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Dong TT, Nie F, Yang LL, Wang T. Ultrasonography in the evaluation of various factors of developmental dysplasia of the hip in infants: Results from a retrospective study in a large hospital of northwest China. J Orthop Sci 2024; 29:976-982. [PMID: 37271675 DOI: 10.1016/j.jos.2023.05.009] [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: 02/15/2022] [Revised: 02/07/2023] [Accepted: 05/17/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND The occurrence and development of developmental dysplasia of the hip (DDH) are related to a variety of factors, which have been reported in the literature, but the literature does not mention factors related to the severity of DDH. The purpose of this study is to analyze the related factors of the occurrence and severity of DDH in combination with the Graf ultrasonic diagnostic classification. METHODS This study was a monocentric retrospective study describing the factors associated with DDH in a large hospital of northwest China. A total of 3046 infants (6092 hips) within 6 months after birth using the Graf method were admitted to our department between 2014 and 2018. We analyzed data of DDH. After reviewing medical charts and diagnostic examination results, we assessed whether factors such as ethnicity, gender, gestational age, birth weight, diagnosis age, maternal age, mode of delivery, fetal presentation, amniotic fluid volume and birth order, had any effect on development of hip. RESULT ① Analysis showed that DDH mostly occurs in female and left hip joint, related to intrauterine fetal presentation, amniotic fluid volume, gestational age, mode of delivery, prenatal weight, and diagnosis age after birth, and the occurrence of DDH is also related to maternal age (All P<0.05). Ethnicity and first born showed have no obvious correlation with DDH incidence (p = 0.718, 0.147, respectively). ② The strongest correlation was found with amniotic fluid, followed by birth weight. ③ The severity of DDH was correlated with ethnicity, births, prenatal weight, gestational age, diagnosis age and maternal age (All P<0.05, respectively). ④ There were significant differences in treatment methods, duration and prognosis among different types of DDH. CONCLUSIONS The occurrence and development of DDH are related to a variety of factors. Ultrasound examination can provide an early assessment of the hip development status of infants and may play an important role in establishing an early clinical diagnosis treatment and monitoring and prognosis.
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Affiliation(s)
- Tian-Tian Dong
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China.
| | - Lu-Lu Yang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Ting Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
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Pakarinen O, Ponkilainen V, Uimonen M, Haapanen M, Helenius I, Kuitunen I. A comparison of different selective ultrasound screening strategies for developmental dysplasia of the hip. Bone Joint J 2023; 105-B:247-253. [PMID: 36876446 DOI: 10.1302/0301-620x.105b3.bjj-2022-1068.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
To analyze whether the addition of risk-based criteria to clinical examination-based selective ultrasound screening would increase the rates of early detected cases of developmental dysplasia of the hip (DDH) and decrease the rate of late detected cases. A systematic review with meta-analysis was performed. The initial search was performed in the PubMed, Scopus, and Web of Science databases in November 2021. The following search terms were used: (hip) AND (ultrasound) AND (luxation or dysplasia) AND (newborn or neonate or congenital). A total of 25 studies were included. In 19 studies, newborns were selected for ultrasound based on both risk factors and clinical examination. In six studies, newborns were selected for ultrasound based on only clinical examination. We did not find evidence indicating that there are differences in the incidence of early- and late-detected DDH, or in the incidence of nonoperatively treated DDH between the risk-based and clinical examination-based groups. The pooled incidence of operatively treated DDH was slightly lower in the risk-based group (0.5 (95% confidence interval (CI) 0.3 to 0.7)) compared with the clinical examination group (0.9 per 1,000 newborns, (95% CI 0.7 to 1.0)). The use of risk factors in conjunction with clinical examination in the selective ultrasound screening of DDH might lead to fewer operatively treated cases of DDH. However, more studies are needed before stronger conclusions can be drawn.
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Affiliation(s)
- Oskari Pakarinen
- Tampere University, Faculty of Medicine and Health Technologies, Tampere, Finland
| | - Ville Ponkilainen
- Tampere University, Faculty of Medicine and Health Technologies, Tampere, Finland.,Department of Surgery, Central Finland Hospital Nova, Jyvaskyla, Finland
| | - Mikko Uimonen
- Tampere University, Faculty of Medicine and Health Technologies, Tampere, Finland.,Department of Surgery, Central Finland Hospital Nova, Jyvaskyla, Finland
| | - Marjut Haapanen
- University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland
| | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Paediatric Orthopaedics, Helsinki University Hospital, New Children's Hospital, Helsinki, Finland
| | - Ilari Kuitunen
- University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland.,Department of Pediatrics and Neonatology, Mikkeli Central Hospital, Mikkeli, Finland
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3
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Cheok T, Smith T, Wills K, Jennings MP, Rawat J, Foster B. Universal screening may reduce the incidence of late diagnosis of developmental dysplasia of the hip : a systematic review and meta-analysis. Bone Joint J 2023; 105-B:198-208. [PMID: 36722053 DOI: 10.1302/0301-620x.105b2.bjj-2022-0896.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS 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. METHODS 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. RESULTS 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). CONCLUSION 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 J 2023;105-B(2):198-208.
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Affiliation(s)
- Tim Cheok
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Australia.,Department of Orthopaedic Surgery, Palmerston North Hospital, Palmerston North, New Zealand
| | - Thomas Smith
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Kenneth Wills
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Matthew P Jennings
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Australia
| | - Jaideep Rawat
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia.,Department of Orthopaedic Surgery, Women's and Children's Hospital, Adelaide, Australia
| | - Bruce Foster
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
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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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Souza BGSE, Vasconcelos BMC, Pujoni HP, Nogueira MC, Oliveira VMD, Chaoubah A. Epidemiology and costs of surgical treatment of developmental dysplasia of hip in the Brazilian Public Health System in a decade. EINSTEIN-SAO PAULO 2021; 19:eGS5625. [PMID: 34909975 PMCID: PMC8664290 DOI: 10.31744/einstein_journal/2021gs5625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: To describe and analyze the epidemiology and costs of surgical treatment of hip dysplasia in the Brazilian Public Health System. Methods: An ecological analytical study that evaluated a time series and the geographic distribution of surgical treatment of hip dysplasia in Brazil. Frequencies of cases, number of cases and associated factors were analyzed. Correlations, frequency maps and flow maps are presented and discussed. Results: During the study, 14,584 patients with dysplasia were admitted to hospitals according to Information Technology Department of the Public Health System. Patients underwent hospital treatment specific for dysplasia in 8,592 cases (at an average cost of R$ 2.225,50, total cost of R$ 19.124.086,25– updated values). In this group, mortality rate was 0.046% and mean hospitalization time was 4.41 days (standard deviation of 2,39 days). Age between 1 and 4 years (37.7%), female sex (64.5%) and white race (46%) were more frequent. Greater rates of specialists (R²=0.82; p<0.001), greater proportion of counties with high/very high human development index (R²=0.79; p<0.001), and higher per capita income (R²=0.68; p<0.001) correlated to greater rates of treatments undertaken per 1,000 live births (as per State of treatment). The factor most related to treatment rate per 1,000 live births (as per State of residence) was white race (R²=0.90; p<0.001). Southern states had higher treatment rates (as per State of residence, rate of 0.73/1,000), and Southeast states had greater absolute frequency of cases (46.7%) and greater flow of patients. Conclusion: The surgical treatment of hip dysplasia in Brazil occurs frequently, at relevant costs, and is distributed in a heterogenous and unequal fashion in the Public Health System. Southern states have a higher incidence of cases, and there is an association with racial and socioeconomic factors. There was no large variation in the incidence of cases over time.
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Affiliation(s)
| | | | - Higor Pereira Pujoni
- Núcleo de Pesquisa em Ortopedia e Traumatologia, Hospital e Maternidade Therezinha de Jesus, Juiz de Fora, MG, Brazil
| | - Mário Círio Nogueira
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Valdeci Manoel de Oliveira
- Núcleo de Pesquisa em Ortopedia e Traumatologia, Hospital e Maternidade Therezinha de Jesus, Juiz de Fora, MG, Brazil
| | - Alfredo Chaoubah
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
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6
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Ibrahim A, Mortada E, Alqahtani S, Alkathri H, Alsayyed R, Abualait T, Alwhaibi R. Developmental dysplasia of the hip and associated risk factors in Saudi children: A retrospective study. J Back Musculoskelet Rehabil 2021; 34:573-580. [PMID: 33554882 DOI: 10.3233/bmr-191819] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Studies investigating the association between developmental dysplasia of the hip (DDH) and risk factors in Saudi Arabia are rare. OBJECTIVE Investigate the association between DDH and several risk factors among Saudi children. METHODS The medical records of 82 children born in or admitted to King Abdul Aziz Medical City in Riyadh, Saudi Arabia with clinical suspicion of hip dislocation (HD) were included. The association between DDH and the following risk factors was investigated: age < 3 y, female-gender, twinning, first-born child, C-section, breech presentation, prematurity, positive family history and presence of associated abnormalities. RESULTS HD was confirmed in 73 (89%) children (Positive HD) and excluded in 9 (11%) children (Negative HD). Eleven (13.4%) children were excluded from the positive cases as it was confirmed that they have paralytic hip dislocation not DDH. DDH was confirmed in 62 children (75.6%). The Chi square test (χ2) and odds ratios (OR) revealed that the positive family history, female-gender, age < 3 years, and presence of associated abnormalities had significant associations with the presence of DDH with P values and OR equal 0.00 (16.4), 0.002 (3.1), 0.005 (2.6), and 0.04 (1.9) respectively. Breech presentation, twinning, first-born children, prematurity, and C-section were not associated with DDH with P values and OR equal 0.93 (1.1), 0.46 (0.4), 0.11 (0.4), 0.08 (0.3), and 0.002 (0.3) respectively. CONCLUSIONS Positive family history, female-gender, age < 3 years, and presence of associated abnormalities had approximately 16, 3, 2.5, and 2 times increased risk for DDH.
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Affiliation(s)
- Alaa Ibrahim
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Eman Mortada
- Health Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah University, Riyadh, Saudi Arabia
| | - Saeed Alqahtani
- Orthopedic Department, King Fahad Medical City Hospital, Riyadh, Saudi Arabia
| | - Haya Alkathri
- Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah University, Riyadh, Saudi Arabia
| | - Rania Alsayyed
- Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah University, Riyadh, Saudi Arabia
| | - Turki Abualait
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Reem Alwhaibi
- Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah University, Riyadh, Saudi Arabia
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7
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Biedermann R, Eastwood DM. Universal or selective ultrasound screening for developmental dysplasia of the hip? A discussion of the key issues. J Child Orthop 2018; 12:296-301. [PMID: 30154918 PMCID: PMC6090188 DOI: 10.1302/1863-2548.12.180063] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/17/2018] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To summarize recent developments and provide recommendations as to whether universal or selective programmes are advisable. METHODS A literature review was performed and preference given to studies with higher levels of evidence. All programmes reviewed included clinical screening. RESULTS Recent studies underline the need for high quality screening programmes to promote the early detection of developmental dysplasia of the hip (DDH). A small number of cases may be missed clinically but with universal ultrasound screening programmes the late presentation rates appear to be virtually zero. Contemporary studies show treatment rates with universal screening programmes which are now lower than those with selective ultrasound. There is little agreement over the criteria used for selective programmes. Alternative outcome measures, such as the first operation rate or the percentage undergoing major (open) surgery are both lowest with universal ultrasound screening programmes. Furthermore, a significant reduction in the rate of surgery for DDH later in life was seen after the introduction of universal ultrasound screening, whereas the defined criteria for selective screening may not detect the majority of patients who require late surgery. Abduction bracing with modern orthoses is associated with a zero rate of avascular necrosis (AVN), whereas closed reduction techniques have an overall risk of 10%. CONCLUSION On clinical grounds, if future studies confirm that hip abduction in flexible orthoses is not associated with AVN, it may be time for a paradigm shift of screening for DDH towards a universal ultrasound protocol. The costs associated both with each type of screening programme and with the management of late presenting cases are also important but may be secondary to clinical benefit.
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Affiliation(s)
- R. Biedermann
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - D. M. Eastwood
- Department of Orthopaedics, Great Ormond St Hospital for Children, Orthopaedics, London, UK
- Royal National Orthopaedic Hospital NHS Trust, The Catterall Unit, Stanmore, UK
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8
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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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9
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Abstract
The term “developmental dysplasia of the hip” (DDH) includes a wide spectrum of abnormalities that affect the hip during its growth, ranging from dysplasia to joint dislocation and going through different degrees of coxofemoral subluxation. The incidence of DDH is variable, and depends on a number of factors, including geographical location. Approximately one in 1,000 newborn infants may present hip dislocation and around 10 in 1,000 present hip instability. Brazil has an incidence of five per 1,000 in terms of findings of a positive Ortolani sign, which is the early clinical sign for detecting the disorder. The risk factors for DDH include: female sex, white skin color, primiparity, young mother, breech presentation at birth, family history, oligohydramnios, newborns with greater weight and height, and deformities of the feet or spine. Hip examinations should be routine for newborns, and should be emphasized in maternity units. Among newborns and infants, the diagnosis of DDH is preeminently clinical and is made using the Ortolani and Barlow maneuvers. Conventional radiography is of limited value for confirming the diagnosis of DDH among newborns, and ultrasound of the hip is the ideal examination. The treatment of DDH is challenging, both for pediatric orthopedists and for general practitioners. The objectives of the treatment include diagnosis as early as possible, joint reduction and stabilization of the hip in a secure position. Classically, treatment options are divided according to different age groups, at the time of diagnosis.
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10
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Donnelly KJ, Chan KW, Cosgrove AP. Delayed diagnosis of developmental dysplasia of the hip in Northern Ireland. Bone Joint J 2015; 97-B:1572-6. [DOI: 10.1302/0301-620x.97b11.35286] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Developmental dysplasia of the hip (DDH) should be diagnosed as early as possible to optimise treatment. The current United Kingdom recommendations for the selective screening of DDH include a clinical examination at birth and at six weeks. In Northern Ireland babies continue to have an assessment by a health visitor at four months of age. As we continue to see late presentations of DDH, beyond one year of age, we hypothesised that a proportion had missed an opportunity for earlier diagnosis. We expect those who presented to our service with Tonnis grade III or IV hips and decreased abduction would have had clinical signs at their earlier assessments. We performed a retrospective review of all patients born in Northern Ireland between 2008 and 2010 who were diagnosed with DDH after their first birthday. There were 75 856 live births during the study period of whom 645 children were treated for DDH (8.5 per 1000). The minimum follow-up of our cohort from birth, to detect late presentation, was four years and six months. Of these, 32 children (33 hips) were diagnosed after their first birthday (0.42 per 1000). With optimum application of our selective screening programme 21 (65.6%) of these children had the potential for an earlier diagnosis, which would have reduced the incidence of late diagnosis to 0.14 per 1000. As we saw a peak in diagnosis between three and five months our findings support the continuation of the four month health visitor check. Our study adds further information to the debate regarding selective versus universal screening. Cite this article: Bone Joint J 2015;97-B:1572–6.
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Affiliation(s)
- K. J. Donnelly
- Musgrave Park Hospital, Stockman’s
Lane, Belfast, Northern
Ireland BT9 7JB, UK
| | - K. W. Chan
- Musgrave Park Hospital, Stockman’s
Lane, Belfast, Northern
Ireland BT9 7JB, UK
| | - A. P. Cosgrove
- Musgrave Park Hospital, Stockman’s
Lane, Belfast, Northern
Ireland BT9 7JB, UK
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11
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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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Long-term results of a nationwide general ultrasound screening system for developmental disorders of the hip: the Austrian hip screening program. J Child Orthop 2014; 8:3-10. [PMID: 24488847 PMCID: PMC3935031 DOI: 10.1007/s11832-014-0555-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 01/07/2014] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Diagnosis and early treatment of developmental dysplasia of the hip (DDH) continue to be issues of discussion. In 1992, a nationwide general ultrasound screening program using Graf technique was introduced to detect DDH in Austria. We investigated the effects of this program on the rates of operative and conservative interventions and the influence of the program on the number of hospital admissions for the treatment of DDH. METHODS All cases of DDH documented in Austrian hospitals from 1992 to 2008 were included in this retrospective study. The database of the Austrian Ministry of Health was used to extract documented diagnoses and treatments. RESULTS Since the introduction of the screening program, the number of patients who require pelvic surgery to treat DDH has decreased by 46 % and the number of open reductions is as low as 0.16 per 1,000 live births. Hospital admissions for the treatment of DDH decreased from 9.5 to 3.6 per 1,000 live births. All noted results gained statistical significance. CONCLUSION Compared with routine clinically based screening programs, our results confirm low numbers of open reductions and pelvic surgeries. We, therefore, advocate a standardized nationwide general ultrasound screening program to reduce the rates of operative interventions and hospital admissions associated with the treatment of DDH. LEVEL OF EVIDENCE Level III, diagnostic.
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13
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von Kries R, Ihme N, Altenhofen L, Niethard FU, Krauspe R, Rückinger S. General ultrasound screening reduces the rate of first operative procedures for developmental dysplasia of the hip: a case-control study. J Pediatr 2012; 160:271-5. [PMID: 21962602 DOI: 10.1016/j.jpeds.2011.08.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 06/22/2011] [Accepted: 08/17/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To assess the effectiveness of general ultrasound screening to prevent first operative procedures of the hip. STUDY DESIGN We conducted a case-control study in a population in which general ultrasound screening supplementing clinical screening is recommended and offered free of charge for all children. Participation in ultrasound screening before week 7 as recommended in Germany was the exposure of interest. Case ascertainment was based on active surveillance in orthopedic hospitals. The case definition was: first operative procedure for developmental dysplasia of the hip (closed reduction, open reduction, or osteotomy) in children >9 weeks old and <5 years old and born between 1996 and 2001. Control subjects from the same birth cohorts were recruited in telephone surveys. RESULTS Cases of first operative procedures for developmental dysplasia of the hip (n = 446) were compared with 1173 control subjects for ultrasound screening. Effectiveness of ultrasound screening to prevent first operative procedures for developmental dysplasia of the hip was estimated as 52% (95% CI, 32-67). Effectiveness did not vary substantially for closed and open reductions and osteotomy. CONCLUSIONS General ultrasound screening reduces the rate of operative procedures for developmental dysplasia of the hip; the impact on developmental dysplasia of the hip. Treatment rates and avascular necrosis need further assessment to balance the benefit against potential overtreatment and adverse effects.
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Affiliation(s)
- Rüdiger von Kries
- Division of Epidemiology, Institute for Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University, Munich, Germany.
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Tschauner C, Fürntrath F, Saba Y, Berghold A, Radl R. Developmental dysplasia of the hip: impact of sonographic newborn hip screening on the outcome of early treated decentered hip joints-a single center retrospective comparative cohort study based on Graf's method of hip ultrasonography. J Child Orthop 2011. [PMID: 23205143 PMCID: PMC3221760 DOI: 10.1007/s11832-011-0366-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED PURPOSE/BACKGROUND/INTRODUCTION: The aim of this study was to retrospectively evaluate the impact of neonatal sonographic hip screening using Graf's method for the management and outcome of orthopaedic treatment of decentered hip joints with developmental dysplasia of the hip (DDH), using three decades (1978-2007) of clinical information compiled in a medical database. METHODS Three representative cohorts of consecutive cases of decentered hip joints were selected according to different search criteria and inclusion and exclusion parameters: (1) cohort 1 (1978-1982; n = 80), without sonographic screening; (2) cohort 2.1 (1994-1996; n = 91), with nationwide established general sonographic screening according to the Graf-method; (3) cohort 2.2 (2003-2005; n = 91), with sonographic screening including referred cases for open reduction from non-screened populations. These three cohorts were compared for the following parameters: age at initial treatment, successful closed reduction, necessary overhead traction, necessary adductor-tenotomy, rate of open reduction, rate of avascular necrosis (AVN) and rate of secondary acetabuloplasty. RESULTS The age at initial treatment was reduced from 5.5 months in the first cohort to 2 months in the two subsequent two cohorts and the rate of successful closed reduction increased from 88.7 to 98.9 and 95.6%, respectively. There was a statistically significant improvement in six out of seven parameters with sonographic hip screening; only the rate of secondary acetabuloplasty did not improve significantly. CONCLUSION Compared to the era before the institution of a sonographic hip screening programme according to the Graf-method in Austria in 1992, ultrasound screening based-treatment of decentered hip joints has become safer, shorter and simpler: "safer" means lower rate of AVN, "shorter" means less treatment time due to earlier onset and "simpler" means that the devices are now less invasive and highly standardized.
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Affiliation(s)
| | - Frank Fürntrath
- />General and Orthopaedic Hospital Stolzalpe, 8852 Stolzalpe, Austria
| | - Yasaman Saba
- />Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
| | - Andrea Berghold
- />Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
| | - Roman Radl
- />General and Orthopaedic Hospital Stolzalpe, 8852 Stolzalpe, Austria
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Noordin S, Umer M, Hafeez K, Nawaz H. Developmental dysplasia of the hip. Orthop Rev (Pavia) 2011; 2:e19. [PMID: 21808709 PMCID: PMC3143976 DOI: 10.4081/or.2010.e19] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 08/31/2010] [Accepted: 09/01/2010] [Indexed: 01/02/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) is a spectrum of anatomical abnormalities of the hip joint in which the femoral head has an abnormal relationship with the acetabulum. Most studies report an incidence of 1 to 34 cases per 1,000 live births and differences could be due to different diagnostic methods and timing of evaluation. Risk factors include first born status, female sex, positive family history, breech presentation and oligohydramnios. Clinical presentations of DDH depend on the age of the child. Newborns present with hip instability, infants have limited hip abduction on examination, and older children and adolescents present with limping, joint pain, and/or osteoarthritis. Repeated, careful examination of all infants from birth and throughout the first year of life until the child begins walking is important to prevent late cases. Provocative testing includes the Barlow and Ortolani maneuvers. Other signs, such as shorting of the femur with hips and knees flexed (Galeazzi sign), asymmetry of the thigh or gluteal folds, and discrepancy of leg lengths are potential clues. Treatment depends on age at presentation and outcomes are much better when the child is treated early, particularly during the first six months of life.
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Affiliation(s)
- Shahryar Noordin
- Section of Orthopedics, Dept. of Surgery, Aga Khan University, Karachi, Pakistan
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16
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Bhalvani C, Madhuri V. Ultrasound profile of hips of South Indian infants. Indian Pediatr 2011; 48:475-7. [PMID: 21555794 DOI: 10.1007/s13312-011-0075-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
Abstract
One thousand consecutive infants, 437 girls and 563 boys, attending their first DPT vaccination at a mean age of 48 days underwent ultrasonological screening of the hips by Graf's technique at the immunization clinic of a tertiary hospital in South India. Graf I (mature) hips were seen bilaterally in 925 children. The incidence of Graf type II hips was 74/1000 infants. The incidence of sonographically abnormal hips (II, III and IV) in this population was 7.5%. The hip dislocation rate was 1 in 1000 (0.1%).
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Affiliation(s)
- Chirag Bhalvani
- Unit of Pediatric Orthopedics, Christian Medical College, Vellore, India
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17
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Natural progression of hip dysplasia in newborns: a reflection of hip ultrasonographic screenings in newborn nurseries. J Pediatr Orthop B 2010; 19:418-23. [PMID: 20440222 DOI: 10.1097/bpb.0b013e328339ecff] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hip screening is recommended for early detection of hip dysplasia; however, the strategy and efficacy were questioned. We performed ultrasonography to objectively observe the hip development in a group of infants and raise reflections on the efficacy of newborn ultrasonographic hip screening. A total of 1333 newborns (705 male and 628 female) received hip ultrasonography in the first week after birth. Clinical hip instability was detected by the Ortolani test. Hip dysplasia was defined by ultrasonography. A second survey of 90 babies was performed 1 month later on the babies with clinical hip instability or ultrasonographic Graf's type IIa, IIc, D, III, and IV hips. All the hip ultrasonographies were performed by the same investigator. Clinical instability was detected in 13 hips of 10 babies. Manual tests helped to detect unstable hips that had worse ultrasonographic measurements than those stable hips. Five Graf's type IIc hips and four type III hips were detected from the 2666 hips. At the age of 1 month, eight of the nine Graf's type IIc or III hips attained physiological status without treatment. A strong trend of spontaneous resolution in clinical hip instability and ultrasonographic dysplasia was observed in the newborns. The results did not support immediate treatment on the basis of newborn manual or ultrasound hip screening. We recommend manual testing in the newborn nursery to detect the hips at risk of dysplasia and ultrasonography after the first month after birth to confirm the diagnosis and judge the management.
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Farr S, Grill F, Müller D. [When is the optimal time for hip ultrasound screening?]. DER ORTHOPADE 2008; 37:532, 534-6, 538-40. [PMID: 18483720 DOI: 10.1007/s00132-008-1236-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The perfect time for hip screening is when every pathologically deformed hip can be diagnosed by sonography and after spontaneous resolution of immature, dysplastic hips. In addition, the beginning of therapy should be early enough to provide the best possible outcome concerning the anatomically correct healing of the patient's hip. Even though every child should be screened by sonography in the first few days of life, a reasonable way could be ultrasound screening in the first week for clinically unstable hips or newborns with risk factors such as breech position combined with ultrasound screening of every newborn between the fourth and sixth week.
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Affiliation(s)
- S Farr
- Abteilung für Unfallchirurgie und Sporttraumatologie, Landesklinikum, St. Pölten, Austria
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19
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[Hip ultrasound screening in Germany. Results and comparison with other screening procedures]. DER ORTHOPADE 2008; 37:541-6, 548-9. [PMID: 18491073 DOI: 10.1007/s00132-008-1237-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
General ultrasound screening programmes to determine DDH are still a matter of discussion due to a lack of evidence. To facilitate further discussions this review gives an overview of the international data and literature concerning the different screening policies taking into account the results of the German evaluation study from 1997 to 2002. General ultrasound screening programmes are established in Germany and Austria. The analysis of the German screening showed 535 cases of DDH with first operative procedure (age 10 weeks to 5 years) that were treated as inpatients: 66% underwent a closed reduction, 11% an open reduction and 23% an osteotomy of the acetabulum/femur. The number of children who had no ultrasound of the hip before diagnosis decreased from 22% in the first year to 8% in the last. The first ultrasound examination was without pathological findings in 12% of the cases. Capture-recapture estimates suggested that 52% of cases were reported, so that the incidence for first operation due to DDH was 0.26 per 1,000 live births in 1997. This is much lower than in other countries and 4/5 less than the time before screening with ultrasound in Germany. At most 42% of the cases might be preventable by an improvement of the screening programme, but at least 51% would not be prevented. The German ultrasound screening programme has proved to be effective. Improvement of economic efficiency is still possible. Therefore, the German programme with different screening times can be recommended.
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Shipman SA, Helfand M, Moyer VA, Yawn BP. Screening for developmental dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force. Pediatrics 2006; 117:e557-76. [PMID: 16510634 DOI: 10.1542/peds.2005-1597] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) represents a spectrum of anatomic abnormalities that can result in permanent disability. OBJECTIVE We sought to gather and synthesize the published evidence regarding screening for DDH by primary care providers. METHODS We performed a systematic review of the literature by using a best-evidence approach as used by the US Preventive Services Task Force. The review focused on screening relevant to primary care in infants from birth to 6 months of age and on interventions used in infants before 1 year of age. RESULTS The literature on screening and interventions for DDH suffers from significant methodologic shortcomings. No published trials directly link screening to improved functional outcomes. Clinical examination and ultrasound identify somewhat different groups of newborns who are at risk for DDH. A significant proportion of hip abnormalities identified through clinical examination or ultrasound in the newborn period will spontaneously resolve. Very few studies examine the functional outcomes of patients who have undergone therapy for DDH. Because of the high rate and unpredictable nature of spontaneous resolution of DDH and the absence of rigorous comparative studies, the effectiveness of interventions is not known. All surgical and nonsurgical interventions have been associated with avascular necrosis of the femoral head, the most common and most severe harm associated with all treatments of DDH. CONCLUSIONS Screening with clinical examination or ultrasound can identify newborns at increased risk for DDH, but because of the high rate of spontaneous resolution of neonatal hip instability and dysplasia and the lack of evidence of the effectiveness of intervention on functional outcomes, the net benefits of screening are not clear.
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Affiliation(s)
- Scott A Shipman
- Department of Pediatrics, Oregon Health and Science University, Portland, OR 97239, USA.
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von Kries R, Ihme N, Oberle D, Lorani A, Stark R, Altenhofen L, Niethard FU. Effect of ultrasound screening on the rate of first operative procedures for developmental hip dysplasia in Germany. Lancet 2003; 362:1883-7. [PMID: 14667743 DOI: 10.1016/s0140-6736(03)14957-4] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ultrasound screening for developmental hip dysplasia and early conservative treatment might prevent later hip operations. A national hip ultrasound-screening programme, undertaken during the first 6 weeks of life, was introduced across Germany in 1996 and was continued for 5 years. We assessed the rate of first operation on the hip during this programme. METHODS A national active surveillance programme of initial operations for developmental hip dysplasia was started in 1997 and continued for 5 years. Screening participation was assessed by a random digit dialing telephone survey. Cases were children aged between 10 weeks and 5 years at first operation, who had had no underlying disease leading to developmental hip dysplasia. Completeness of case ascertainment was validated with a capture-recapture study in a representative subsample. Calculated incidences were compared with previously established rates. FINDINGS About 90% of all children were screened. 147 cases in the first year, and between 81 and 105 for subsequent years were reported. Treatment included closed reductions 353 (66%), open reductions 61 (11%), and osteotomies 121 (23%). Developmental hip dysplasia was diagnosed by ultrasound before 6 weeks of age in 272 (55%) of cases, 64 (13%) were screened at the recommended time but had normal findings, 70 (14%) had delayed screening, and 89 (18%) were not screened. Capture-recapture estimates suggested that 52% of cases were reported. The corrected incidence for first operation was 0.26 per 1000 livebirths (95% CI 0.22-0.32). INTERPRETATION Ultrasound screening seems to prevent many, but not all, operations for developmental hip dysplasia. Rates of timely screening (ie, before 6 weeks of age) and training of doctors in ultrasound screening need to be improved.
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Affiliation(s)
- Rüdiger von Kries
- Department for Paediatric Epidemiology, Institute for Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University, Munich, Germany.
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Brown J, Dezateux C, Karnon J, Parnaby A, Arthur R. Efficiency of alternative policy options for screening for developmental dysplasia of the hip in the United Kingdom. Arch Dis Child 2003; 88:760-6. [PMID: 12937092 PMCID: PMC1719653 DOI: 10.1136/adc.88.9.760] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS To assess, using a decision model, the efficiency of ultrasound based and clinical screening strategies for developmental dysplasia of the hip. METHODS The additional cost per additional favourable outcome was compared for the following strategies: clinical screening alone using the Ortolani and Barlow tests; addition of static and dynamic ultrasound examination of the hips of all infants (universal ultrasound) or restricted to infants with defined risk factors (selective ultrasound); "no screening" (that is, clinical diagnosis only). RESULTS Ultrasound based screening strategies are predicted to be more effective but more costly than clinical screening or no screening. Estimated total costs per 100,000 live births are approximately pound 4 million for universal ultrasound, pound 3 million for selective ultrasound, pound 1 million for clinical screening alone, and pound 0.4 million for no screening. The relative efficiency of selective ultrasound and clinical screening is poorly differentiated, and depends on how infants are selected for ultrasound as well as the expertise of clinical screening examiners. If training costs less than pound 20 per child screened, clinical screening alone would be more efficient than selective ultrasound. Relative to no screening, each of the 16 additional favourable outcomes achieved as a result of selective ultrasound costs approximately pound 0.2 million, while each of the five favourable outcomes achieved through universal ultrasound screening, over and above selective ultrasound, costs approximately pound 0.3 million. CONCLUSIONS Policy choice depends on values attached to the different outcomes, willingness to pay to achieve these and total budget.
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Affiliation(s)
- J Brown
- MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol BS8 2PR, UK.
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Dezateux C, Brown J, Arthur R, Karnon J, Parnaby A. Performance, treatment pathways, and effects of alternative policy options for screening for developmental dysplasia of the hip in the United Kingdom. Arch Dis Child 2003; 88:753-9. [PMID: 12937091 PMCID: PMC1719641 DOI: 10.1136/adc.88.9.753] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS To compare, using a decision model, performance, treatment pathways and effects of different newborn screening strategies for developmental hip dysplasia with no screening. METHODS Detection rate, radiological absence of subluxation at skeletal maturity and avascular necrosis of the femoral head, as favourable and unfavourable treatment outcomes respectively, were compared for the following strategies: clinical screening alone using the Ortolani and Barlow tests; the addition of static and dynamic ultrasound examination of the hips of all infants (universal ultrasound) or restricted to infants with defined risk factors (selective ultrasound); "no screening" (that is, clinical diagnosis only). RESULTS Universal or selective ultrasound detects more more affected children (76% and 60% respectively) than clinical screening alone (35%), results in a higher proportion of affected children with favourable treatment outcomes (92% and 88% respectively) than clinical screening alone (78%) or no screening (75%), and the highest proportion of these achieved without recourse to surgery (64% and 79% respectively) compared with clinical screening alone (18%). However, ultrasound based strategies are also associated with the highest number of unfavourable treatment outcomes arising in unaffected children treated following a false positive screening result. The detection rate of clinical screening alone becomes similar to that reported for universal ultrasound when based on studies using experienced examiners (80%) rather than junior medical staff (35%). CONCLUSION From the largely observational data available, ultrasound based screening strategies appear to be most sensitive and effective but are associated with the greatest risk of potential adverse iatrogenic effects arising in unaffected children.
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Affiliation(s)
- C Dezateux
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH, UK.
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