in Salah Al-deen General Hospital

This cross sectional study aimed to assess the effectiveness of clinical examination using the Barlow and Ortolani tests compared to ultrasound diagnosis for identifying developmental dysplasia of the hip (DDH) in infants. The study involved 100 babies aged 1 week to 12 weeks, randomly selected from Salah Al-deen General Hospital between January and June 2020. The infants were examined using the Barlow and Ortolani tests, followed by ultrasound confirmation of DDH diagnosis. Results showed that 9% of the infants had DDH. Infants with abnormal ultrasound findings had a higher birth weight, and significant associations were found with breech presentation, vaginal bleeding during pregnancy, and a family history of the same condition. Senior specialists were more accurate in diagnosing DDH compared to residents. The sensitivity of the Barlow and Ortolani maneuvers was low for both residents and seniors, while specificities were high. Positive predictive values were better for residents, but negative predictive values were better for seniors. False-negative rates were lower for seniors, and false-positive rates were generally low. In conclusion, clinical examination alone may not always accurately identify DDH in infants, as some babies with normal hips may show abnormalities on ultrasound. Conversely, ultrasound scans may indicate clinical dysfunction in babies with normal hips. Female infants had a higher incidence of DDH, and certain risk factors were associated with the condition. The sensitivity of the Barlow and Ortolani tests was limited, but specificities were high, and the choice of examiner impacted predictive values

Consistency of Indices Obtained via Hip Medial Ultrasound and Magnetic Resonance Imaging in Reduction and Spica Cast Treatment for Developmental Dysplasia of the Hip

Children younger than 18 mo with developmental dysplasia of the hip (DDH) were treated with reduction and spica cast. X-Ray, computed tomography or magnetic resonance imaging (MRI) was used to evaluate reduction effectiveness. This study explored the hip medial ultrasonography method and anatomic structure sonograms. Twenty-eight children with DDH were enrolled. A total of 51 hips (24 left hips /27 right hips) were measured, including 30 affected hips and 21 normal hips. Various indices, including femoral head diameter (DIA), triradiate cartilage–femoral distance (TFD), acetabular–femoral distance (AFD) and ilium–femoral distance (IFD), were measured in the acetabular median coronal plane of ultrasound and the median coronal plane of MRI. The intra-group correlation coefficients for DIA, TFD, AFD and IFD were 0.968 (95% confidence interval: 0.917–0.985), 0.959 (0.929–0 976), 0.923 (0.869–0.955) and 0.950 (0914–0.971), respectively. Hip medial ultrasound and MRI exhibited good consistency. It is feasible to use hip medial ultrasound to evaluate the reduction of DDH in infants and children after spica cast.

Developmental Dysplasia of the Hip: Management of Graf IIa Dysplastic Hip

Developmental Dysplasia of the Hip (DDH) describes a wide range of anatomic abnormalities of the growing hips which might result in permanent abnormal gait. Therefore, early detection and management is crucial to improve the outcome and minimise the risk of osteoarthritis in later life. Hip ultrasound is used to evaluate DDH based on Graf classification. Graf score is a widely used ultrasound grading score to evaluate DDH in infants. There is conflicting evidence regarding the management of the developmentally immature Graf type IIa hip. Some physicians adopt watchful waiting for natural maturation of hips while other early treatment. This article will provide an evidence-based review on the management modalities of the Graf type IIa hip.

Asymmetrical thigh creases or isolated thigh crease may be a false positive sign with low predictive value in the diagnosis of developmental dysplasia of the hip in infants: a prospective cohort study of 117 patients.

The clinical importance of asymmetrical thigh creases in the diagnosis of developmental dysplasia of the hip (DDH) in infants remains controversial. The aim of this study is to investigate the association of asymmetrical skinfolds of the thigh as the only clinical finding with the DDH in infants. One hundred and thirty-four infants between January 2010 and December 2015 were referred to our clinics for DDH with the only clinical sign being asymmetrical or isolated thigh creases and met the inclusion criteria of the study. Patients with another clinical sign for DDH in our initial evaluation, those infants suspicious for syndrome and those older than 6months were excluded. Finally, 117 patients had undergone clinical and ultrasound evaluation and were included to statistical analysis. There were 82 females and 35 males, with mean age of 2.2months old. In 96 of the 117 infants (82.1%), there were provocative skin creases in the opposite thigh after a little pressure of the thigh by the examiner during the evaluation. Three of the babies (3.1%) with provocative skin creases and 1 (4.8%) with true isolated thigh crease had immature hips in ultrasonography. Positive predictive value for DDH of an isolated or asymmetrical thigh crease was 4.55% (95% CI 0.83-21.36%), and negative predictive value was 96.97% (95% CI 94.75-98.27%). Sensitivity of skinfold asymmetry found to be 25% (95% CI 0.63-80.59%), and specificity was 82.05% (95% CI 73.88-88.53%) for DDH. The positive predictive value of asymmetrical or isolated thigh creases for DDH in infants was found to be low, as the majority of hips with normal clinical examination and asymmetry in thigh skinfolds seemed to be normal. Moreover, in-depth evaluation of the patients could highlight new provocative thigh creases in the opposite thigh, which could limit the referrals to expert physicians to exclude DDH. Level III.

Investigating the need for routine ultrasound screening to detect developmental dysplasia of the hip in infants born with breech presentation

Breech presentation is a recognized risk factor for developmental dysplasia of the hip (DDH). Within North America, there is a lack of consensus on screening guidelines for DDH in infants with a negative physical examination of the hips. This study evaluates the need for ultrasound screening in all breech born infants to detect DDH and whether this is influenced by gender, gestational age and mode of delivery. A retrospective chart review was conducted to identify breech born infants who underwent routine hip ultrasound to detect DDH between 2010 and 2015. Patients were grouped by physical exam and ultrasound findings and compared based on gender, gestational age and mode of delivery. Three hundred and eighteen patients were identified (191 female, 127 male; 26 preterm, 57 late preterm, 235 term; 263 caesarean section delivery, 55 vaginal delivery). Three hundred and eight patients had a negative physical exam of which 27 were diagnosed with DDH based on screening ultrasound with females predominant (P<0.05). 12.50% of females with a negative physical exam had DDH compared to 3.23% of males (P<0.05). There was no difference in the rate of DDH detected by screening ultrasound based on gestational age (P=0.94) or mode of delivery (P=0.59). The diagnosis of DDH in breech born infants by screening ultrasound in those with a negative physical exam of the hips is more predominant in females, with no apparent association with gestational age or mode of delivery. Future analyses with larger sample sizes are needed before conclusions can be made on screening protocols.

Evaluation and Referral for Developmental Dysplasia of the Hip in Infants.

Developmental dysplasia of the hip (DDH) encompasses a wide spectrum of clinical severity, from mild developmental abnormalities to frank dislocation. Clinical hip instability occurs in 1% to 2% of full-term infants, and up to 15% have hip instability or hip immaturity detectable by imaging studies. Hip dysplasia is the most common cause of hip arthritis in women younger than 40 years and accounts for 5% to 10% of all total hip replacements in the United States. Newborn and periodic screening have been practiced for decades, because DDH is clinically silent during the first year of life, can be treated more effectively if detected early, and can have severe consequences if left untreated. However, screening programs and techniques are not uniform, and there is little evidence-based literature to support current practice, leading to controversy. Recent literature shows that many mild forms of DDH resolve without treatment, and there is a lack of agreement on ultrasonographic diagnostic criteria for DDH as a disease versus developmental variations. The American Academy of Pediatrics has not published any policy statements on DDH since its 2000 clinical practice guideline and accompanying technical report. Developments since then include a controversial US Preventive Services Task Force "inconclusive" determination regarding usefulness of DDH screening, several prospective studies supporting observation over treatment of minor ultrasonographic hip variations, and a recent evidence-based clinical practice guideline from the American Academy of Orthopaedic Surgeons on the detection and management of DDH in infants 0 to 6 months of age. The purpose of this clinical report was to provide literature-based updated direction for the clinician in screening and referral for DDH, with the primary goal of preventing and/or detecting a dislocated hip by 6 to 12 months of age in an otherwise healthy child, understanding that no screening program has eliminated late development or presentation of a dislocated hip and that the diagnosis and treatment of milder forms of hip dysplasia remain controversial.

Clinical evaluation of ultrasound screening in follow-up visits of infants with cerebral palsy at high risk for developmental dysplasia of the hip.

The aim of the study was to assess the clinical value of ultrasound screenings for the developmental dysplasia of the hip (DDH) and explore its etiology in high-risk infants with cerebral palsy in follow-up visits. A group of 98 cases of infants at high-risk of cerebral palsy who received rehabilitation treatment between July, 2009 and July, 2010 were selected. Infants included 58 men and 40 women, aged <6 months and not lost to follow-up visits. Ultrasound (using Graf static inspection) screening of hips was performed and the infants with abnormalities were given clinical intervention, and 1- to 2-year-old infants were given outpatient follow-ups. The results were analyzed and there were 40 abnormal cases among the 98 cases of infants at high risk of cerebral palsy, including 18 cases of unstable hip joint, and 22 cases of DDH (12 cases of hip dysplasia, 3 cases of hip subluxation and 7 cases of hip dislocation). Early clinical intervention for infants with hip dysplasia and outpatient follow up for infants aged 1–2 years was carried out and had ischemic necrosis of femoral head, with the exception of 1 case of femoral detorsion that was poorly restored. In conclusion, the probability of DDH was higher in infants at high-risk of cerebral palsy compared to the normal infants. Hip ultrasound is a safe, simple, and effective screening method for these infants, which is of great clinical significance for an earlier diagnosis and treatment of DDH in infants with cerebral palsy.

Radiographic Follow-up of DDH in Infants: Are X-rays Necessary After a Normalized Ultrasound?

Concerns about radiation exposure have created a controversy over long-term radiographic follow-up of developmental dysplasia of the hip (DDH) in infants who achieve normal clinical and ultrasonographic examinations. The purpose of this study was to assess the importance of continued radiographic monitoring by contrasting the incidence of residual radiographic dysplasia to the risks of radiation exposure. We reviewed a consecutive series of infants with idiopathic DDH presenting to our institution over 4 years. Infants with "normalized DDH" had achieved a stable clinical examination with an ultrasound revealing no signs of either hip instability or acetabular dysplasia. We excluded infants with persistently abnormal ultrasonographic indices, clinical examinations, or both by 6 months of age, including those requiring surgical reduction. Anteroposterior pelvic radiographs at approximately 6 and 12 months of age were then evaluated for evidence of residual radiographic acetabular dysplasia. Radiation effective dose was calculated using PCXMC software. We identified 115 infants with DDH who had achieved both normal ultrasonographic and clinical examinations at 3.1±1.1 months of age. At the age of 6.6±0.8 months, 17% of all infants demonstrated radiographic signs of acetabular dysplasia. Of infants left untreated (n=106), 33% had dysplasia on subsequent radiographs at 12.5±1.2 months of age. No significant differences were evident in either the 6- or 12-month rates of dysplasia between infants successfully treated with a Pavlik harness and infants normalizing without treatment but with a history of risk factors (P>0.05). The radiation effective dose was <0.01 mSv for the combined 6- and 12-month single-view anteroposterior radiographs of the pelvis. The notable incidences of radiographic dysplasia after previous DDH normalization in our study cohort appear to outweigh the risks of radiation exposure. Our findings may warrant radiographic follow-up in this population of infants through at least walking age to allow timely diagnosis and early intervention of residual acetabular dysplasia. Level IV-retrospective case series.

Maternal Height and Infant Body Mass Index Are Possible Risk Factors for Developmental Dysplasia of the Hip in Female Infants.

Developmental dysplasia of the hip (DDH) is a wide-spectrum disease with a multifactorial etiology and, despite its prevalence, no definitive etiology has yet been established. The aim of this study was to investigate new risk factors for DDH by evaluating newly defined potential risk factors. A total of 71 infants were separated into 2 groups:Group I, 28 female first-born infants diagnosed with DDH and their mothers;and Group II, 43 healthy female first-born infants and their mothers. The maternal height and weight before pregnancy, infant height and weight at birth, and body mass index (BMI) of both mother and infant were determined. Calculations were made of the ratios between these parameters. Of the examined risk factors, only maternal height and the ratio of maternal height to infant BMI (MH/I-BMI) were found to be significant for DDH in infants. In conclusion, the results of this study show that a short maternal height and a low MH/I-BMI increase the risk of DDH. Further studies with a larger series are necessary to confirm these results.

Rehabilitation management of congenital muscular torticollis coexisted with developmental dysplasia of the hip in children

Objective Congenital muscular torticollis (CMT) and developmental dysplasia of the hip (DDH) are common congenital problems in infants. Association between CMT and DDH has been reported in literatures. The aim of this study was to assess coexistence of DDH in infants with CMT and curative effects of its rehabilitative therapy. Methods In total, 187 infants less than two months old with CMT were recruited in the study. DDH was diagnosed and graded by Graf's bilateral hip type B ultrasonography and pelvic X-ray films. Massage manipulation, magnetic strapping, postural orthosis at home and heat compress were instituted for CMT and frog spica device and hip-flexion abduction plaster immobilization were instituted for DDH. Their early rehabilitative effects were evaluated. Results DDH was coexisted in 24 of 187 infants with CMT, with incidence of 12. 8%. The hips of 22 infants were graded as type Ⅱ b (91.7%) and two as type Ⅲ a (8.3%), and eight at the left side and seven at the right side.Comorbid hips completely recovered normal with early frog spica device and hip-flexion abduction therapy in 24 infants. Conclusions Coexistence of CMT and DDH are relatively common in infants. Type B ultrasonography can be used as a measure for screening DDH in neonates with CMT. Early rehabilitative therapy is effective for those coexisted with DDH and CMT at the same time. Key words: Plagiocephaly,nonsynostotic; Hip; Joint diseases; Rehabilitation

ACR Appropriateness Criteria® on Developmental Dysplasia of the Hip—Child

Developmental dysplasia of the hip (DDH) affects 1.5 of every 1,000 caucasian Americans and less frequently affects African Americans. Developmental dysplasia of the hip comprises a spectrum of abnormalities, ranging from laxity of the joint and mild subluxation to fixed dislocation. Early diagnosis of DDH usually leads to low-risk treatment with a harness. Late diagnosis of DDH in children may lead to increased surgical intervention and complications. Late diagnosis of DDH in adults can result in debilitating end-stage degenerative hip joint disease. Screening decreases the incidence of late diagnosis of DDH. Clinical evaluation for DDH should be performed periodically at each well-baby visit until the age of 12 months. There is no consensus on imaging screening for DDH. Consideration for screening with ultrasound is balanced between the benefits of early detection of DDH and the increased treatment and cost factors. In addition, randomized trials evaluating primary ultrasound screening did not find significant decrease in late diagnosis of DDH. In the United States, hip ultrasound is selectively performed in infants with risk factors, such as family history of DDH, breech presentation, and inconclusive findings on physical examination. Ultrasound for DDH should be performed after 2 weeks of age because laxity is common after birth and often resolves itself. A pelvic radiograph can optimally be performed after the age of 4 months, when most infants will have ossification centers of the femoral heads.