Article

Neonatal incidence of hip dysplasia

Department of Orthopedic Surgery B, Rambam Health Care Campus, Haifa, Israel.
Clinical Orthopaedics and Related Research (Impact Factor: 2.88). 05/2008; 466(4):771-5. DOI: 10.1007/s11999-008-0132-8
Source: PubMed

ABSTRACT The advantages of sonographic examination are well known, but its main disadvantage is that it might lead to overdiagnosis, which might cause overtreatment. Variations in the incidence of developmental dysplasia of the hip are well known. We ascertained the incidence of neonatal sonographic developmental dysplasia of the hip without considering the development of those joints during followup. All 45,497 neonates (90,994 hips) born in our institute between January 1992 and December 2001 were examined clinically and sonographically during the first 48 hours of life. Sonography was performed according to Graf's method, which considers mild hip sonographic abnormalities as Type IIa. We evaluated the different severity type incidence pattern and its influence on the total incidence during and between the investigated years. According to our study, sonographic Type IIa has major effects on the incidence of overall developmental dysplasia of the hip with a correlation coefficient of 0.95, whereas more severe sonographic abnormalities show relatively stable incidence patterns. LEVEL OF EVIDENCE: Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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    ABSTRACT: Developmental dysplasia of the hip (DDH) is one of the most widely discussed abnormalities in neonates. The advantages of sonographic examination are well known, but its main disadvantage is that it might lead to over diagnosis, which might cause over treatment. Variations in the incidence of developmental dysplasia of the hip are well known. During six months study since September 2006 all 1300 neonates (2600 hips) were born in our hospital examined clinically and sonographically (587 hips) in the first 48 hours of life. Sonography was performed according to Graf's method, which considers mild hip sonographic abnormalities as type II a. Type IIb Graf were considered pathologic. Sonography screening of 587 hips detected 36 instances of deviation from normal indicating a sonographic DDH incidence of 12.5%. However, only 8 neonates remained abnormal and required treatment, indicating a true DDH incidence of 6 per 1000 live birth. Risk of diagnosis clinically and sonographicaly were 2.5 and 4.5 percent respectively and was significant (P<0.00001, x(2)=1170). In order to avoid over diagnosis in first days examination, repeated clinical and sonographic examination is required.
    Acta medica Iranica 01/2011; 49(1):25-7.
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    ABSTRACT: The etiology of developmental dysplasia of the hip (DDH) is unknown. There are many insights, however, from epidemiologic/demographic information. A systematic medical literature review regarding DDH was performed. There is a predominance of left-sided (64.0%) and unilateral disease (63.4%). The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans. There is significant variability in incidence within each racial group by geographic location. The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. Predictors of DDH are breech presentation, positive family history, and gender (female). Children born premature, with low birth weights, or to multifetal pregnancies are somewhat protected from DDH. Certain HLA A, B, and D types demonstrate an increase in DDH. Chromosome 17q21 is strongly associated with DDH. Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. Swaddling is strongly associated with DDH. Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. Associated conditions are congenital muscular torticollis and congenital foot deformities. The opposite hip is frequently abnormal when using rigorous radiographic assessments. The role of acetabular dysplasia and adult hip osteoarthritis is complex. Archeological studies demonstrate that the epidemiology of DDH may be changing.
    10/2011; 2011. DOI:10.5402/2011/238607
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    ABSTRACT: Objective The purpose of this study was to investigate the usefulness of screening ultrasound to detect developmental dysplasia of the hip in infants with risk factors and to assess its socioeconomic impact. Patients and methods This is a retrospective study. In the duration of 30 months, all infants born at Hospitals in our region were examined clinically for hip dislocation. All those with clinically dislocated hips were excluded and referred for follow up to a pediatric orthopedic surgeon. After referral to our tertiary care center, a 6 week hip ultrasound scan was performed for those infants with stable hips on examination, having risk factors for dysplastic hips including positive family history, breech presentation and inconclusive clinical findings. We used an ultrasound technique that combines the two known methods (Graf’s technique and Harcke’s method). Results 3540 Hip ultrasound scans were performed, of those scanned 12 (0.33%) were found to have dislocated hips and 98 (2.8%) to have different grades of dysplastic hips. Among these twelve patients; six of them had a first degree relative with congenital dislocation of hips, three had breech presentation at birth and three had inconclusive clinical findings. Those with dysplastic hips were followed up by serial ultrasound examinations but did not require active intervention. Conclusion Screening ultrasound is a useful tool for detection of hip dislocation and dysplasia especially among the population of infants at increased risk of developmental dysplasia of the hip. Limitation of screening ultrasound programs for those at risk only reduces the financial burden with better outcome in choosing candidates for further workup especially surgical intervention.
    01/2013; 50(1). DOI:10.1016/j.ajme.2013.04.006

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