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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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Johnson MD, Kuschel C, Donnan L. Neonatal clinical examination and selective ultrasound screening are not reliable for the early diagnosis of hip dysplasia: A retrospective cohort study. J Paediatr Child Health 2023; 59:1146-1151. [PMID: 37545325 DOI: 10.1111/jpc.16472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/16/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
AIM To compare the incidence, clinical features and timing of initial treatment of early- and later-presenting developmental dysplasia of the hip (DDH) in infancy in the context of a risk-based selective ultrasound screening programme. METHODS We conducted a retrospective observational study of infants born at a tertiary perinatal centre in Melbourne, Australia, between July 2016 and June 2020 and treated for DDH up to 18 months of age at a tertiary paediatric centre. The incidence of DDH was calculated for early- and later-presenting cases. Clinical features and ultrasound indications were analysed using multivariate logistic regression. RESULTS There were 192 infants with DDH requiring treatment, 100 (52%) of which were not detected by universal neonatal hip examination and selective ultrasound screening based on risk factors (overall incidence 6.3 per 1000 livebirths). The median age at which treatment was commenced was delayed by 8 weeks for the later-presenting group compared to those detected through screening (16.7 vs. 7.9 weeks, P < 0.001). Skin crease asymmetry was associated with later presentation (adjusted odds ratio (aOR) 44.03, 95% confidence interval (CI) 9.99-333), whilst breech presentation (aOR 0.08, 95% CI 0.02-0.26) and Barlow/Ortolani test positivity (aOR 0.06, 95% CI 0.01-0.25) were associated with early presentation. Only 39 (1.45%) infants receiving a screening ultrasound had DDH. CONCLUSION Approximately half of all infants with DDH were not detected by combining risk-based selective ultrasound screening with neonatal clinical findings, highlighting the failure of this screening method to reliably detect a significant proportion of dysplastic infant hips.
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Affiliation(s)
- Mitchell D Johnson
- Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Neonatal Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Carl Kuschel
- Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Leo Donnan
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedics, Royal Children's Hospital, Melbourne, Victoria, Australia
- Gait Lab and Orthopaedics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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MacArthur C, Hansen M, Baynam G, Bower C, Kelty E. Trends in prenatal diagnosis of congenital anomalies in Western Australia between 1980 and 2020: A population-based study. Paediatr Perinat Epidemiol 2023; 37:596-606. [PMID: 37143205 PMCID: PMC10947594 DOI: 10.1111/ppe.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 04/09/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Advances in screening and diagnostics have changed the way in which we identify and diagnose congenital anomalies. OBJECTIVE To examine changes in rates of prenatal diagnosis of congenital anomalies over time and by demographic characteristics. METHODS We undertook a population-based retrospective cohort study of all children born in Western Australia between 1980 and 2020 and diagnosed with a congenital anomaly. Age at diagnosis (prenatal, neonatal, infancy, early childhood or childhood) prevalence (all-type and type-specific), and prevalence ratios (PR) were calculated. We fit joinpoint regression models to describe the average annual percentage change (APC) in prenatal diagnosis over time, and log-binomial regression models to estimate the association between prenatal diagnosis and demographic characteristics. RESULTS Prenatal diagnosis prevalence between the first (1980-1989: 28.3 per 10,000 births) and last (2005-2014: 156.1 per 10,000 births) decades of the study increased 5.5-fold (95% confidence interval [CI] 5.0, 5.9). Substantial increases were observed for cardiovascular (PR 10.7, 95% CI 8.0, 14.6), urogenital (PR 10.5, 95% CI: 8.7, 12.6) and chromosomal anomalies (PR 7.0, 95% CI 5.9, 8.3). Prenatal diagnosis was positively associated with the birth year (adjusted risk ratio [RR] 1.04, 95% CI 1.03, 1.04), advanced maternal age (RR 1.14, 95% CI 1.11, 1.18), multiple anomalies (RR 2.86, 95% CI 2.77, 2.96) and major anomalies (RR 3.75, 95% CI 3.36, 4.19), and inversely associated with remoteness (RR 0.89, 95% CI: 0.83, 0.95) and Aboriginality (RR 0.90, 95% CI 0.83, 0.97). CONCLUSIONS Increases in prenatal diagnosis of congenital anomalies were observed in Western Australia from 1980 to 2020, reflecting advances in screening. Prenatal diagnosis was less common in remote regions and in Aboriginal children, strengthening calls for increased provision of antenatal care services for these populations.
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Affiliation(s)
- Cassandra MacArthur
- School of Population and Global HealthThe University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Michele Hansen
- Telethon Kids InstituteThe University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Gareth Baynam
- Western Australian Register of Developmental AnomaliesKing Edward Memorial HospitalPerthWestern AustraliaAustralia
- Faculty of Health and Medicine, Institute and Division of PaediatricsUniversity of Western AustraliaCrawleyWestern AustraliaAustralia
- Rare Care, Clinical Centre of Expertise for Rare and Undiagnosed DiseasesPerth Children's HospitalPerthWestern AustraliaAustralia
| | - Carol Bower
- Telethon Kids InstituteThe University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Erin Kelty
- School of Population and Global HealthThe University of Western AustraliaCrawleyWestern AustraliaAustralia
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Dawod MS, Alswerki MN, Abuqudiri AZ, Albadaineh AA, Mahmoud LM, Altarawneh DJ, Rbeihat NH, Alkhanazreh RM. The Impact of Maternal Age and Educational Level on Developmental Dysplasia of the Hip Diagnosis and Screening: A Descriptive Comparative Study. Adv Orthop 2023; 2023:6793645. [PMID: 37275323 PMCID: PMC10234724 DOI: 10.1155/2023/6793645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/05/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023] Open
Abstract
Background Early and proper screening for developmental dysplasia of the hip (DDH) is very critical to prevent catastrophic complication on the developing hip joint. Many factors (either maternal or child-related) that hinder timely DDH screening have been previously investigated. Methods A cross-sectional descriptive study design was adopted. 175 babies presented for DDH screening coming with their mothers were investigated. Maternal age, age group, and educational level were recorded. In addition, multiple child-related variables such as age of screening, gender, positive family history, preterm delivery, and mode of delivery were recorded as well. Analysis for association between delayed vs. early screening was made against the maternal and the child-related variables. Results A total number of 175 children with their mothers were investigated. The mean maternal age was 27.9 years, about one third of the mothers had a graduate level of education (36.3%), while 41.1% had high school education, and 22.3% had middle school education. On the other hand, 40.0% of the investigated babies were first born and two thirds of our sample babies were females (66.9%). Of the included babies, 100 (57.1%) were screened at the appropriate 4-month age, while 75 (42.9%) missed the 4-month screening. Chi-square analysis showed that delayed DDH screening was associated with a lower maternal educational level (P ≤ 0.001), younger maternal age (P ≤ 0.001), and first born baby (P ≤ 0.001). Positive family history was protective against delayed DDH screening (P = 0.032). Conclusion The lower maternal educational level, younger maternal age group, and first born babies are risk factors for delayed DDH screening.
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Kuitunen I, Uimonen MM, Haapanen M, Sund R, Helenius I, Ponkilainen VT. Incidence of Neonatal Developmental Dysplasia of the Hip and Late Detection Rates Based on Screening Strategy: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2227638. [PMID: 35980635 PMCID: PMC9389349 DOI: 10.1001/jamanetworkopen.2022.27638] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Universal ultrasonographic screening for developmental dysplasia of the hip (DDH) has gained increasing popularity despite the lack of benefit in terms of reducing the rates of late-detected cases (age ≥12 weeks) in randomized clinical trials. OBJECTIVE To report the reported incidence of DDH in the English scientific literature and compare rates of late-detected cases in settings with different DDH screening strategies. DATA SOURCES PubMed, Scopus, and Web of Science databases were searched on November 25 and 27, 2021. No time filters were used in the search. STUDY SELECTION All observational studies reporting the incidence of early-detected or late-detected (age ≥12 weeks) DDH were included. Non-English reports were excluded if the abstract did not include enough information to be included for analysis. DATA EXTRACTION AND SYNTHESIS The number of newborns screened and the detection rates were extracted. Meta-analysis calculated the pooled incidence of DDH per 1000 newborns with 95% CIs using a random- or fixed-effects model. This study is reported according to the PRISMA and MOOSE guidelines. MAIN OUTCOMES AND MEASURES The main outcome measures were early detection, early treatment, late detection, and operative treatment incidences. RESULTS A total of 1899 studies were identified, 203 full texts were assessed, and 76 studies with 16 901 079 infants were included in final analyses. The early detection rate was 8.4 (95% CI, 4.8-14.8) infants with DDH per 1000 newborns with clinical screening, 4.4 (95% CI, 2.4-8.0) infants with DDH per 1000 newborns with selective ultrasonographic screening, and 23.0 (95% CI, 15.7-33.4) infants with DDH per 1000 newborns with universal ultrasonographic screening. Rates for nonoperative treatment were 5.5 (95% CI, 2.1-14) treatments per 1000 newborns with clinical screening, 3.1 (95% CI, 2.0-4.8) treatments per 1000 newborns with selective ultrasonographic screening, and 9.8 (95% CI, 6.7-14.4) treatments per 1000 newborns with universal ultrasonographic screening. The incidence of late-detected DDH was 0.5 (95% CI, 0.2-1.5) infants with DDH per 1000 newborns with clinical screening, 0.6 (95% CI, 0.3-1.3) infants with DDH per 1000 newborns with selective ultrasonographic screening, and 0.2 (95% CI, 0.0-0.8) infants with DDH per 1000 newborns with universal ultrasonographic screening. The corresponding incidences of operative treatment were 0.2 (95% CI, 0.0-0.9) operations per 1000 newborns with clinical screening, 0.5 (95% CI, 0.4-0.7) operations per 1000 newborns with selective ultrasonographic screening, and 0.4 (95% CI, 0.2-0.7) operations per 1000 newborns with universal ultrasonographic screening. CONCLUSIONS AND RELEVANCE This meta-analysis found that early detection rates and nonoperative treatments were higher with universal screening. The late detection and operative treatment rates with universal screening were similar to those among selectively and clinically screened newborns. Based on these results, universal screening may cause initial overtreatment without reducing the rates of late detection and operative treatment.
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Affiliation(s)
- Ilari Kuitunen
- Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics and Neonatology, Mikkeli Central Hospital, Mikkeli, Finland
| | - Mikko M. Uimonen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Marjut Haapanen
- Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Paediatric Orthopedics, Helsinki University Hospital, New Children’s Hospital, Helsinki, Finland
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Marriott E, Twomey S, Lee M, Williams N. Variability in Australian screening guidelines for developmental dysplasia of the hip. J Paediatr Child Health 2021; 57:1857-1865. [PMID: 34555227 DOI: 10.1111/jpc.15744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
AIM To assess the variability in Australian screening guidelines for developmental dysplasia of the hip (DDH). METHODS Ovid MEDLINE®, EMBASE, EMB Reviews-Cochrane, CINAHL, TRIP and grey literature were searched to identify screening guidelines for DDH. Key data items related to recommendations for timing and method of screening were extracted and summarised in a table format for qualitative analysis. RESULTS Seventeen guidelines met inclusion criteria, comprising nine Australian DDH screening guidelines and eight Child Health Books. The guidelines showed variation in recommendations for the examiner, specific screening methods used for high-risk groups, timing of examinations and recommendations for referral. CONCLUSIONS Variability exists within Australian DDH screening guidelines. Lack of knowledge regarding local screening guidelines may contribute to the current trend of increased incidence of late diagnosed DDH in Australia, reported in New South Wales, South Australia, and Western Australia. An evidence-based and consistent approach to DDH screening is necessary to minimise late detected cases.
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Affiliation(s)
- Emily Marriott
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Sarah Twomey
- Healthy Hips Australia, Perth, Western Australia, Australia
| | - Michael Lee
- Department of Orthopaedic Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Nicole Williams
- Department of Orthopaedic Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
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Screening of Newborns and Infants for Developmental Dysplasia of the Hip: A Systematic Review. Indian J Orthop 2021; 55:1388-1401. [PMID: 35003532 PMCID: PMC8688670 DOI: 10.1007/s43465-021-00409-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Developmental dysplasia of hip (DDH) is a common disorder of childhood and has a good prognosis when treated at an early age. In spite of being a significant concern, many children with DDH are not picked early and present late at walking age. In our country, it is presumed to be due to absence of a national policy for screening of DDH. Screening programmes including the combination of clinical and radiological methods in different ways have been suggested. However, the exact method of screening is controversial. PURPOSE To analyze effectiveness and cost-effectiveness of various screening methods for DDH. STUDY DESIGN Systematic review. METHODS This review was conducted in accordance with PRISMA guidelines. Medline database was explored for original case series and randomized clinical trials. Inclusion criteria were English language, screening for DDH in neonates, sample size more than 500, and studies with minimum duration of one year. RESULTS Thirty-four studies were selected to write the manuscript. This included 23 studies looking for effectiveness of a screening programme and 11 studies comparing various outcomes of different screening strategies. A trend favoring universal ultrasound screening was observed. CONCLUSION The literature supports universal ultrasound screening and has proved its cost-effectiveness. However, considering the logistic and financial challenges in our country, immediate implementation of universal ultrasound screening seems impractical. In the absence of any current guidelines for screening for DDH in India, we suggest professional organizations involved in the care of children and public health policy-makers to come together to develop national screening guidelines for DDH.
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St George J, Kulkarni V, Bellemore M, Little DG, Birke O. Importance of early diagnosis for developmental dysplasia of the hip: A 5-year radiological outcome study comparing the effect of early and late diagnosis. J Paediatr Child Health 2021; 57:41-45. [PMID: 32772467 DOI: 10.1111/jpc.15111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/25/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023]
Abstract
AIM Australia utilises a selective ultrasound screening programme. The rate of late diagnosis of developmental dysplasia of the hip (DDH) in Australia is increasing. The aim of this study is to quantify the treatment required and compare the 5-year radiological outcomes between early and late diagnosis in children with DDH with frank dislocation. METHODS We performed a case-matched control study of children with frank DDH dislocations from 2000 to 2010 comparing three groups: children with an early diagnosis successfully treated in a Pavlik harness (SP), children with an early diagnosis who failed Pavlik harness treatment (FP) and children with a late diagnosis (LD). Minimum follow-up was 4 years. RESULTS A total of 115 hips were included. Patients in the LD group required significantly more open reductions (P < 0.001), acetabular osteotomies (P < 0.001) and femoral osteotomies (P < 0.001). LD was also associated with significantly higher rates of growth disturbance at 46.3%, compared to 20.6% in the FP group and 5% in the SP group (P < 0.001). Overall, there were excellent radiological outcomes in 58.5% of the LD group compared to 79.4% in the FP group and 100% in the SP group. CONCLUSION In Australia, high rates of LD in DDH persist in the context of selective ultrasound screening. While good radiological outcomes are achievable, a significantly greater level of surgical intervention is required and this is associated with significantly higher rates of growth disturbance. Optimisation of screening in Australia is vital.
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Affiliation(s)
- Justine St George
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Vinay Kulkarni
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Michael Bellemore
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David G Little
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Oliver Birke
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Li D, Wang H, He JY, Wang CL, Feng WJ, Shen C, Zhu JF, Wang DL, Chen XD. Inflammatory and fibrosis infiltration in synovium associated with the progression in developmental dysplasia of the hip. Mol Med Rep 2019; 19:2808-2816. [PMID: 30720141 DOI: 10.3892/mmr.2019.9910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/13/2018] [Indexed: 11/05/2022] Open
Abstract
Developmental dysplasia of the hip (DDH) is a common musculoskeletal disorder characterized by progressive joint soreness and limited mobility. The aim of the present study was to investigate the pathological changes and inflammatory infiltration in the hypertrophic synovium of the hip joint associated with the progression of DDH. Synovial biopsies in the hip joint are obtained from patients with moderate DDH and severe DDH during surgery. These biopsies are processed for histological and immunohistochemical (IHC) analysis and investigation of the pathological processes in a synovium, including types of inflammatory cell infiltration, synovial angiogenesis and fibrosis, neuron endings and neuropeptide invasion. Correlation analysis was performed between the mean optical density (MOD) of each antibody, and Harris hip score (HHS) and visual analogue score (VAS) using the Spearman correlation test. Chronic inflammation in the synovium was observed via the positive IHC staining of inflammatory cells, such as T cells, B cells, macrophages and leukocytes. Excessive staining of vimentin and α smooth muscle actin in the synovium of severe DDH represented significant fibrosis and angiogenesis. These targets were also significantly correlated with HHS in severe DDH. The MOD levels of CD68 (indicators of macrophage) indicated apparent correlations with HHS and VAS in patients with severe DDH. The labels of nerve fibers and pain transmission indicators were as follows: Neurofilament‑200 and substance P. Calcitonin gene‑related peptide was upregulated in the synovium of severe DDH in contrast to that in the synovium of moderate DDH. The MOD levels of NF‑200, SP and CGRP were correlated with VAS in severe DDH. The pathology of DDH includes chronic inflammatory cell infiltration corresponding with nerve fibers and fibroblastic proliferation, which might contribute to arthritis progression and joint soreness in DDH.
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Affiliation(s)
- De Li
- Department of Orthopedic Surgery, Xin‑Hua Hospital, Shanghai Jiao‑Tong University School of Medicine, Shanghai 200092, P.R. China
| | - Hui Wang
- Department of Orthopedic Surgery, Xin‑Hua Hospital, Shanghai Jiao‑Tong University School of Medicine, Shanghai 200092, P.R. China
| | - Ji-Ye He
- Department of Orthopedic Surgery, Xin‑Hua Hospital, Shanghai Jiao‑Tong University School of Medicine, Shanghai 200092, P.R. China
| | - Cheng-Long Wang
- Department of Orthopedic Surgery, Xin‑Hua Hospital, Shanghai Jiao‑Tong University School of Medicine, Shanghai 200092, P.R. China
| | - Wei-Jia Feng
- Department of Orthopedic Surgery, Xin‑Hua Hospital, Shanghai Jiao‑Tong University School of Medicine, Shanghai 200092, P.R. China
| | - Chao Shen
- Department of Orthopedic Surgery, Xin‑Hua Hospital, Shanghai Jiao‑Tong University School of Medicine, Shanghai 200092, P.R. China
| | - Jun-Feng Zhu
- Department of Orthopedic Surgery, Xin‑Hua Hospital, Shanghai Jiao‑Tong University School of Medicine, Shanghai 200092, P.R. China
| | - Dong-Liang Wang
- Department of Orthopedic Surgery, Xin‑Hua Hospital, Shanghai Jiao‑Tong University School of Medicine, Shanghai 200092, P.R. China
| | - Xiao-Dong Chen
- Department of Orthopedic Surgery, Xin‑Hua Hospital, Shanghai Jiao‑Tong University School of Medicine, Shanghai 200092, P.R. China
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Lee WC, Gera SK, Mahadev A. Developmental dysplasia of the hip: why are we still operating on them? A plea for institutional newborn clinical screening. Singapore Med J 2018; 60:150-153. [PMID: 29774363 DOI: 10.11622/smedj.2018064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Developmental dysplasia of the hip (DDH) is a common orthopaedic condition at birth. Non-surgical management with the Pavlik harness can effectively treat DDH in the newborn by providing an early clinical diagnosis, but open surgeries continue to be performed. We aimed to elucidate the reasons for this. METHODS A retrospective review was performed of all open surgeries related to DDH from 2006 to 2016. Patients were either born at our institution (Group 1) or outside of it (Group 2). All Group 1 newborns were routinely screened for DDH at birth. RESULTS 27 patients (Group 1: n = 5, Group 2: n = 22) presented at age 25 ± 19 months. Left-sided DDH (n = 21, 77.8%) and female infants (n = 22, 81.5%) were more common. The mean age at surgery was 40 ± 31 months. The most commonly performed procedure was soft tissue release open reduction with acetabuloplasty (n = 20, 74.1%). Gender, site, median age at presentation and at surgery, and prevalence of risk factors were similar for both groups. Both groups were mostly made up of late presenters (> 3 months; p = 0.34). A few patients had undergone prior treatment (p = 0.64). Newborn screening was the only significantly different variable between the groups (p < 0.01). CONCLUSION Lack of institutionalised newborn clinical screening appears to be the root cause of late presentation of DDH leading to open surgery for its management. We recommend quality institutionalised newborn clinical screening to reduce the number of late presentations.
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Affiliation(s)
- Wu Chean Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Sumanth Kumar Gera
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore
| | - Arjandas Mahadev
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore
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Wright S, Cotterell E, Schmidt D. Screening for developmental dysplasia of the hip in a rural health district: An analysis of practice. Aust J Rural Health 2017; 26:199-205. [DOI: 10.1111/ajr.12400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Suzanne Wright
- Physiotherapy Department; Armidale and New England Hospital; Armidale New South Wales Australia
| | - Elizabeth Cotterell
- Tablelands Clinical School - Rural Medicine; University of New England; Armidale New South Wales Australia
| | - David Schmidt
- Rural Research Capacity Building Program; NSW Health Education and Training Institute; Gladesville New South Wales Australia
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Studer K, Williams N, Antoniou G, Gibson C, Scott H, Scheil WK, Foster BK, Cundy PJ. Increase in late diagnosed developmental dysplasia of the hip in South Australia: risk factors, proposed solutions. Med J Aust 2016; 204:240. [DOI: 10.5694/mja15.01082] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/21/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | - Nicole Williams
- Women's and Children's Hospital, Adelaide, SA
- University of Adelaide Centre for Orthopaedic and Trauma Research, Adelaide, SA
| | | | - Catherine Gibson
- South Australian Birth Defects Register, Women's and Children's Hospital, Adelaide, SA
| | - Heather Scott
- South Australian Birth Defects Register, Women's and Children's Hospital, Adelaide, SA
| | - Wendy K Scheil
- Pregnancy Outcomes Statistics Unit, SA Health, Adelaide, SA
| | - Bruce K Foster
- Women's and Children's Hospital, Adelaide, SA
- University of Adelaide Centre for Orthopaedic and Trauma Research, Adelaide, SA
| | - Peter J Cundy
- Women's and Children's Hospital, Adelaide, SA
- University of Adelaide Centre for Orthopaedic and Trauma Research, Adelaide, SA
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Wang H, Zhang X, He JY, Zheng XF, Li D, Li Z, Zhu JF, Shen C, Cai GQ, Chen XD. Increasing expression of substance P and calcitonin gene-related peptide in synovial tissue and fluid contribute to the progress of arthritis in developmental dysplasia of the hip. Arthritis Res Ther 2015; 17:4. [PMID: 25578529 PMCID: PMC4320827 DOI: 10.1186/s13075-014-0513-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 12/23/2014] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Developmental dysplasia of the hip (DDH) is a common musculoskeletal disorder that has pain and loss of joint function as major pathological features. In the present study, we explored the mechanisms of possible involvement and regulation of substance P (SP) and calcitonin gene-related peptide (CGRP) in the pathological and inflammatory processes of arthritis in DDH. METHODS Blood, synovial tissue and fluid samples were collected from patients diagnosed with different severities of DDH and from patients with femoral neck fracture. Levels of SP, CGRP and inflammatory cytokines in synovium and synovial fluid (SF) in the different groups were evaluated by immunohistochemistry, real-time PCR and enzyme-linked immunosorbent assay (ELISA). Correlations between neuropeptides and inflammatory cytokines in SF were evaluated by partial correlation analysis. The proinflammatory effects of SP and CGRP on synoviocytes obtained from patients with moderate DDH were investigated in vitro by real-time PCR and ELISA. The mechanisms of those effects were evaluated by Western blot analysis and nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB) DNA binding assay. RESULTS Significantly increased levels of neuropeptides and inflammatory cytokines were observed in synovium and SF from patients in the severe DDH group compared with the moderate DDH and control groups. In moderate DDH samples, SP in SF correlated with tumor necrosis factor (TNF)-α, and CGRP in SF correlated with TNF-α and interleukin (IL)-10. In the severe DDH group, SP in SF correlated with interleukin (IL)-1β, TNF-α and IL-10. CGRP in SF correlated with TNF-α. Additionally, SP might have had obvious proinflammatory effects on synoviocytes through the activation of NF-κB. CONCLUSIONS The upregulation of SP and CGRP in synovium and SF might participate in the inflammatory process of arthritis in DDH. The activation of the NF-κB pathway seems indispensable in the proinflammatory effect of SP on synoviocytes. This original discovery may indicate a potential clinical drug target and the development of innovative therapies for DDH.
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Affiliation(s)
- Hui Wang
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China.
| | - Xiang Zhang
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China.
| | - Ji-Ye He
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China.
| | - Xin-Feng Zheng
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China.
| | - De Li
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China.
| | - Zheng Li
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China.
| | - Jun-Feng Zhu
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China.
| | - Chao Shen
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China.
| | - Gui-Quan Cai
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China.
| | - Xiao-Dong Chen
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, People's Republic of China.
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Developmental dysplasia of the hip: incidence and treatment outcomes in the Southeast of Ireland. Ir J Med Sci 2014; 184:411-5. [DOI: 10.1007/s11845-014-1133-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
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Wang H, Zheng XF, Zhang X, Li Z, Shen C, Zhu JF, Cui YM, Chen XD. Increasing substance P levels in serum and synovial tissues from patients with developmental dysplasia of the hip (DDH). BMC Musculoskelet Disord 2014; 15:92. [PMID: 24642234 PMCID: PMC3995111 DOI: 10.1186/1471-2474-15-92] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 03/10/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The tachykininergic neurotransmitters have been proved to be involved in the inflammatory progress and chronic pain in series of disease. The present study was undertaken to evaluate the levels of substance P (SP) and its receptors NK-1 receptor (NK-1R) in both serum and synovial tissues of hip joint from patients with different stages of DDH, and to detect the possible correlation of serum SP levels with pain sensation and dysfunction of the hip joint. METHODS SP levels in serum and synovial tissues from patients with DDH and DDH combined with osteoarthritis (DDH&OA) group were compared through immunohistochemistry (IHC), ELISA, and 2-step acetic acid extraction method respectively. Expression of NK-1R in synovial tissues was compared through IHC, quantitive Real-Time PCR (QRT-PCR) and Western-Blot. The severities of pain sensation and the functional activities of hip joint were assessed by Visual analogue scale (VAS) and Harris hip score (HHS). Correlations of serum SP levels with VAS, HHS and erythrocyte sedimentation rate (ESR) were evaluated respectively in these groups. RESULTS Significantly elevated serum SP levels were detected in group of DDH and DDH&OA compared to that in normal group. IHC, QRT-PCR as well as tissue Elisa showed that SP levels in synovial tissue of DDH&OA group is stronger than that in DDH group. Serum SP levels in each group have no gender differences. The enhanced SP levels in synovial tissue mainly came from the segregation of peripheral nerve endings. Serum SP correlated with VAS and HHS in patients with DDH&OA (Male + Female). Serum SP correlated with HHS in patients with DDH (Male). Serum SP levels also correlated with erythrocyte sedimentation rate (ESR) in patients with DDH&OA (Male + Female). Up-regulated expression of NK-1R was also observed in synovial tissue of patients with DDH&OA compared to patients with DDH, through western-blot, IHC, and QRT-PCR. CONCLUSIONS These findings indicated that the increasing SP levels in serum and synovial tissues, observed from patients with DDH to patients with DDH&OA, might associate with the loss of function and chronic pain sensation in hip joint. SP along with its receptors NK-1R might be involved in the progression of DDH into DDH&OA. In the future, inhibitors of SP as well as NK-1R may represent a novel pharmacotherapy target for pain relieving, inflammation alleviating and joint degeneration delaying for patients with DDH.
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Affiliation(s)
| | | | | | | | | | | | | | - Xiao-Dong Chen
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Kongjiang Road, No,1665, Yangpu District, Shanghai, China.
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