Hip Dysplasia In Newborns Research Articles

Current issues in the diagnostics of hip dysplasia in newborns in the regions of the Russian Federation

BACKGROUND:Early diagnostics of hip dysplasia in newborns are important medical and social problems because untimely treatment of these children leads to severe irreversible pathological disorders of the hip joint, dysplastic coxarthrosis, and consequently disability. Anamnesis data of patients from the Department of Hip Pathology of H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery show that late diagnoses of the dysplastic pathology of the hip joint are not rare, which does not tend to decrease in number.
 AIM:To identify and analyze the causes of the late diagnosis of dysplastic hip joint pathology in newborns in the Russian Federation.
 MATERIALS AND METHODS:Statistical data from 64 regions of the Russian Federation were collected and analyzed to study the causes of untimely diagnosis of dysplastic hip joint pathology in newborns.
 RESULTS:According to the information received, 3,456,207 children were born in 64 regions of the Russian Federation between 2019 and 2021. Of these children, 108,737 (3.1%) were diagnosed with hip dysplastic pathology of varying severity (acetabular dysplasia, subluxation, and dislocation), and 3,943 cases (3.6%) had untimely diagnosis.
 CONCLUSIONS: Late diagnosis is primarily caused by the untimely appearance of patients for ultrasound screening and initial examination by an orthopedist. The secondary reason is the understaffing of medical organizations with specialists–orthopedists and specialists in Doppler ultrasound examination. To reduce the number of cases of late diagnosed or missed dysplastic hip pathologies and improve the quality of orthopedic care for children in the Russian Federation, strengthening health education must be recommended among parents and staff of medical organizations with orthopedic and ultrasound specialists.

The evaluation of ultrasonographic hip measurement differences among physicians according to the Graf method in newborns

Background/Aim: Hip ultrasonography (USG) is the most important diagnostic method in developmental hip dysplasia in newborns. However, a disadvantage of the ultrasonography method is that there can be measurement differences among doctors measuring the same hip. We aimed to investigate the causes and solutions of this situation. We further strived to measure the hip ultrasonography performed by different physicians using the Graf method and comparing the obtained values.
 Methods: Hip USGs of newborns admitted to Malatya Turgut Ozal University Faculty of Medicine Hospital between Jan. 8, 2020 and Jan. 5,.2021 were measured and classified using the Graf method. The study type is consistent with retrospective cohort studies. Newborns aged 0-22 weeks without any additional pathology were included in the study. A radiologist and two orthopedists measured and interpreted the images separately in accordance with the Graf method. The first hip measurements (R1) were made by the radiologist (R) with the USG device, and they were classified according to alpha and beta angles; two printouts were made. The first orthopedic specialist (OS1) and the second orthopedic specialist (OS2) made their measurements with printouts. Subsequently, the results from the physicians were compared.
 Results: A statistically significant difference was found between R1-OS2 (P < 0.001) and OS1-OS2 (P < 0.001) in terms of the Graf classifications. No statistically significant difference was found between R1 and OS1 in terms of the Graf classification (P = 0.562). A statistically significant difference was found between R1-OS2 (P < 0.001) and OS1-OS2 (P = 0.048) angles (alpha and beta) measurements. While R1 and OS1 measurements were compatible with each other, OS2 measurements were found to be inconsistent.
 Conclusion: We think that there may be differences in angle measurements and the Graf classification among physicians who perform hip ultrasonography in newborns, and the most important way to correct this is through regular participation of physicians in subject-specific trainings.

Pavlik harness and Frejka pillow: compliance affects results of outpatient treatment.

Outpatient treatment of hip dysplasia in newborns has excellent results. A combination of general screening with early treatment with a functional abduction device works well. Treatment with the Frejka pillow and the Pavlik harness is frequently used in our region. The aim of the study is to compare efficiency and treatment duration, related to the brace used, and to prove that the choice of an abduction device implies parental compliance with the treatment protocol. Data of 286 treated children were analyzed. The diagnosis was made in the first weeks of life by clinical and sonographic examinations during general screening. The choice of treatment device was expert dependent and was involved by many variables. The experience, type of clinical finding and sonographic pathology according to Graf, availability of a treating facility, and the potential cooperation of individual parents were major parameters. The Frejka pillow was used to treat 145 children and the Pavlik harness was used in 137 children. The treatment duration and percentage of infants lost from follow-up in relation to the device used was documented. The success rate of outpatient treatment was 98.6%. In six patients, the type of device had to be changed during the treatment period. Physiological sonographic findings were achieved in all hips by the end of the treatment. The Frejka pillow was used as the preferred device in milder stable dysplastic hips, while unstable and decentered hips were treated more frequently with the Pavlik harness. Treatment lasted, on average, 95 days and 119 days in the Frejka and in the Pavlik group, respectively; there was no statistical significance in treatment duration of comparable sonographic pathologies. We observed statistically greater parental non-compliance with the treatment protocol in the Pavlik harness group (p = 0.0279; OR 2.7; 95% CI 1.07; 8.5). Neither of the abduction devices was inferior with regard to treatment efficiency. We found that parental cooperation was an important factor during screening and treatment. The treatment decision and the choice of the brace must be made with full consent of the parents, keeping in mind that comfort during the nursing care may have a significant influence on compliance with the treatment protocol.

Targeted Screening of Hip Dysplasia in Newborns: Experience at a District General Hospital in Scotland.

National Health Service Quality Improvement Scotland (NHS QIS) published a health technology scoping report in 2006 acknowledging that there are serious concerns within Scotland in relation to Developmental Dysplasia of Hip (DDH) as there is no formal screening program in place and there are significant variations between NHS boards leading to confusion for staff and parents. NHS QIS identified need for audit work to improve hip screening in Scotland. The aim of this study is review of current practice of selective screening for DDH. All newborns who had their first hip scan during one year period (2014) were included in this retrospective study and followed up until June 2015 to include any surgical intervention for dysplastic hip. Out of 428 babies (856 hip scans), abnormality was seen in 119 babies/147 hips (134 Graf 2a/2b, 10 hips were 2c and 3 hips were Graf grade 3). Average age when first scan was performed was 5 weeks (range 3 weeks to 22 weeks). Analysis of risk factors in 119 babies with abnormal scan was consistent with literature (83 breech, 12 family history, 12 HBW, 10 instability and 2 twins of breech). Twelve babies (16 hips) required treatment and were successfully treated in Pavlik harness. There was one case of missed/late dislocation, which lived in outside catchment area for 3 years since birth. During this study period there was no case of avascular necrosis or femoral nerve palsy as a result of treatment. In our experience, selective hip screening by ultrasound scan is useful in avoiding overtreatment and minimizing late presentations.

Validity and Reliability of a Measuring Device Based on Sound Transmission for Diagnosis of Hip Dysplasia in Newborns

Sound transmission has been used for diagnosis of hip dysplasia in newborns and infants with tunning fork and sthetoscope. The study aims to identify the validity of a device based on sound transmission. Male and female newborns from Celaya, Gto, ranging from 4 to 28-day-old were selected for the study. The sound transmission device was used both, in bilateral assessment (compared sound transmission) and on each hip separately (sound transmission with extension/flexion). In the first application if the sound is lower by a digit, there is a hip unhealthy. In the second application if the sound is increased by a digit, there is also an alteration of the hip. A hip ultrasound was applied using the Graf technique as a gold standard. Sensitivity, specificity and predictive values were calculated to identify validity. The intra-observer and inter-observer Kappa Test was applied to identify reliability. The hips of 103 newborns were assessed, obtaining a sensitivity of 60.9%, and a specificity of 92%; it should be a positive predictive value of 51.9% and a negative predictive value of 95% for the compared sound transmission test. In the sound transmission test with extension/flexion, the values were 82.6%, 96.2%, 73.1% and 97.8% for sensitivity, specificity, positive predictive value and negative predictive value, respectively. The result of the intra-observer kappa was 0.80 and the inter-observer was 0.70 for the compared sound transmission. The intra-observer Kappa was 0.88 and the inter-observer was 0.78 for the compared sound transmission test with extension/flexion. The device for sound transmission is valid and reliable for the diagnosis of dysplastic development hip disease in newborns.

Immediate Treatment Versus Sonographic Surveillance for Mild Hip Dysplasia in Newborns

Immediate Treatment Versus Sonographic Surveillance for Mild Hip Dysplasia in Newborns

Natural progression of hip dysplasia in newborns: a reflection of hip ultrasonographic screenings in newborn nurseries

Hip screening is recommended for early detection of hip dysplasia; however, the strategy and efficacy were questioned. We performed ultrasonography to objectively observe the hip development in a group of infants and raise reflections on the efficacy of newborn ultrasonographic hip screening. A total of 1333 newborns (705 male and 628 female) received hip ultrasonography in the first week after birth. Clinical hip instability was detected by the Ortolani test. Hip dysplasia was defined by ultrasonography. A second survey of 90 babies was performed 1 month later on the babies with clinical hip instability or ultrasonographic Graf's type IIa, IIc, D, III, and IV hips. All the hip ultrasonographies were performed by the same investigator. Clinical instability was detected in 13 hips of 10 babies. Manual tests helped to detect unstable hips that had worse ultrasonographic measurements than those stable hips. Five Graf's type IIc hips and four type III hips were detected from the 2666 hips. At the age of 1 month, eight of the nine Graf's type IIc or III hips attained physiological status without treatment. A strong trend of spontaneous resolution in clinical hip instability and ultrasonographic dysplasia was observed in the newborns. The results did not support immediate treatment on the basis of newborn manual or ultrasound hip screening. We recommend manual testing in the newborn nursery to detect the hips at risk of dysplasia and ultrasonography after the first month after birth to confirm the diagnosis and judge the management.

Immediate Treatment Versus Sonographic Surveillance for Mild Hip Dysplasia in Newborns

We conducted a blinded, randomized, controlled trial to examine whether mildly dysplastic but stable or instable hips would benefit from early treatment, as compared with watchful waiting. A total of 128 newborns with mild hip dysplasia (sonographic inclination angle [alpha angle] of 43 degrees -49 degrees ) and stable or instable but not dislocatable hips were randomly assigned to receive either 6 weeks of abduction treatment (immediate-treatment group) or follow-up alone (active-sonographic-surveillance group). The main outcome measurement was the acetabular inclination angle, measured by radiograph, at 1 year of age. Both groups included 64 newborns, and there was no loss to follow-up. With the exception of a small but statistically significant excess of girls in the active-sonographic-surveillance group, there were no statistically significant differences in baseline characteristics between the 2 groups. The mean inclination angle at 12 months was 24.2 degrees for both groups (difference: 0.1 [95% confidence interval (CI): -0.8 to 0.9]), and all children had improved and were without treatment. The mean alpha angle was 59.7 degrees in the treatment group and 57.1 degrees in the active-surveillance group for a difference of 2.6 degrees evaluated after 1.5 and 3 months (95% CI: 1.8 to 3.4; P < .001). At 1.5 months of age, the hips had improved in all treated children but not in 5 children under active surveillance (P = .06). Among the sonographic-surveillance group, 47% received treatment after the initial surveillance period of 1.5 months. Active-sonographic-surveillance halved the number of children requiring treatment, did not increase the duration of treatment, and yielded similar results at 1-year follow-up. Given a reported prevalence of 1.3% for mildly dysplastic but stable hips, a strategy of active surveillance would reduce the overall treatment rate by 0.6%. Our results may have important implications for families as well as for health care costs.

1382: Natural Progression of Hip Dysplasia in Newborns: A Reflection of Hip Ultrasonographic Screenings in Newborn Nursery

Hip screening is recommended for the early detection of hip dysplasia; however late diagnosed cases persist. We performed ultrasonography to objectively observe the hip development in newborns and questioned the rationale behind hip screening.

Good Results after Treatment with the Frejka Pillow for Hip Dysplasia in Newborns: A 3-year to 6-year follow-up study

Good Results after Treatment with the Frejka Pillow for Hip Dysplasia in Newborns: A 3-year to 6-year follow-up study

Good Results after Treatment with the Frejka Pillow for Hip Dysplasia in Newborns: A 3-year to 6-year follow-up study

Because there is no consensus with regard to the efficiency of the Frejka pillow in the treatment of hip joint dysplasia in newborns, the aim of the present study was to evaluate our results with this device. During the 3-year period 1988 to 1990, the Frejka pillow was used in 108 newborns with clinically unstable hips verified by ultrasonography. There were three treatment failures (2.8%), defined as infants who needed additional treatment with an abduction splint or hip-spica cast. Avascular necrosis of the femoral head occurred in one patient (0.9%). At an age of 3 years to 6 years, 85 of the children attended a follow-up examination. An intoeing gait was observed in 17% and slightly reduced hip mobility in 20% of the patients. Compared with normal children, the patients had somewhat lower coverage of the femoral head by radiography, indicated by a lower centre-edge angle and a higher migration percentage, but the coverage was within the normal range in all cases. The mean anteversion angle was larger than that of normal children but only three patients had abnormally high anteversion angles. In conclusion, the results with the Frejka pillow were good, with few treatment failures and complications, and it is the most simple abduction device for the parents to handle. More rigid devices like the von Rosen splint seem to involve a slightly lower failure rate, but a higher risk of avascular necrosis. Therefore, we recommend the Frejka pillow when treatment is started within a few days of birth.

Good Results after Treatment with the Frejka Pillow for Hip Dysplasia in Newborns: A 3-year to 6-year follow-up study

Summary: Because there is no consensus with regard to the efficiency of the Frejka pillow in the treatment of hip joint dysplasia in newborns, the aim of the present study was to evaluate our results with this device. During the 3-year period 1988 to 1990, the Frejka pillow was used in 108 newborns with clinically unstable hips verified by ultrasonography. There were three treatment failures (2.8%), defined as infants who needed additional treatment with an abduction splint or hip-spica cast. Avascular necrosis of the femoral head occurred in one patient (0.9%). At an age of 3 years to 6 years, 85 of the children attended a follow-up examination. An intoeing gait was observed in 17% and slightly reduced hip mobility in 20% of the patients. Compared with normal children, the patients had somewhat lower coverage of the femoral head by radiography, indicated by a lower centre-edge angle and a higher migration percentage, but the coverage was within the normal range in all cases. The mean anteversion angle was larger than that of normal children but only three patients had abnormally high anteversion angles. In conclusion, the results with the Frejka pillow were good, with few treatment failures and complications, and it is the most simple abduction device for the parents to handle. More rigid devices like the von Rosen splint seem to involve a slightly lower failure rate, but a higher risk of avascular necrosis. Therefore, we recommend the Frejka pillow when treatment is started within a few days of birth.

A new 3-D technology for visualization and evaluation of hip dysplasia in newborns

A new 3-D technology for visualization and evaluation of hip dysplasia in newborns

Cost-effectiveness of ultrasonographic screening for congenital hip dysplasia in new-borns

Objective. Screening for congenital dysplasia of the hips (CDH) of new-borns, mostly by Ortolani’s or Barlow’s tests, is widely performed, but nevertheless dysplasias are still discovered late. Ultrasonographic screening has been reported to reduce the number of these cases. The present investigation is intended to evaluate the cost-effectiveness of such a screening programme. Materials and methods. The cost of performing ultrasound investigations at Haukeland Hospital and the treatment costs of late-discovered CDH were calculated on the basis of 26 cases of late-discovered CDH at Hagavik Orthopaedic Hospital. Figures for sensitivity and specificity were taken from the literature. Results. General ultrasonographic screening programmes for CDH will not be cost-effective because the population screened will be too large and the demands upon sensitivity too high. However, investigating babies at risk is probably cost-effective. Conclusion. A CDH screening programme requires high sensitivity and one should preferably aim at screening babies at risk. In Norway a centralisation to larger hospitals may therefore be necessary.

Cost-effectiveness of ultrasonographic screening for congenital hip dysplasia in new-borns.

Screening for congenital dysplasia of the hips (CDH) of new-borns, mostly by Ortolani's of Barlow's tests, is widely performed, but nevertheless dysplasias are still discovered late. Ultrasonographic screening has been reported to reduce the number of these cases. The present investigation is intended to evaluate the cost-effectiveness of such as screening programme. The cost of performing ultrasound investigations at Haukeland Hospital and the treatment costs of late-discovered CDH were calculated on the basis of 26 cases of late-discovered CDH at Hagavik Orthopaedic Hospital. Figures for sensitivity and specificity were taken from the literature. General ultrasonographic screening programmes for CDH will not be cost-effective because the population screened will be too large and the demands upon sensitivity too high. However, investigating babies at risk is probably cost-effective. A CDH screening programme requires high sensitivity and one should preferably aim at screening babies at risk. In Norway a centralisation to larger hospitals may therefore be necessary.