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International Orthopaedics

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Open Access 01-08-2019 | Original Paper

Screening program for neonates at risk for developmental dysplasia of the hip: comparing first radiographic evaluation at five months with the standard twelve week ultrasound. A prospective cross-sectional cohort study

Authors: Dorien Geertsema, Joris E. Meinardi, Dagmar R. J. Kempink, Marta Fiocco, Michiel A. J. van de Sande

Published in: International Orthopaedics | Issue 8/2019

Abstract

Purpose

To assess whether delayed radiological hip screening at five months (versus ultrasound at 3 months) results in a higher incidence of persistent developmental dysplasia of the hip (DDH) at 18 months.

Methods

We analyzed 3536 screened neonates (2009–2013) at age two to three weeks. In the case of risk factors for DDH, 460 infants were assigned to a pelvic radiograph at five months between 2009 and 2010 and 651 infants were assigned to an ultrasound at three months (2011–2013). In the case of DDH, appropriate treatment was started and radiological follow-up occurred at eight, ten, 12, and 18 months. We compared incidence and severity of persistent DDH at 18 months. Analysis was performed using linear regression.

Results

Both groups were comparable for risk factors (breech, gender, twins, family history). Eighty-nine patients (2.5%) showed DDH (n = 43 (group 1), n = 46 (group 2)). At 18 months, ten patients showed persistent DDH (n = 8 (group 1), n = 2 (group 2) (7.7% vs. 0.3% respectively)). The mean acetabular index (AI) at 18 months in group 1 (left hip) is 22.4° (95% CI 20.6–24.3°) vs. group 2 at 22.3° (95% CI 21.2–23.4°) (p = 0.098). The mean AI in group 1 (right hip) is 21.9° (95% CI 18.9–24.9°) vs. 21.2° (95% CI 20.5–22.0°) in group 2 (p = 0.293). Adjusted for risk factors, there is no difference in incidence of persistent DDH between both groups after 18 months (OR 0.519; 0.07, 3.845).

Discussion

This study revealed no significant difference in incidence or severity of persistent DDH at 18 months between the two screening groups. These results suggest justification for delayed screening to prevent overtreatment of immature hips.

Conclusion

In clinically stable hips, delayed ultrasound between three and five months is regarded as safe and could prevent for overtreatment of mild dysplastic hips.

Bialik V, Bialik GM, Blazer S, Sujov P, Wiener F, Berant M (1999) Developmental dysplasia of the hip: a new approach to incidence. Pediatrics 103(1):93–99CrossRefPubMed

Burger BJ, Burger JD, Bos CF, Obermann WR, Rozing PM, Vandenbroucke JP (1990) Neonatal screening and staggered early treatment for congenital dislocation or dysplasia of the hip. Lancet. 336(8730):1549–1553CrossRefPubMed

Ramwadhdoebe S, Van Merode G, Boere-Boonekamp M, Sakkers RJB, Buskens E (2010) Implementation by simulation; strategies for ultrasound screening for hip dysplasia in the Netherlands. BMC Health Serv Res 23(10):75CrossRef

Swiss Society of Paediatrics: Checklisten für die Vorsorgeuntersuchungen nach den Empfehlungen der Schweizerischen Gesellschaft für Pädiatrie

Früherkennung von Krankheiten bei Kindern bis zur Vollendung des 6 (2017) Lebensjahres (Kinder-Richtlinie). Last update January 2017. https://www.g-ba.de/informationen/richtlinien/15/

American Academy of Pediatrics (2000) Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip Clinical Practice Guideline: Early Detection of Developmental Dysplasia of the Hip. Pediatrics. 105(4 Pt 1):896–905

Tönnis D, Brunken D (1968) Differentiation of normal and pathological acetabular roof angle in the diagnosis of hip dysplasia. Evaluation of 2294 acetabular roof angles of hip joints in children. Arch Orthop Unfallchir (64): 197–228

Graf R (1984) Classification of hip joint dysplasia by means of sonography. Arch Orthop Trauma Surg (102): 248–255

Graf R (1980) The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg (97): 117–133

10.

Kolb A, Benca E, Willegger M, Puchner SE, Windhager R, Chiari C (2017) Measurement considerations on examiner-dependent factors in the ultrasound assessment of developmental dysplasia of the hip. Int Orthop. 41(6):1245–1250CrossRefPubMed

11.

Rosendahl K, Dezateux C, Fosse KR, Aase H, Aukland SM, Reigstad H, Alsaker T, Moster D, Lie RT, Markestad T (2010) Immediate treatment versus sonographic surveillance for mild hip dysplasia in newborns. Pediatrics 125(1):9–16CrossRef

12.

Brurås KR, Aukland SM, Markestad T, Sera F, Dezateux C, Rosendahl K (2011) Newborns with sonographically dysplastic and potentially unstable hips: 6-year follow-up of an RCT. Pediatrics 127(3):661–666CrossRef

13.

Dunn PM, Evans RE, Thearle MJ, Griffiths HE, Witherow PJ (1985) Congenital dislocation of the hip: early and late diagnosis and management compared. Arch Dis Child. (60):407-414

14.

Ultrasound Examination for Detection and Assessment of Developmental Dysplasia of the Hip (2013) Standard from American Institute of Ultrasound in Medicine (AIUM) in conjuction with the American College of Radiology (ACR), the Society for Pediatric Radiology (SPR), and the Society of Radiologists in Ultrasound (SRU). http://www.aium.org/resources/guidelines/hip.pdf. Assessed September 2017

15.

Vedantam R, Bell MJ (1995) Dynamic ultrasound assessment for monitoring of treatment of congenital dislocation of the hip. J Pediatr Orthop (15): 725–728

16.

Li Y, Guo Y, Li M, Zhou Q, Liu Y, Chen W, Li J, Canavese F, Xu H (2018) Multi-center Pediatric Orthopedic Study Group of China. (2018) Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip. Int Orthop. 42(3):631–640CrossRefPubMed

17.

Roovers E, Boere-Boonekamp M, Castelein R, Zielhuis G, Kerkhoff T (2005) Effectiveness of ultrasound screening for developmental dysplasia of the hip. Arch Dis Child Fetal Neonatal Ed. 90(1):25–30CrossRef

18.

Malkawi H, Tadros F, Khasawneh Z, Al Asir B (1997) Simple or stress sonographic hip screening in the newborn versus simple hip screening at the age of three to four months. Saudi Med J (18): 507–11

19.

Pillai A, Joseph J, McAuley A, Bramley D (2011) Diagnostic accuracy of static graf technique of ultrasound evaluation of infant hips for developmental dysplasia. Arch Orthop Trauma Surg (131): 53–5

20.

Woolacott NF, Puhan MA, Steurer J, Kleijnen J (2005) Ultrasonography in screening for developmental dysplasia of the hip in newborns: systematic review. BMJ 330(7505):1413CrossRefPubMedPubMedCentral

21.

Cha SM, Shin HD, Shin BK (2018) Long-term results of closed reduction for developmental dislocation of the hip in children of walking age under eighteen months old. Int Orthop 42(1):175–182CrossRefPubMed

22.

Yong B, Li Y, Li J, Andreacchio A, Pavone V, Pereria B, Xu H, Canavese F (2018) Post-operative radiograph assessment of children undergoing closed reduction and spica cast immobilization for developmental dysplasia of the hip: does experience matter?. Int Orthop

Title: Screening program for neonates at risk for developmental dysplasia of the hip: comparing first radiographic evaluation at five months with the standard twelve week ultrasound. A prospective cross-sectional cohort study
Authors: Dorien Geertsema
Joris E. Meinardi
Dagmar R. J. Kempink
Marta Fiocco
Michiel A. J. van de Sande
Publication date: 01-08-2019
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 8/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-4089-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Screening program for neonates at risk for developmental dysplasia of the hip: comparing first radiographic evaluation at five months with the standard twelve week ultrasound. A prospective cross-sectional cohort study

Abstract

Purpose

Methods

Results

Discussion

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Discussion

Conclusion

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