Developmental dysplasia of the hip in infants referred for a combined pediatric orthopaedic and radiologic examination. A prospective cohort study

Developmental dysplasia of the hip in infants younger than six months: Ultrasonographic assessment in relation with risk factors

Objectives

In newborns, developmental dysplasia of the hip (DDH) is an abnormal development of the hip joint but its accurate detection is challenging. This study was designed to determine an accurate detection of DDH and their associated risk factors in infants younger than 6 months using sonographic and clinical examinations.

Methods

Infants younger than 6 months (n = 404) with their hip instability were recruited. Infants' hips were examined by ultrasonographic and clinical examinations. Ultrasonographic data were accessed in relation with the risk factors. Omni calculator was used to measure sensitivity, specificity and accuracy.

Results

Out of 808 hips, 97.3% hips were categorized as Graf I type, 1.4% hips were Graf type IIa, 0.87% were type IIb, and 0.49% were type IIc. The data revealed that 93.9% hips were congruous and 6.1% hips were immature. Importantly, the data showed that risk factors such as mode of delivery, breech presentation, oligohydramnios, family history, and malformations were proportionally associated with positive DDH cases. Interestingly, the sensitivity, specificity, and accuracy of ultrasonography in relation with clinical positivity of DDH infants were 51.83%, 99.43%, and 73.16%, respectively.

Conclusions

This study proved that ultrasonographic assessments are highly sensitive, specific and accurate for the detection of DDH onset in infants younger than 6 months. In addition, the study investigated a number of risk factors associated with the onset of DDH; therefore, it is extremely important that ultrasonography and clinical examination should be performed by those sonographers and orthopedic surgeons, who will have the knowledge of associated risk factors.

Surgical procedures in infants with early diagnoses of developmental dysplasia of the hip. A prospective 4-year follow-up study

Background

Dysplastic hips infants may normalize spontaneously without any intervention due to the natural growth. However, some infants need one or more surgical interventions to achieve stable and non-dysplastic hips. The purpose of this study is to determine the proportion of infants diagnosed with DDH before the age of 6 months undergoing surgical procedures of the hip(s) before the age of four years and to determine the number and types of surgical procedures in each infant.

Methods

A prospective and consecutive study of all infants aged 0-6 months diagnosed with dysplasia of the hips in the combined paediatric orthopaedic and radiologic examination in the Region of Southern Denmark 2013-2017. From medical records, we obtained information about all surgical procedures in the hips including open or closed reductions, arthrographies, tenotomies, and pelvic osteotomies before the age of 4 years.

Results

Overall, 281 infants with hip dysplasia were included. The median age at first examination was 48 days. In 254 (90%) of the infants, the hips resolved spontaneously, and 27 (10%) needed one or more surgical interventions. Overall, the 27 infants had 47 surgical intervention as 12 infants had more than one intervention. One infants had five surgical interventions. The most frequent surgical procedures were closed reduction and arthrography with or without adductor tenotomy (58%) and pelvic osteotomy (27%). Among infants with surgical interventions, 23 (8.2%) had unstable hips, and four (1.4%) had stable hips. All four infants with stable hips had an arthrography and none required a pelvic osteotomy.

Discussion

This study supports the propensity for spontaneous normalization early dysplasia of the hips in infants. Only a small proportion of the infants needed surgical interventions to achieve stable and non-dysplastic hips.