Diagnosis Of Developmental Dysplasia Of The Hip Research Articles

Optimizing the Time for Developmental Dysplasia of the Hip Screening: Earlier or Later?

Developmental dysplasia of the hip (DDH) is still a common and important disorder of childhood, with a prevalence of 0.1 to 2/1000 children. Using ultrasonography (US) in screening of DDH reduces the rates of open reductions and complications. In the current study, we aim to detect the optimal time for US examination for detecting DDH to prevent unnecessary repeating US examinations and treatments. Children referred to US examination for a healthy child screening program, according to the health policy of our country, are included in the current prospective study. Both hips of each child were sonographically examined by the same radiologist using Graf's method at 4th, 8th, 12th weeks of life. A total of 2020 hips of 1010 children were examined. Fourth-week US results can predict 12th-week results (right hip: sensitivity 100%, specificity 75.7%; left hip: sensitivity 100%, specificity 78.3%). Eighth-week US results can predict 12th-week results (right hip: sensitivity 100%, specificity 87.5%; left hip: sensitivity 100%, specificity 83.9%). In predicting 12th-week US results, 8th-week results are found to be more successful than 4th-week results. Late diagnosis of DDH might cause serious public health problems. On the other hand, early US examinations can result in false-positive diagnosis. Unfortunately, there is still confusion about the optimal time for DDH screening with US, especially among radiologists who are not specialized in DDH sonography. A US scan performed at eighth week of life can predict any pathology presence safely and correctly.

What is the incidence of late detection of developmental dysplasia of the hip in England?: a 26-year national study of children diagnosed after the age of one.

The aim of this study was to establish the incidence of developmental dysplasia of the hip (DDH) diagnosed after one-year of age in England, stratified by age, gender, year, and region of diagnosis. A descriptive observational study was performed by linking primary and secondary care information from two independent national databases of routinely collected data: the United Kingdom Clinical Practice Research Datalink and Hospital Episode Statistics. The study examined all children from 1 January 1990 to 1 January 2016 who had a new first diagnostic code for DDH aged between one and eight years old. The incidence of late-diagnosed DDH was 1.28 per 1000 live births. Within the study population, 754 children were identified with a diagnosis of DDH after one-year of age. Of all late diagnoses, 536 (71.1%) were detected between one to two years of age. There were 608 female patients (80.6%) and 146 male patients (19.4%), giving a female-to-male ratio of 4.2:1. Distribution was evenly spread throughout England. The incidence of late-diagnosed DDH has not been reduced from that reported 35 years ago, prior to the introduction of the national selective screening programme for DDH. Cite this article: Bone Joint J 2019;101-B:281-287.

Genetic variant of WIF1 gene is functionally associated with developmental dysplasia of the hip in Han Chinese population

Developmental dysplasia of the hip (DDH) is a common skeletal disorder. Studies have demonstrated a significant role of WIF1 gene in skeletal development. The present study was conducted to reveal the association between DDH and gene WIF1. A two-stage case-control candidate gene association study was conducted in total 1573 samples (586 DDH patients and 987 healthy controls) in this study. Polymorphism rs3782499 was genotyped in all samples. Difference of WIF1 expression in hip joint tissue was compared between the patients and the controls. WIF1 expression was compared among different genotypes in DDH patients. The SNP rs3782499 was found significantly associated with DDH in the two-stage study with 585 patients and 987 controls. There was a significant difference in allele frequency (p = 4.37 * 10−5) and genotype distribution in a recessive model (AG + GG vs. AA). DDH patients were found to have significantly higher WIF1 expression than controls. Moreover, Patients with rs3782499 genotype AA have a significantly increased expression of WIF1 than those with GG. To conclude, polymorphism rs3782499 of WIF1 gene is a functional variant regulating the expression of WIF1 in DDH in Chinese Han population, which might be a potential biomarker for the early diagnosis of DDH.

Developmental Dysplasia of the Hip.

Pediatricians are often the first to identify developmental dysplasia of the hip (DDH) and direct subsequent appropriate treatment. The general treatment principle of DDH is to obtain and maintain a concentric reduction of the femoral head in the acetabulum. Achieving this goal can range from less-invasive bracing treatments to more-invasive surgical treatment depending on the age and complexity of the dysplasia. In this review, we summarize the current trends and treatment principles in the diagnosis and treatment of DDH.

Three-dimensional Computerized Tomography and Multiplanar Imaging of Developmental Hip Dysplasia.

Developmental dysplasia of the hip (DDH) is still one of the biggest orthopedic problems in the world. Global poverty and refugee crises have led to it becoming a greater issue even in developed nations. Early diagnosis and effective treatment of DDH are required to prevent the possibility of arthrosis, limb shortening, pelvic asymmetry, and vertebral scoliosis. In late cases, surgery is the only choice for correction. Direct radiography has been used for many years and continues to have an important role, though ultrasonography is the primary source for early postnatal screening. Although magnetic resonance imaging (MRI) has become an important modality to provide sectional imaging in many cases, in late-period dysplasia, computed tomography (CT) and three-dimensional (3D) CT are preferred because it can more effectively demonstrate the cortical bony structures. The aim of this review was to demonstrate the effectiveness of 3D CT and multiplanar reconstruction based on previous studies.

Medico-legal examination of patients with developmental dysplasia of hip treated surgically due to late diagnosis

Aim: Physicians assessing newborns with risk factors for developmental dysplasia of the hip (DDH) have responsibility for early diagnosis. Written records of the fulfillment of such responsibility is required in medico-legal terms. The present study aims to examine the written records of the hospitals where patients with late-diagnosed DDH were born.Material and Methods: This retrospective study examined the records of the hospitals in which 53 DDH patients aged more than nine months were born. We investigated whether the requirements for the early diagnosis of these patients were recorded in written and interviewed with the obstetricians, pediatricians and family physicians who followed these patients. They were asked about their attitudes toward giving families informational documents about DDH and explaining protective measures verbally.Results: There was no written approved record that they have been informed about the disease in any institution and indicating that the responsibilities for the early diagnosis of these patients were fulfilled. The families were given informational documents in three of five private hospitals and in one university hospital. All of physicians informed the families about the early DDH diagnosis and the things to do, verbally. Conclusion: In case of late-diagnosed DDH, the society as well as the child and the child’s family get harmed socioeconomically. Therefore, it may pose a medico-legal problem. This risk increases more in countries where newborn screening policies are not adequately implemented. In conclusion, written documents taken from families about the early diagnosis of DDH will legally protect physicians and health care organizations.

Computed Tomography Characteristics of the Acetabulum in Developmental Dysplasia of the Hip

Background: Low-dose computed tomography (CT) is the preferred method for post-reduction evaluation of hips of infants in spica casts, but the assessment of acetabular morphological features in developmental dysplasia of the hip (DDH) using CT has not be done before. Objectives: To determine CT imaging characteristics of the acetabulum in DDH and to be able to determine DDH in pelvic CT examinations performed for different purposes. Patients and Methods: CT images of 102 consecutive patients with DDH (90 females, 12 males) and 51 age-matched controls (26 females, 25 males) were included in this study. Acetabular shape abnormalities, surface irregularity, subcortical sclerosis, shallowing, and measurement of acetabular cortical bone thickness were evaluated in coronal reformatted images. Differences in the cortical thickness of dysplastic and normal hips were assessed. Results: Forty-four patients (43.1%) had unilateral and 58 had bilateral DDH (56.9%). Acetabular margin irregularity was present in all patients with unilateral DDH and 55 of the 58 patients with bilateral DDH (94%). Thickening on the inferior part of the ilium compared to the normal side was seen in 41 of the 44 unilateral DDH patients (93%). In the 44 patients with unilateral DDH, the mean cortical thickness measured from the central part of the acetabulum was 0.86 ± 0.03 mm and 0.65 ± 0.03 mm on the normal and dysplastic sides, respectively (P = 0.0001). This difference was more distinct at the acetabular rim, measuring 1.11 ± 0.06 mm and 0.70 ± 0.04 mm on normal and dysplastic sides, respectively (P = 0.0001). Conclusion: Acetabular marginal irregularity and flattening is a reliable finding in the diagnosis of DDH when combined with thickening on the inferior part of ilium and will help in the diagnosis of DDH in patients older than 6 months old with a pelvic CT scan due to diseases other than DDH.

The 'clicky hip': to refer or not to refer?

The significance of the 'clicky hip' in neonatal and infant examination remains controversial with recent conflicting papers reigniting the debate. We aimed to quantify rates of developmental dysplasia of the hip (DDH) in babies referred with 'clicky hips' to our dedicated DDH clinic. A three-year prospective cohort study was undertaken between 2014 and 2016 assessing the diagnosis and treatment outcomes of all children referred specifically with 'clicky hips' as the primary reason for referral to our dedicated DDH clinic. Depending on their age, they were all imaged with either ultrasound scan or radiographs. There were 69 'clicky hip' referrals over the three-year period. This represented 26.9% of the total 257 referrals received in that time. The mean age at presentation was 13.6 weeks (1 to 84). A total of 19 children (28%) referred as 'clicky hips' were noted to have hip abnormalities on ultrasound scan, including 15 with Graf Type II hips (7 bilateral), one Graf Type III hip, and three Graf Type IV hips. Of these, ten children were treated with a Pavlik harness, with two requiring subsequent closed reduction in theatre; one child was treated primarily with a closed reduction and adductor tenotomy. In total, 11 (15.9%) of the 69 'clicky hip' referrals required intervention with either harness or surgery. Our study provides further evidence that the 'clicky hip' referral can represent an underlying diagnosis of DDH and should, in our opinion, always lead to further clinical and radiological assessment. In the absence of universal ultrasound screening, we would encourage individual units to carefully assess their own outcomes and protocols for 'clicky hip' referrals and tailor ongoing service provision to local populations and local referral practices. Cite this article: Bone Joint J 2018;100-B:1249-52.

The influence of health policy on early diagnosis and surgical incidence of developmental dysplasia of the hip.

BackgroundHip screening is the standard approach for the early detection of developmental dysplasia of the hip (DDH). However, there is a lack of evidence regarding the effects of national policy on early diagnosis and later surgical incidence. The purpose of this national study is to estimate DDH incidence in the Taiwanese population through a new diagnosis definition and to examine whether a health promotion policy could reduce surgeries for DDH.Methods and resultsSix birth-year cohorts (2000–2005) were evaluated for DDH diagnosis and related surgeries using the database of the National Health Insurance Administration, which covers 99% of the population of Taiwan. Children with three or more sequential International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes (754.3x) in the outpatient claim file or DDH-related surgeries were studied. The outcome of hip screening was evaluated with the ratio of early diagnosis (0–6 months) to late diagnosis (1–5 years) and the incidence of major surgeries for DDH. DDH incidence was 1.54 per thousand live births (2,255/1,462,539). After a hip screening promotion policy was implemented in 2002, ratios of early/late diagnosis increased from 1.06, 1.25, 1.38, and 1.5 to 1.75 for the years 2000 to 2005, respectively. Incidences of major surgery decreased from 0.41–0.47 per thousand before policy administration to 0.33–0.37 per thousand after policy administration.DiscussionThe DDH incidence of 1.54 per 1,000 in a geographically well-defined area offered epidemiological data for further studies in Asian populations. The results suggest that the health promotion policy is associated with an increase in early diagnosis and subsequently a decrease in surgeries for DDH.

A Systematic Review and Meta-analysis on the Reproducibility of Ultrasound-based Metrics for Assessing Developmental Dysplasia of the Hip.

The purposes of this study were to (1) perform a systematic review of articles that reported agreement or reproducibility in repeated diagnosis of developmental dysplasia of the hip (DDH) using ultrasound imaging, (2) estimate the reproducibility in the available dysplasia metrics, and (3) compare reproducibility of the available dysplasia metrics. A systematic review of the Medline and Embase databases was performed by using a search strategy formulated from our research question: "For infants at risk of DDH, are US imaging-based diagnoses reproducible?" Two reviewers independently identified articles for inclusion in the systematic review, and then assessed the quality of the included studies using the Guidelines for Reporting Reliability and Agreement Studies guideline. Variability and agreement-related statistics in the included studies were extracted and included in a meta-analysis for summarizing the available statistics. The reproducibility of the available dysplasia metrics was compared, with a Bonferroni correction made to adjust for multiple comparisons. Twenty eight studies were included in the systematic review. Overall, the quality of the included studies was moderate (average, 10.7/15; range, 6 to 12). Graf's alpha angle had the lowest interexamination variability of the metrics assessed, followed by Graf's beta angle (the variability of the alpha angle was 10% lower than the variability of the beta angle, P<0.05). However, despite Graf's angles having lower variability compared with other dysplasia metrics, their actual variability was still problematically high. This finding was supported by the low intraclass correlation and Kappa coefficient values reported in the included studies. There was also evidence to suggest that the reproducibility in DDH diagnosis has potentially worsened over time. Overall, we found high variability and low agreement in all reported dysplasia metrics. Furthermore, in the last 3 decades, the repeatability of dysplasia metrics has not markedly improved and may even have declined, indicating a genuine need for improving repeatability and reliability of ultrasound-based DDH diagnosis. Level III-systematic review of level III studies.

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.

Diagnostic and treatment preferences for developmental dysplasia of the hip: a survey of EPOS and POSNA members.

PurposeThe aim of this study was to elucidate developmental dysplasia of the hip (DDH) diagnosis and treatment preferences among members of the Pediatric Orthopaedic Society of North America (POSNA) and European Paediatric Orthopaedic Society (EPOS).MethodsA 54-question survey on DDH diagnosis and treatment preferences was distributed to POSNA and EPOS members. Descriptive statistics were performed.ResultsA total of 459 responses were analyzed. Ultrasound was the preferred modality for diagnosing DDH in infants less than six months old; few surgeons preferred radiographs. In all, 57% of POSNA members had radiology technicians perform ultrasounds, only 7% of EPOS members did. The percent coverage defining a dislocated hip varied greatly, the most frequent response being < 20% for POSNA and < 40% for EPOS members. Pavlik harnesses were the most popular harness/brace, used by 90% of POSNA and 71% of EPOS members. POSNA members were more likely than EPOS members to use a rigid abduction brace following initial harness/brace failure. For residual acetabular dysplasia, POSNA members were twice as likely as EPOS members to institute hip abduction bracing. Most surgeons would not perform closed reduction at less than three months of age or open reduction at less than six months of age. Most EPOS ­members used traction prior to reduction; few POSNA members did. Few POSNA and EPOS members believed that reduction should be delayed until the ossific nucleus was visible.ConclusionThere is great variation in the preferred methods for diagnosing and treating DDH. This survey is the largest transcontinental survey to compile diagnostic and treatment preferences for DDH. With wide variations in practice, there is room for quality improvement.Level of Evidence II

Ultrasound measurement and analysis of the hip in healthy infants: a multicenter study

Objective To analysis the change of hip joint in healthy infants by ultrasound, and establish the normal reference value of the developmental dysplasia of the hip(DDH). Methods A total of 8 000 healthy infants from 0 to 24 weeks were collected from the Multi-center study of 10 children′s medical centers. Among them, 3 855 infants(2 065 females and 1 790 males) with complete data and follow-up were included in this study. All subjects were divided into 6 groups (<4, 4~7, 8~11, 12~15, 16~19 and≥20 weeks group). α angle, femoral head length and width, femoral head coverage ratio by acetabulum (FHC) were measured in the coronal view on the neutral position; distance from pubis to femoral head (P-H) and distance from ischium to femoral head (I-H) were measured in the transverse view on neutral position; distance from femoral head topubis (H-P) was measured in the posterolateraltransverse view on the flexion position. The results of each group changes with age were analysised. Results ①The α angle of healthy infants from 0 to 20 weeks were increased with age, the difference among the groups were statistically significant(P 0.05). ②The femoral head length and width of all age groups were increased with age, the difference among all the groups was statistically significant(all P 0.05). ④The P-H and I-H in all age groups showed no statistically significant (all P>0.05). ⑤The H-P of all age groups were increased with age, the difference between the groups were statistically significant(all P<0.05). Conclusions The development of hip joints have the certain regular developmental pattern in healthy infants less than 5 months of birth and are relatively constant after birth more than 5 months. The ultrasound normal reference value of the hip joints can be used for the early diagnosis of the DDH. Clinical Trial Registry ChiCTR-ODC-16008748 Key words: Ultrasonography; Developmental dysplasia of the hip; Infant; Normal reference value

The positive predictive value of asymmetrical skin creases in the diagnosis of pathological developmental dysplasia of the hip.

The aim of this study was to identify the association between asymmetrical skin creases of the thigh, buttock or inguinal region and pathological developmental dysplasia of the hip (DDH). Between 1 January 1996 and 31 December 2016, all patients referred to our unit from primary or secondary care with risk factors for DDH were assessed in a "one stop" clinic. All had clinical and sonographic assessment by the senior author (RWP) with the results being recorded prospectively. The inclusion criteria for this study were babies and children referred with asymmetrical skin creases. Those with a neurological cause of DDH were excluded. The positive predictive value (PPV) for pathological DDH was calculated. A total of 105 patients met the inclusion criteria. There were 71 girls and 34 boys. Only two were found to have pathological DDH. Both also had unilateral limited abduction of the hip in flexion and a positive Galeazzi sign with apparent leg-length discrepancy. Thus, if the specialist examination of a patient with asymmetrical skin creases was normal, the PPV for DDH was 0%. Isolated asymmetrical skin creases are an unreliable clinical sign in the diagnosis of pathological DDH. Greater emphasis should be placed on the presence of additional clinical signs to guide radiological screening in babies and children. Cite this article: Bone Joint J 2018;100-B:675-9.

Developmental dysplasia of the hip: addressing evidence gaps with a multicentre prospective international study.

There is a lack of high quality evidence available to guide clinical practice in the treatment and management of developmental dysplasia of the hip (DDH). Evidence has been limited by persistent confusion on diagnostic and classification terminology, variability in surgeon decision making and a reliance on single centre, retrospective studies with small patient numbers. To address gaps in knowledge regarding screening, diagnosis and management of DDH, the International Hip Dysplasia Institute began a multicentre, international prospective study on infants with hips dislocated at rest. This review discusses the current state of screening, diagnostic and management practices in DDH and addresses important unanswered questions that will be critical in identifying best practices and optimising patient outcomes. There is insufficient evidence to support universal ultrasound screening; instead, selective screening should be performed by 6-8 weeks of age on infants with risk factors of breech presentation, family history, or history of clinical hip instability. Follow-up of infants with risk factors and normal initial screening should be considered to at least 6 months of age. Brace treatment is a sensible first-line treatment for management of dislocated hips at rest in infants < 6 months of age. Early operative reduction may be considered as there is insufficient evidence to support a protective role for the ossific nucleus in the development of avascular necrosis.

Normal Percentile Reference Curves and Correlation of Acetabular Index and Acetabular Depth Ratio in Children.

Radiographic surveillance of the hip is vital in the diagnosis and treatment of developmental dysplasia of the hip (DDH) in children. The acetabular index (AI) and the acetabular depth ratio (ADR) are radiographic parameters for evaluation of acetabular morphology. Normal reference curves for these parameters that allow for serial evaluation of acetabular development in a manner that is independent of age are necessary and clinically useful. The purpose of this study was (1) to establish normal values of AI and ADR in the normally developing pediatric hip up to age 14, (2) to generate percentile reference curves of both parameters, (3) to determine the extent of correlation between AI and ADR, and (4) to assess intrarater and interrater reliability of AI measurement. We identified 1734 patients who underwent anterior-posterior pelvic radiography between 2004 and 2014. A total of 1152 patients (age range, 0.15 to 13.97 y; 2304 hips) were identified as radiographically normal in the radiology report, signed by the attending pediatric radiologist on the basis of the absence of structural deformity of the hip and previously established reference values for DDH assessment. A review of the medical records confirmed that patients had no diagnosis of DDH or any other orthopaedic hip pathology. The AI and ADR were measured in all radiographs. Normal values and fully parametric percentile curves were generated from birth to skeletal maturity. Correlation between AI and ADR was assessed using linear regression analysis. Normal AI decreased, and ADR increased, with age. Percentile curves were generated for AI and ADR. Using the provided equations, measured values can be converted to age-appropriate percentile and Z-score. The 2 parameters exhibited strong correlation (Pearson correlation=-0.789, P<0.001). For every unit increase in ADR, AI decreased by 0.94 degrees. We present updated normative values of AI that expand up to age 14, and novel reference values for ADR. The reference curves allow for the easy conversion of measured values to percentile and Z-score. Using the presented method during surveillance of the pathologic hip, change in acetabular development can now be assessed in a manner that is independent of age and the natural development of the acetabulum. Level IV-case series.

Late-Presenting Developmental Dysplasia of the Hip

Research Article| March 01 2018 Late-Presenting Developmental Dysplasia of the Hip AAP Grand Rounds (2018) 39 (3): 31. https://doi.org/10.1542/gr.39-3-31 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Late-Presenting Developmental Dysplasia of the Hip. AAP Grand Rounds March 2018; 39 (3): 31. https://doi.org/10.1542/gr.39-3-31 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: developmental hip dysplasia, hip abduction, leg length inequality, live birth Source: Talbot C, Adam J, Paton R. Late presentation of developmental dysplasia of the hip: a 15-year observational study. Bone Joint J. 2017; 99-B(9): 1250– 1255; doi: https://doi.org/10.1302/0301-620X.99B9.BJJ-2016-1325.R1Google Scholar Investigators from multiple institutions in the United Kingdom conducted an observational cohort study to assess the incidence and characteristics of late-presenting irreducible developmental dysplasia of the hip (DDH). All infants referred to a regional pediatric orthopedic clinic from 1997–2011 with DDH were included. This was the referral clinic for all infants identified by the regional DDH screening program, a program that required a clinical hip exam for all infants within 48 hours of birth and referral within 1–2 weeks for those with clinical hip instability (ie, positive Ortolani or Barlow maneuvers) and 6–9 weeks for those without hip instability but with DDH risk factors present (ie, breech birth and/or family history). All referred infants had risk factors confirmed, hips reexamined, and hip ultrasound performed. Irreducible DDH was diagnosed by ultrasound, and late-presenting DDH was defined as the diagnosis after 3 months of age or having a delayed review or investigation as part of the regional screening program. Investigators calculated the incidence of late-presenting irreducible DDH as the ratio of cases over the number of live births in the region during the study period. The clinical characteristics of infants with late-presenting irreducible DDH were described. There were 64,670 live births and 18 infants with late-presenting irreducible DDH over the study period, resulting in an incidence of 0.48 per 1,000 live births. Each of the 18 infants had a normal clinical examination at birth and no recorded abnormality at 6–8 weeks of age. Two infants were late-presenting because of delayed review despite having DDH risk factors (both had missed appointments). An additional 3 infants had a positive family history (2 parents did not know their family history prior to referral to the orthopedic clinic, and the other was never asked about their family history at the 48-hour exam). The most common reasons for referral for infants who were diagnosed with late-presenting irreducible DDH were leg length discrepancy and limited hip abduction. The investigators conclude that despite universal DDH screening, late-presenting irreducible DDH still occurs and can present as leg length discrepancy and limited hip abduction. Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Early diagnosis and treatment of DDH is important to provide the optimal clinical outcome.1 The incidence of DDH varies depending on the criteria used for diagnosis, the population studied, and the method of screening2 ; the incidence is approximately 1 in 1,000 live births.2 Important risk factors for DDH include breech position, female gender, being first born, and a positive family history. Breech presentation is the most important single risk factor.3 Screening for DDH is important because the condition is initially occult, is easier to treat... You do not currently have access to this content.

CHALLENGES OF MOLECULAR-BASED DIAGNOSIS DEVELOPMENTAL DYSPLASIA OF THE HIP IN CHILDHOOD

Developmental dysplasia of the hip (DDH) is a vital and most frequently diagnosed disorder in pediatricrequiring developement and implementation of new diagnostic methods because of failure in detection of early dysplastic changes. Limitation in applying the diagnostic instrumental methods in infants and lack of uniform standards of clinical practice and management results in the increase in treatment cost and duration of rehabilitation. The purpose of this study was the search for new sensitive methods of diagnostics and treatment of DDH and profound study of pathogenic mechanisms. Despite the great attention of international pediatric specialists to the problem of DDH in children, the methods for early diagnostics, prevention of severe forms and complications are not still developed. The current study identifies the molecular mechanisms of DDH pathology and analyses the opportunities of instrumental and non-instrumental methods for its diagnosis. The authors presented the promising biomarkers and cytokines for the diagnosis and prediction of DDH.

Diagnosis and treatment of developmental dysplasia of the hip: A current practice of paediatric orthopaedic surgeons.

Developmental dysplasia of the hip (DDH) is one of the prevalent musculoskeletal conditions in young adults and is a leading cause of hip osteoarthrosis in this age group. The optimum age for surgical intervention when needed is not well established in the literature and the lack of management guidelines and standard practice of DDH leads to different practices worldwide. This study aims to investigate the current practice of paediatric orthopaedic surgeons in diagnosing and treating DDH worldwide and identify points of agreement and disagreement. A cross-sectional study utilizing an online questionnaire was designed to examine the different points of view and current practice of paediatric orthopaedic surgeons worldwide regarding DDH diagnosis and treatment. Ninety-one surgeons responded, with an overall response of 45.5%. The vast majority of respondents use ultrasonography in children less than 3 months of age and pelvic radiography in over 3 months to diagnose DDH. Pavlik harness is the most popular DDH treatment for children younger than 6 months. For older children, closed reduction with hip spica cast is the most preferable treatment. The maximum duration of first-line treatment has a broad range. The treatment of bilateral DDH varies widely among surgeons. This study shows clearly that paediatric orthopaedic surgeons do not agree on the diagnosis and treatment protocol of DDH, hence different approaches to this common disease are practised. The lack of an international guideline should motivate paediatric orthopaedic surgeons to discuss and formulate a uniform and evidence-based protocol for the diagnosis and treatment of DDH.

Early dynamic ultrasound for neonatal hip instability: implications for rural Australia

BackgroundNeonatal instability of the hip (NIH), where the femoral head can move away from the acetabulum, in the first weeks of life, is an important risk factor for developmental dysplasia of the hip (DDH). In rural areas in Australia, there is a recent trend to increased late diagnosis of DDH. Clinical screening of infant hips, a common practice in Australia, is experience dependent. Best practice early screening techniques are still debated with different techniques and timing used internationally. This systematic review examines early dynamic ultrasound (eDUS) screening for hip instability in the first 6 weeks after birth, and the early interventions informed by these findings and considers the findings for the context of rural Australia.MethodsThe Cochrane Library, Medline, CINAHL and PEDro were searched for original research or systematic reviews, and clinical studies 1998 to 2015 involving dynamic ultrasound. Critical Appraisal Skills Programme tools were used to appraise the studies.ResultNineteen studies were included. Early Dynamic Ultrasound (DUS) is consistently described as a reliable assessment of NIH. Early DUS is recommended for risk factors including geographical areas of high prevalence. Approaches to early intervention of hips with excessive movement are somewhat discipline-related and include: primary prevention (advice), secondary prevention (abduction supports), and conservative management (removable splints).ConclusionsIn the context of increased prevalence of DDH in rural Australia, contemporary evidence suggests that introduction of early DUS could provide rural infants with more effective screening than clinical examination alone. Targeted early advice about posturing and simple removable supports to abduct infant hips could prevent some cases of DDH in rural Australia.