Late Developmental Dysplasia Of The Hip Research Articles

Universal screening may reduce the incidence of late diagnosis of developmental dysplasia of the hip : a systematic review and meta-analysis.

We investigated the prevalence of late developmental dysplasia of the hip (DDH), abduction bracing treatment, and surgical procedures performed following the implementation of universal ultrasound screening versus selective ultrasound screening programmes. A systematic search of PubMed, Embase, The Cochrane Library, OrthoSearch, and Web of Science from the date of inception of each database until 27 March 2022 was performed. The primary outcome of interest was the prevalence of late detection of DDH, diagnosed after three months. Secondary outcomes of interest were the prevalence of abduction bracing treatment and surgical procedures performed in childhood for dysplasia. Only studies describing the primary outcome of interest were included. A total of 31 studies were identified, of which 13 described universal screening and 20 described selective screening. Two studies described both. The prevalence of late DDH was 0.10 per 1,000 live births (95% confidence interval (CI) 0.00 to 0.39) in the universal screening group and 0.45 per 1,000 live births (95% CI 0.31 to 0.61) in the selective screening group. Abduction bracing treatment was performed on 55.54 per 1,000 live births (95% CI 24.46 to 98.15) in the universal screening group versus 0.48 per 1,000 live births (95% CI 0.07 to 1.13) in the selective screening group. Both the universal and selective screening groups had a similar prevalence of surgical procedures in childhood for dysplasia being performed (0.48 (95% CI 0.32 to 0.63) vs 0.49 (95% CI 0.31 to 0.71) per 1,000 live births, respectively). Universal screening showed a trend towards lower prevalence of late DDH compared to selective screening. However, it was also associated with a significant increase in the prevalence of abduction bracing without a significant reduction in the prevalence of surgical procedures in childhood for dysplasia being performed. High-quality studies comparing both treatment methods are required, in addition to studies into the natural history of missed DDH.Cite this article: Bone Joint J2023;105-B(2):198-208.

Is the surgery safe for DDH in a walking child? Analysis of approach and medium-term outcomes of surgical management of DDH in walking children

Background: Developmental dysplasia of the hip (DDH) is one of the common paediatric orthopaedic condition. Although a set protocol is in place to detect this problem during neonatal period, a majority of which goes unnoticed and present at very late age when the child is walking. The outcomes of survival of femoral head and the morphology of hip in the long term mainly depend on the time of intervention to contain the femoral head in the acetabulum. Our hospital being a tertiary referral centre often deals with late presenting DDH. We present our approach in managing untreated DDH in a walking child.Materials and Methods: This study included a total number of 64 children with 85 hips were treated and evaluated between the periods 2006 to 2015 with a minimum follow up of one year. Children with hip dysplasia due to cerebral palsy, myopathies, connective tissue disorders and teratological dislocations were excluded from the study. All children were treated with open reduction and capsulorrhaphy through a standard anterior approach to the hip. Femoral shortening and an acetabulopalsty were done as and when needed for the coverage of the femoral head. The children were evaluated clinically and radiologically for a minimum period of one year.Results: Open reduction with capsulorrhaphy was done in all children and this was combined with an additional acetabulopalsty in 15 children, femoral shortening osteotomy in 15 children and both procedures were done in 10 children. 75% of the patients had hip stiffness during early postoperative period which resolved in 6 months and inferior subluxation was noted in one patient. Re dislocation was seen in 4 hips, and avascular necrosis of femoral head was observed in 3 hips. Superficial wound infection was observed in 3 children which was treated conservatively.Conclusion: DDH in a walking child can be managed with open reduction to give good functional outcome but carries more complication rates than early intervention. An additional procedure of acetabulopalsty, femoral shortening osteotomy in selected patients is necessary for good concentric reduction of the hip joint and to minimise the complications.

Is Radiographic Imaging Necessary for Identifying Late Developmental Dysplasia of the Hip in Breech Infants with Normal Ultrasounds?

Purpose. The goal of our study was to investigate the prevalence of late DDH cases in breech infants who had a normal screening hip ultrasound and subsequent follow-up hip x-ray imaging. Methods. Infants with a history of intrauterine breech position, normal hip ultrasound within 3-months of birth, and follow-up hip x-rays within 2-years were included. Acetabular indices were measured on a supine AP pelvis radiograph. Results. Fifty-six patients had breech presentation at birth, a normal hip ultrasound, and returned for radiographic evaluation within 2 years. Of those, 11/112 (10%) of hips had late DDH based on their radiographic images at 1 standard deviation greater than normative values from age-adjusted controls. No infants showed hip dysplasia at 2 standard deviations greater than normative values from age-adjusted controls. Conclusions. Our results support previous studies that follow up should be considered for infants with breech presentation and normal hip ultrasounds near birth. Level of evidence. II.

Examining the effectiveness of examination at 6–8 weeks for developmental dysplasia: testing the safety net

ObjectiveThe ‘GP check’ at 6–8 weeks forms part of the selective surveillance system for developmental dysplasia of the hip (DDH) in the UK. It is imperative to pick up DDH...

Hip sonography screening - the basis for early developmental dysplasia detection and successful treatment

Introduction: Developmental dysplasia of the hip (DDH) is a wide spectrum of anomalies, ranging from simple instability with laxity of the articulation capsule to total dislocation of the femoral head from the acetabular socket. The development of the baby in the first months is very fast and the early diagnosis and the appropriate treatment is important for the successful outcome of the disease. Materials and Methods: Several infantile hip ultrasonography methods have been defined to assess the relationship between the femoral head and acetabulum. The method of Graf is the one that was defined first and is perhaps the most widely used. Reinhard Graf from Stolzalpe, Austria developed his technique in the late 1970s. The primary advantage of this method is that it has a standardised ex­amination technique, as well as a very well defined numeric hip typing system. It divides the joint in 4 types which correlate with the pathological changes. The ultrasound typing is based on a description of important elements of the acetabulum and measurement of two angles which quantify the bony ac­etabular roof and the cartilaginous acetabular roof. Throughout the years, a number of studies have shown the efficiency of the method of Graf in reducing the rate of late DDH and invalidity. Results: The study present the results of the screening and early treatment of DDH in the Department of Orthopaedics and traumatology - Medical University of Varna. The operative activity of this dis­ease has decreased substantially - from 2-3 per month in the late 90s, to 2-3 per year today. Conclusion: Early diagnosis and regular examinations lead to better and more effective treatment - by means of abduction gymnastics, abduction pants, and Pavlik harness. Thus the successful treat­ment of DDH depends on an early accurate diagnosis and an earlier start of the treatment.

Screening for developmental dysplasia of the hip in a rural health district: An analysis of practice.

To describe hip dysplasia screening practices in a local rural health district. Cross-sectional study of hospital birth records, local physiotherapy records, public community health electronic medical record (Community Health Information Management Enterprise database) and a survey of local clinicians who work with infants and children. Three rural public hospitals and community health centres in a New South Wales health district. Birth records (n=196) from March 2012 to May 2012; attendance at child and family nurse checks (n=788) May 2013-April 2014; 13 cases of managed developmental dysplasia of the hip (DDH) 2012 and local clinicians (n=49). At birth, the majority of infants (91%, 179/196) had documented hip screening. Community health records show this dropped to 75% (587/788) at 1-4weeks and 29% (227/788) at 6-8weeks. A survey of local clinicians (54% response rate; 49/91) revealed most (78%) screen for DDH and less than half (43%) use guidelines. Almost all (97%) clinicians reported screening for DDH at 6-8weeks of age. Only 51% of clinicians reported having specific training for DDH screening and 76% would like further training. The rate of late DDH requiring management in 2012 was 0.87% (7/806) and the rate of late DDH requiring surgery was 0.25% (2/806). DDH screening practices are well established at birth in the rural health district. There is variability in DDH screening practices beyond 8weeks of age. Clinicians report variations in their knowledge and training. Training in DDH screening and hip screening prompts added to the personal health record might improve rates of DDH screening beyond 8weeks of age.

Late presentation of developmental dysplasia of the hip : a 15-year observational study.

Despite the presence of screening programmes, infants continue to present with late developmental dysplasia of the hip (DDH), the impact of which is significant. The aim of this study was to assess infants with late presenting dislocation of the hip despite universal clinical neonatal and selective ultrasound screening. Between 01 January 1997 to 31 December 2011, a prospective, longitudinal study was undertaken of a cohort of 64 670 live births. Late presenting dislocation was defined as presentation after three months of age. Diagnosis was confirmed by ultrasound and plain radiography. Patient demographics, referral type, reason for referral, risk factors (breech presentation/strong family history) and clinical and radiological findings were recorded. There were 31 infants with an irreducible dislocation of the hip, an incidence of 0.48 (95% confidence interval (CI) 0.34 to 0.68) per 1000 live births. Of these, 18 (0.28 (95% CI 0.17 to 0.44) per 1000 live births; 58%) presented late. All infants had a documented normal newborn clinical examination and no abnormality reported in the six to eight week check. Of the 18 late presenting cases 72% (n = 13) had no risk factors: 16 were referred by GPs and two were late due to administrative issues (missed appointments). The mean time to diagnosis was 62.4 weeks (19 to 84). Despite universal clinical neonatal and selective ultrasound screening, late cases of irreducible hip dislocation still occur. We recommend an update of the national screening programme for DDH, a review of training and education of healthcare professionals involved in the physical examination of neonates and infants, and the addition of a further assessment after the six to eight week check. Cite this article: Bone Joint J 2017;99-B:1250-5.

Characteristics of developmental dysplasia of the hip at a tertiary hospital in Riyadh, Saudi Arabia

Context: Developmental dysplasia of the hip (DDH) is a spectrum of disorders ranging from subluxation to complete dislocation of the hip joint. There are limited number of recent studies describing the characteristics of patients with DDH in Saudi Arabia. Aims: The aim of the study was to describe the characteristics of DDH patients and the types of treatment methods they underwent. Subjects and Methods: The present retrospective study comprised data exploring some related factors of DDH in King Abdulaziz Medical City (KAMC) in Riyadh from 2004 to 2014. Primary data of children referred to the orthopaedic outpatient clinic with DDH were analysed. Data included: gender, laterality, place of delivery, age at the time of diagnosis and type of intervention. Descriptive and inferential statistics were computed. Results: A total of 176 DDH diagnosed patients were studied; 151 of which were female (85.8%). Of whom, 87 patients were delivered at KAMC (49.4%). There were 82 patients diagnosed with bilateral DDH (46.6%). The ages of diagnosis were included with 88.8% of the sample diagnosed after 3 months which was highly associated with unilateral disease (P Conclusions: The awareness of DDH should be increased among paediatricians to decrease the incidence of late DDH diagnosis. A structured screening program has to be created and implemented in all hospitals of the country to detect DDH earlier and to provide treatment as early as possible.

Late Developmental Dysplasia of the Hip That Was Sonographically Determined to Be Stable at First Examination: A Case Report.

Developmental dysplasia of the hip (DDH) is the most common skeletal dysplasia in childhood1. If the diagnosis of DDH is not determined during the first months of life and therefore is left untreated, it can lead to permanent deformities and osteoarthritis in later years2. In infants, hips that are clinically and sonographically stable just after birth should develop normally as long as their evolution is not disrupted by neurologic, septic, or traumatic reasons. In the first six months after birth, ultrasonography of the hip is the most valuable method to diagnose DDH. Early diagnosis of DDH with sonographic screening programs and early treatment have reduced the rate of late-developing dysplasia1,2. This case report describes a patient who was assessed for DDH when she was eight weeks old. At that time, the hips were found to be clinically and sonographically stable. However, DDH was evident six months later. The patient’s parents were informed that data concerning the case would be submitted for publication, and they provided consent. A six-month-old baby girl was admitted to our clinic because of limited range of motion in the left hip. During the physical examination, skinfold asymmetry and limited abduction of the left hip …

Ultrasound Can Help Solve Orthopaedic Mysteries.

Among orthopaedic imaging modalities, ultrasound is a useful adjunct to radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Relative to the other technologies, ultrasound is the safest, most portable, and least expensive. But because sound waves cannot penetrate beyond cortical bone, it’s easy to overlook the value of ultrasound in orthopaedic practice. Routine use of ultrasound to help screen newborns for developmental dysplasia of the hip (DDH) has substantially decreased the incidence of related disabilities later in life. However, like all imaging modalities, ultrasound is not infallible, as demonstrated in a case report by Gumustas et al. in the November 13, 2013 JBJS Case Connector. A six-month-old baby girl presented to the authors’ pediatric orthopaedic clinic with limited abduction of the left hip. When the infant was eight weeks old, an experienced pediatric orthopaedist had evaluated both hips clinically and with ultrasound, and found them to be normal. Based on the patient’s history upon presentation, trauma and infection were ruled out as possible causes of the symptoms, but a pelvic radiograph revealed left hip subluxation indicative of late DDH. The patient underwent adductor tenotomy and closed reduction, followed by …

Open reduction for developmental dysplasia of the hip: failures of screening or failures of treatment?

IntroductionThe aim of this study was to define the clinical indications and demographic characteristics of patients undergoing open reduction for developmental dysplasia of the hip (DDH), and determine the proportion due to preventable failures of contemporary clinical screening and early management.MethodsCase notes were reviewed of consecutive primary open reductions performed for non-teratologic hip dislocation at the Great Ormond Street Hospital for Children over a five-year period. Forty-eight patients (64 hips) were suitable for inclusion. A telephone survey confirmed selective hip ultrasonography screening protocols were employed in all maternity hospitals in our referral base.ResultsThere were no cases of open reduction for unilateral DDH following Pavlik treatment commenced by six weeks of age, highlighting the importance of early detection and treatment. Eleven cases (23%) may have been avoided by appropriate implementation of existing selective ultrasonography screening protocols. Thirty-four cases (71%) presented after four months of age, suggesting open reduction is associated with late diagnosis rather than failure of primary management. None of these patients had neonatal hip ultrasonography and only 12% (4 patients) had a risk factor that should have triggered a scan.ConclusionsCompared with published results, the contemporary screening practices in our referral base are failing to eliminate late presenting DDH and the need for open surgical reduction. Changes in strategy and implementation are required to significantly improve screening efficacy.

Developmental Dysplasia of the Hip

1. Blaise A. Nemeth, MD, MS* 2. Vinay Narotam, MD† 1. *Associate Professor, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI. 2. †Assistant Professor, Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, NC. * Abbreviations: AVN: : avascular necrosis DDH: : developmental dysplasia of the hip Early detection of developmental dysplasia of the hip is essential because restoration of the normal relationship of the femoral head and acetabulum increases the likelihood of normal development. Pediatricians must be aware of the American Academy of Pediatrics guidelines for early detection. After completing this article, readers should be able to: 1. Acknowledge the spectrum of hip pathology included in developmental dysplasia of the hip (DDH). 2. Identify newborns at risk for DDH. 3. Diagnose hip dislocations by using appropriate physical examination maneuvers. 4. Appropriately use imaging modalities to screen for DDH in infants who have normal or equivocal physical findings. 5. Recognize the presentation of hip dislocation in the older child. Developmental dysplasia of the hip (DDH) encompasses the spectrum of hip abnormalities involving the relationship between the femoral head and the acetabulum during early growth and development. A hip may be dislocated at rest, dislocatable (but in a normal position at rest), subluxed (incomplete contact between the femoral head and acetabulum), subluxable (incomplete contact induced with provocative maneuvers), or appear normal on physical examination yet have an abnormally shaped acetabulum or femoral head radiographically. The previously used term, “congenital hip dislocation,” has been abandoned in recognition of this spectrum, acknowledging as well the fact that a child may have normal examination findings at birth but progress to dislocation later in life. Strictly speaking, the term DDH does not apply to abnormal development of the hip due to other diseases, such as cerebral palsy, Legg-Calve-Perthes disease, or slipped capital femoral epiphysis, in which “hip dysplasia” is a sufficient term, nor does the term include traumatic dislocation. In addition, the term “teratologic dislocation” is reserved …

Predictive Value for Femoral Head Sphericity From Early Radiographic Signs in Surgery for Developmental Dysplasia of the Hip

Avascular necrosis after treatment for late developmental dysplasia of the hip can result in deformity of the femoral head and long-term morbidity. This study aims to analyze the clinical and radiographic factors that are associated with femoral head deformity in the early stage of avascular necrosis. Thirty patients with unilateral developmental dysplasia of the hip treated by the same operation before 3 years of age and who developed early signs of avascular necrosis, were studied. Avascular necrosis was diagnosed by either broadening of the femoral neck, fragmentation of the capital epiphysis, or the presence of a metaphyseal growth disturbance line in the first postoperative year. After 10-year follow-up, the hips were classified into spherical head or deformed head by irregularity <2 mm or more to analyze the associated factors. Sixteen hips had spherical femoral heads and the other 14 hips had deformed femoral heads. Age, sex, side, Tonnis classification, and preoperative or postoperative acetabular index were not associated with the outcome after avascular necrosis. Among the early signs of avascular necrosis, fragmentation of the capital epiphysis was significantly associated with later head deformity. Fragmentation was a sign with high sensitivity (79%) and high specificity (88%) in predicting a deformed head. Broadening of femoral neck had a high sensitivity (93%), but a low specificity (38%) in outcome prediction. Fragmentation and flattening of the femoral epiphysis are the worst radiographic signs indicating subsequent growth disturbance and deformity of the proximal femur. Broadening of the femoral neck exhibited high sensitivity in predicting later deformity, and physicians should be alerted to subsequent epiphyseal fragmentation. A metaphyseal growth disturbance line is a sign of avascular necrosis, but the predictive value is limited. Diagnostic level 3.

Combined pelvic osteotomy for the bipartite acetabulum in late developmental dysplasia of the hip

In late developmental dysplasia of the hip in childhood, the deformed dysplastic acetabulum is malaligned and has lost its shape due to pressure from the subluxed femoral head. The outer part of the acetabulum involves the upper part of the original acetabulum, thereby giving a bipartite appearance. A clear edge separates the outer from inner part which represents the lower part of the original acetabulum and has no direct contact with the femoral head. Combined pelvic osteotomy (CPO) using a Lance acetabuloplasty with either a Salter or a Pemberton procedure restores the original shape and realigns the acetabulum. A total of 20 children (22 hips), with a mean age of 46 months (28 to 94) at primary operation underwent CPO with follow-up for between 12 and 132 months. In each case concentric stable reduction with good acetabular cover was achieved and maintained throughout the period of follow-up.

The role of comparative panoramic visualization of radiographs in the diagnosis of developmental dysplasia of the hip: reply to Daza and Osorio

Sir, We read with interest the recent letter of Drs. Daza and Osorio [1] concerning radiography in developmental dysplasia of the hip (DDH) and are pleased to note their comments and respond to them. We are in full agreement about their depiction of findings in DDH and their explanation of the correlation with normal and abnormal stresses upon the developing neonatal and infant acetabulum. When one examines the literature and history of medical care of DDH, one finds many methods over the years that have been developed radiographically to examine qualitatively and quantitatively the hip joints of infants and children. All are helpful, with some more than others. Our recent article was published in a supplement of Pediatric Radiology that summarized our contribution to the postgraduate course at the 2008 annual meeting of the Society for Pediatric Radiology where the theme was “Evidence-Based Imaging in Pediatrics.” Our task was to examine the last decade of literature on imaging in DDH and report upon the latest available information of whether outcomes in babies with DDH are improved by imaging. In doing so, we reviewed all modalities and comparisons with clinical examination that we could find. Admittedly, we searched only in English. The development and evolution of hip sonography in the last 20 years has been in response to the late emergence of DDH that previously had not been prevented by clinical examination alone or the accompanying use of radiography. In our opinion, the best evidence, as reported in our article, has come out of two Norwegian randomized controlled trials [2, 3]. In babies without risk factors, no statistical difference has been found between expert clinical hip examiners and expert hip sonologists in preventing the rare emergence of cases of late DDH. In babies with DDH risk factors, there has been a trend, not statistically significant, of hip sonography being slightly better diagnostically than clinical examination alone. Some evidence and opinion suggest that when clinical examiners are inexperienced or are unsure of their findings, the use of imaging is likely to be more sensitive in detecting DDH or confirming normal. We are not aware of any large-scale recent trials of infant AP pelvic radiography being compared to clinical hip examination and then checking long-term outcome and the late discovery of DDH. In our opinion, selective use of hip radiography remains a useful adjunct in the care of children beyond early infancy in the follow-up of DDH but has not been shown to improve outcomes when used in routine neonatal and early infant screening.

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.

The lack of evidence of the effect of selective ultrasound screening on the incidence of late developmental dysplasia of the hip in the Greater Glasgow Region

The lack of evidence of the effect of selective ultrasound screening on the incidence of late developmental dysplasia of the hip in the Greater Glasgow Region

The lack of evidence of the effect of selective ultrasound screening on the incidence of late developmental dysplasia of the hip in the Greater Glasgow Region

The aim of our study was to establish whether the use of ultrasound to screen babies with risk factors has reduced the number of children presenting late with developmental dysplasia of the hip. Screening based on selection by risk factors was introduced in 1997. The average annual incidence from 1992 to 1996 was 0.84 and from 1997 to 2001 was 0.57 per 1000 live births. This decline in incidence of late developmental dysplasia of the hip was not significant (P=0.088). Sixty-four children (82%) had nothing that could be perceived as a risk factor for the condition. Our study presents population-based findings and it is clear that selective screening is not working in our region. It is unlikely that there will be one solution that could be applied throughout the United Kingdom given the diversity in the access to healthcare facilities. Clear leadership and accountability are required if we are to make any progress towards abolishing this condition that causes a significant morbidity in young adults.

Ultrasound in the diagnosis of developmental dysplasia of the hip in newborns. The European approach. A review of methods, accuracy and clinical validity

Based on soft evidence that ultrasound screening tends to reduce the rate of late developmental dysplasia of the hip (DDH) and the need for surgical interventions, different screening strategies including universal or selective ultrasound screening have been established in several European countries and centres during the last decade. We performed an extensive search for articles on ultrasound diagnosis of developmental dysplasia of the hip over the last 26 years. A few studies reported an adequate repeatability for the static [Graf, Morin, modified Morin (Terjesen)] and for the combined static/dynamic methods [modified Graf (Rosendahl)], while no such reports were found for the dynamic (Harcke) ultrasound techniques. The effect of newborn ultrasound screening on late DDH have been addressed in two randomised trials (RCTs), both concluding that both selective and universal ultrasound screening tend to reduce the prevalence of subluxed or dislocated DDH, thus without reaching statistical significance. Finally, several observational studies have shown that morphologically normal hips tend to remain normal with or without a co-existing instability, and 97% of sonographically immature hips tend to normalise spontaneously within 3 months. Two studies report on a similar pattern for mildly dysplastic, but stable hips. From the data available we suggest that selective ultrasound screening is worthwhile in areas with a high prevalence of late cases, given a well-organised, high-quality service can be provided.

Differences in risk factors between early and late diagnosed developmental dysplasia of the hip

Background: Developmental dysplasia of the hip (DDH) is common, affecting 7.3 per 1000 births in South Australia. Clinical screening programmes exist to identify the condition early to gain the maximum...