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Tan SHS, Lim JXY, Lim AKS, Hui JHP. Risk factors for a false negative Ortolani and Barlow examination in developmental dysplasia of the hip. Orthop Traumatol Surg Res 2024; 110:103796. [PMID: 38081355 DOI: 10.1016/j.otsr.2023.103796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Although universal screening by neonatal clinical examination with Ortolani and Barlow manoeuvres is widely adopted, its role as a sole screening tool is controversial due to its poor sensitivity and failure in identifying hip joints that eventually require surgical intervention. HYPOTHESIS This study aims to identify risk factors for a false negative Ortolani and Barlow examination in neonatal screening for DDH. The hypothesis is that risk factors for developmental dysplasia of the hips could similarly be risk factors for a false negative Ortolani and Barlow examination. MATERIAL AND METHODS In the 14-year retrospective cohort study, all newborn infants born in a single institution from 1st January 1999 to 31st December 2013 were screened clinically with the Ortolani/Barlow manoeuvre by a neonatologist. Infants with positive risk factors, despite a normal clinical examination, were then scheduled for bilateral hip ultrasound in the first three months of life and evaluated according to the Graf's method, Harcke's method of dynamic ultrasound screening and Terjesen's method of evaluation for femoral head coverage. RESULTS A total of 164 infants with normal Ortolani and Barlow examinations were scheduled for bilateral hip ultrasound due to the presence of risk factors. Amongst these, 32 (19.5%) infants were evaluated to have an abnormal hip on ultrasound. Breech position was the only statistically significant risk factor for a false negative Ortolani/Barlow examination (14/34, 41.2% vs. 18/112, 13.8%; p<0.001). DISCUSSION Sonographic hip examinations are recommended for all infants with breech presentation even if they have a normal Ortolani and Barlow examination. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Si Heng Sharon Tan
- Department of Orthopaedic Surgery, National University Health System (NUHS) Tower Block Level 11, 1E Kent Ridge Road, Singapore 119074, Singapore.
| | - Joel Xue Yi Lim
- Department of Orthopaedic Surgery, National University Health System (NUHS) Tower Block Level 11, 1E Kent Ridge Road, Singapore 119074, Singapore
| | - Andrew Kean Seng Lim
- Department of Orthopaedic Surgery, National University Health System (NUHS) Tower Block Level 11, 1E Kent Ridge Road, Singapore 119074, Singapore
| | - James Hoi Po Hui
- Department of Orthopaedic Surgery, National University Health System (NUHS) Tower Block Level 11, 1E Kent Ridge Road, Singapore 119074, Singapore
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Ramírez-Rosete JA, Hurtado-Vazquez A, Miranda-Duarte A, Peralta-Cruz S, Cuevas-Olivo R, Martínez-Junco JA, Sevilla-Montoya R, Rivera-Paredez B, Velázquez-Cruz R, Valdes-Flores M, Rangel-Escareno C, Alanis-Funes GJ, Abad-Azpetia L, Grimaldo-Galeana SG, Santamaría-Olmedo MG, Hidalgo-Bravo A. Environmental and Genetic Risk Factors in Developmental Dysplasia of the Hip for Early Detection of the Affected Population. Diagnostics (Basel) 2024; 14:898. [PMID: 38732313 PMCID: PMC11083091 DOI: 10.3390/diagnostics14090898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/13/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Diagnosis of developmental dysplasia of the hip (DDH) mostly relies on physical examination and ultrasound, and both methods are operator-dependent. Late detection can lead to complications in young adults. Current evidence supports the involvement of environmental and genetic factors, such as single nucleotide variants (SNVs). Incorporating genetic factors into diagnostic methods would be useful for implementing early detection and management of affected individuals. Our aim was to analyze environmental factors and SNVs in DDH patients. We included 287 DDH cases and 284 controls. Logistic regression demonstrated an association for sex (OR 9.85, 95% CI 5.55-17.46, p = 0.0001), family history (OR 2.4, 95% CI 1.2-4.5, p = 0.006), fetal presentation (OR 3.19, 95% CI 1.55-6.54, p = 0.002), and oligohydramnios (OR 2.74, 95%CI 1.12-6.70, p = 0.026). A model predicting the risk of DDH including these variables showed sensitivity, specificity, PPV, and NPV of 0.91, 0.53, 0.74, and 0.80 respectively. The SNV rs1800470 in TGFB1 showed an association when adjusted for covariables, OR 0.49 (95% CI 0.27-0.90), p = 0.02. When rs1800470 was included in the equation, sensitivity, specificity, PPV and NPV were 0.90, 0.61, 0.84, and 0.73, respectively. Incorporating no-operator dependent variables and SNVs in detection methods could be useful for establishing uniform clinical guidelines and optimizing health resources.
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Affiliation(s)
- Judit A. Ramírez-Rosete
- Department of Genomics Medicine, National Institute of Rehabilitation (INRLGII), Calzada Mexico-Xochimilco 289, Arenal de Guadalupe, Mexico City 14389, Mexico; (J.A.R.-R.); (A.H.-V.); (A.M.-D.); (M.V.-F.); (L.A.-A.); (S.G.G.-G.); (M.G.S.-O.)
| | - Alonso Hurtado-Vazquez
- Department of Genomics Medicine, National Institute of Rehabilitation (INRLGII), Calzada Mexico-Xochimilco 289, Arenal de Guadalupe, Mexico City 14389, Mexico; (J.A.R.-R.); (A.H.-V.); (A.M.-D.); (M.V.-F.); (L.A.-A.); (S.G.G.-G.); (M.G.S.-O.)
| | - Antonio Miranda-Duarte
- Department of Genomics Medicine, National Institute of Rehabilitation (INRLGII), Calzada Mexico-Xochimilco 289, Arenal de Guadalupe, Mexico City 14389, Mexico; (J.A.R.-R.); (A.H.-V.); (A.M.-D.); (M.V.-F.); (L.A.-A.); (S.G.G.-G.); (M.G.S.-O.)
| | - Sergio Peralta-Cruz
- Department of Pediatric Orthopedics, National Institute of Rehabilitation (INRLGII), Calzada Mexico-Xochimilco 289, Arenal de Guadalupe, Mexico City 14389, Mexico; (S.P.-C.); (R.C.-O.); (J.A.M.-J.)
| | - Ramiro Cuevas-Olivo
- Department of Pediatric Orthopedics, National Institute of Rehabilitation (INRLGII), Calzada Mexico-Xochimilco 289, Arenal de Guadalupe, Mexico City 14389, Mexico; (S.P.-C.); (R.C.-O.); (J.A.M.-J.)
| | - José Antonio Martínez-Junco
- Department of Pediatric Orthopedics, National Institute of Rehabilitation (INRLGII), Calzada Mexico-Xochimilco 289, Arenal de Guadalupe, Mexico City 14389, Mexico; (S.P.-C.); (R.C.-O.); (J.A.M.-J.)
| | - Rosalba Sevilla-Montoya
- Department of Genetics and Human Genomics, National Institute of Perinatology, Montes Urales 800, Lomas-Virreyes, Lomas de Chapultepec IV Secc, Miguel Hidalgo, Mexico City 11000, Mexico;
| | - Berenice Rivera-Paredez
- Research Center in Policies, Population and Health, School of Medicine, National Autonomous University of Mexico, Zona Cultural s/n, CIPPS 2° Piso Ciudad Universitaria, Coyoacán, Mexico City 04510, Mexico;
| | - Rafael Velázquez-Cruz
- Genomics of Bone Metabolism Laboratory, National Institute of Genomic Medicine (INMEGEN), Arenal Tepepan, Tlalpan, Mexico City 14610, Mexico;
| | - Margarita Valdes-Flores
- Department of Genomics Medicine, National Institute of Rehabilitation (INRLGII), Calzada Mexico-Xochimilco 289, Arenal de Guadalupe, Mexico City 14389, Mexico; (J.A.R.-R.); (A.H.-V.); (A.M.-D.); (M.V.-F.); (L.A.-A.); (S.G.G.-G.); (M.G.S.-O.)
| | - Claudia Rangel-Escareno
- Computational Genomics Department, Instituto Nacional de Medicina Genómica (INMEGEN), Arenal Tepepan, Tlalpan, Mexico City 14610, Mexico;
| | - Gerardo J. Alanis-Funes
- School of Engineering and Sciences, Tecnologico de Monterrey, Campus Querétaro, Querétaro 76130, Mexico;
| | - Laura Abad-Azpetia
- Department of Genomics Medicine, National Institute of Rehabilitation (INRLGII), Calzada Mexico-Xochimilco 289, Arenal de Guadalupe, Mexico City 14389, Mexico; (J.A.R.-R.); (A.H.-V.); (A.M.-D.); (M.V.-F.); (L.A.-A.); (S.G.G.-G.); (M.G.S.-O.)
| | - Sacnicte G. Grimaldo-Galeana
- Department of Genomics Medicine, National Institute of Rehabilitation (INRLGII), Calzada Mexico-Xochimilco 289, Arenal de Guadalupe, Mexico City 14389, Mexico; (J.A.R.-R.); (A.H.-V.); (A.M.-D.); (M.V.-F.); (L.A.-A.); (S.G.G.-G.); (M.G.S.-O.)
| | - Monica G. Santamaría-Olmedo
- Department of Genomics Medicine, National Institute of Rehabilitation (INRLGII), Calzada Mexico-Xochimilco 289, Arenal de Guadalupe, Mexico City 14389, Mexico; (J.A.R.-R.); (A.H.-V.); (A.M.-D.); (M.V.-F.); (L.A.-A.); (S.G.G.-G.); (M.G.S.-O.)
| | - Alberto Hidalgo-Bravo
- Department of Genomics Medicine, National Institute of Rehabilitation (INRLGII), Calzada Mexico-Xochimilco 289, Arenal de Guadalupe, Mexico City 14389, Mexico; (J.A.R.-R.); (A.H.-V.); (A.M.-D.); (M.V.-F.); (L.A.-A.); (S.G.G.-G.); (M.G.S.-O.)
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Abstract
Developmental dysplasia of the hip (DDH) encompasses a wide spectrum of clinical severity, from mild developmental abnormalities to frank dislocation. Clinical hip instability occurs in 1% to 2% of full-term infants, and up to 15% have hip instability or hip immaturity detectable by imaging studies. Hip dysplasia is the most common cause of hip arthritis in women younger than 40 years and accounts for 5% to 10% of all total hip replacements in the United States. Newborn and periodic screening have been practiced for decades, because DDH is clinically silent during the first year of life, can be treated more effectively if detected early, and can have severe consequences if left untreated. However, screening programs and techniques are not uniform, and there is little evidence-based literature to support current practice, leading to controversy. Recent literature shows that many mild forms of DDH resolve without treatment, and there is a lack of agreement on ultrasonographic diagnostic criteria for DDH as a disease versus developmental variations. The American Academy of Pediatrics has not published any policy statements on DDH since its 2000 clinical practice guideline and accompanying technical report. Developments since then include a controversial US Preventive Services Task Force "inconclusive" determination regarding usefulness of DDH screening, several prospective studies supporting observation over treatment of minor ultrasonographic hip variations, and a recent evidence-based clinical practice guideline from the American Academy of Orthopaedic Surgeons on the detection and management of DDH in infants 0 to 6 months of age. The purpose of this clinical report was to provide literature-based updated direction for the clinician in screening and referral for DDH, with the primary goal of preventing and/or detecting a dislocated hip by 6 to 12 months of age in an otherwise healthy child, understanding that no screening program has eliminated late development or presentation of a dislocated hip and that the diagnosis and treatment of milder forms of hip dysplasia remain controversial.
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