Neonatal incidence of hip dysplasia: Ten years of experience
Department of Orthopedic Surgery B, Rambam Health Care Campus, Haifa, Israel.Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 05/2008; 466(4):771-5. DOI: 10.1007/s11999-008-0132-8
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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- "The reason of the difference is the large sample size of our study because small sample size leads to change sensitivity. Besides the experience of the examiner and sonographer has an essential role in making differences. In our study, we took assistance from a 10 years experienced orthopedic surgeon and sonographer. "
ABSTRACT: Developmental dysplasia of hip (DDH) is one of the congenital anomalies in newborns that if not diagnosed and treated on time can lead to a severe disability. Although clinical examination is a very useful way for screening, but in some patients, a confirmatory diagnostic method such as ultrasonography is needed. The aim of the present study is to compare the sensitivity and specificity of clinical examination and ultrasonography in early detecting of DDH. A total of 5800 of newborns were examined by orthopedic surgeon as a screening method. The newborns with risk factors or suspicious on clinical examination were introduced to repeat clinical and ultrasonographic examination of hip. The results were collected and recorded by a check list and then the sensitivity and specificity of clinical examination were calculated. Of 5701 newborns (11402 hips) who were studied by two methods of clinical examination and ultrasonography (by Graf method), the overall incidence of DDH was 29 per 1000. Only 94 hips (13.5%) of 694 disordered ones according to clinical examination were involved on ultrasonographic evaluation. A total of 240 hips of 334 (72%) involved hips according to ultrasonography (Graf type IIb or more) were diagnosed normal on clinical examination, considering ultrasonography as a gold standard method of evaluating DDH, the sensitivity and specificity of clinical examination were calculated 28.1% and 94.5%, respectively. According to the present study, ultrasonogeraphic examination has a high valuable in screening of DDH and the clinical examination done by an experienced orthopedic surgeon has an acceptable value in primary screening of DDH in developing countries for detecting of healthy neonates, but if the newborn has a risk factor or is suspicious on clinical examination, it will be necessary to get assistance from ultrasonography by an experienced sonographer.
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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.
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ABSTRACT: The purpose of the study was to evaluate the association of sonographic worsening in type 2a hips with risk factors of developmental dysplasia of the hip, stability of the hip, and initial sonographic findings. Among infants who were referred for hip sonography between 2007 and 2009, 3450 were included in this study. Sonographic examinations were performed by combining the static Graf technique and the dynamic Harcke technique. The rate of sonographic worsening in type 2a hips and the relationship between sonographic worsening and risk factors for developmental dysplasia, instability of the hip, lateralization (right or left) of immaturity, and the presence of unilateral and bilateral immature hips were evaluated. Type 2a hips were observed in 529 infants (15.3%; 780 hips [11.3%]). Of these, in 36 cases (6.8%; 44 hips [5.6%]), the sonographic results worsened. Twenty-five of these 36 cases (32 of 44 hips) were diagnosed as type 2 b; in others, the dysplasia worsened, and 6 cases (7 hips) were classified as type 2 c, 3 cases (3 hips) as type D, and 2 cases (2 hips) as type 3. Instability, unilateral type 2a hips, and associated central nervous system anomalies were found to be independent predictors of sonographic worsening in type 2a hips. Type 2a hips may worsen sonographically at a rate of 5.6%; hence, sonographic follow-up is needed. Instability, central nervous system anomalies, and unilateral type 2a hips were found to be independent predictors of sonographic worsening. Our study shows that cases with these risk factors should be followed more carefully.