Neonatal incidence of hip dysplasia: Ten years of experience

ArticleinClinical Orthopaedics and Related Research 466(4):771-5 · May 2008with10 Reads
DOI: 10.1007/s11999-008-0132-8 · Source: PubMed
Unlabelled: 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.
    • "Developmental dysplasia of the hip (DDH), formerly defined as congenital dislocation of the hip, is one of the most common neonatal deformities that may have significant influence on the life quality of patient [1]. Its incidence is estimated to be 3 to 5 per 1000 hips, which is clouded by the absence of definitive diagnostic criteria and the wide range of mild to severe anatomical variations that fall within the spectrum of DDH [2]. Although several options exist including proximal femoral and periacetabular osteotomies, total hip arthroplasty (THA) remains the standard treatment in end stage DDH, predominantly Crowe type IV in Crowe classification [3] or high dislocation DDH in Hartofilakidis classification [4], which leads to significant pain and loss of function [5]. "
    [Show abstract] [Hide abstract] ABSTRACT: Subtrochanteric femoral shortening osteotomy is a crucial procedure to prevent nerve injury in total hip arthroplasty for severe developmental dysplasia of the hip. Transverse osteotomy was first applied, and other modified methods have also been reported. Each has its own advantages and limitations, but no definitive conclusions regarding differences in outcomes have been reached to date. We therefore performed a comprehensive meta-analysis to compare the outcomes of different approaches. 37 studies (795 hips) were included in the final analysis. Meta-analysis, subgroup analysis and meta-regression were performed. Meta-analysis and subgroup analysis showed no significant difference between transverse and modified method. This is further confirmed by meta-regression. Method of osteotomy was found to be not associated with nonunion rate (P = 0.472), as well as other post-operative outcomes including nerve palsy (P = 0.240), dislocation (P = 0.735), revision (P = 0.653) and Harris hip score improvement (P = 0.562). In addition, western countries (P = 0.010) and duration of follow-up more than 5 years (P = 0.014) were associated with higher revision rate. Transverse osteotomy and modified osteotomy appear to be equivalent in terms of nonunion, safety and efficacy. Transverse osteotomy may be recommended, due to its simplicity and convenience in adjusting the anteversion angle. Well-designed and large-sample-size randomized controlled trials are expected to confirm and update the findings of this analysis.
    Full-text · Article · Oct 2014
    • "Individual SNP association to CHD was tested using a x 2 -based statistic for the comparison of allele frequencies using PLINK software, and revealed association to multiple chromosomal regions, including chromosome 1, 3, 5, 8, 11, 12, 13, 15, 19, 20, 25, 28, 32, 34 and the X chromosome (P-value ,0.001,Figure 1). A Bonferroni correction of a = 0.05 over 17,859 tests was performed to correct for multiple testing and only the region on chromosome 8 was significantly associated to CHD, with BICF2S23913508 located at position 33707642 bp of the reference genome CanFam2 as the most strongly associated SNP in this region (corrected P-value = 0.0007,Figure 1A). "
    [Show abstract] [Hide abstract] ABSTRACT: Hip dysplasia, an abnormal laxity of the hip joint, is seen in humans as well as dogs and is one of the most common skeletal disorders in dogs. Canine hip dysplasia is considered multifactorial and polygenic, and a variety of chromosomal regions have been associated with the disorder. We performed a genome-wide association study in Dutch Labrador Retrievers, comparing data of nearly 18,000 single nucleotide polymorphisms (SNPs) in 48 cases and 30 controls using two different statistical methods. An individual SNP analysis based on comparison of allele frequencies with a χ(2) statistic was used, as well as a simultaneous SNP analysis based on Bayesian variable selection. Significant association with canine hip dysplasia was observed on chromosome 8, as well as suggestive association on chromosomes 1, 5, 15, 20, 25 and 32. Next-generation DNA sequencing of the exons of genes of seven regions identified multiple associated alleles on chromosome 1, 5, 8, 20, 25 and 32 (p<0.001). Candidate genes located in the associated regions on chromosomes 1, 8 and 25 included LAMA2, LRR1 and COL6A3, respectively. The associated region on CFA20 contained candidate genes GDF15, COMP and CILP2. In conclusion, our study identified candidate genes that might affect susceptibility to canine hip dysplasia. These genes are involved in hypertrophic differentiation of chondrocytes and extracellular matrix integrity of basement membrane and cartilage. The functions of the genes are in agreement with the notion that disruptions in endochondral bone formation in combination with soft tissue defects are involved in the etiology of hip dysplasia.
    Full-text · Article · Jan 2014
    • "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.[19] In our study, we took assistance from a 10 years experienced orthopedic surgeon and sonographer. "
    [Show abstract] [Hide abstract] 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.
    Article · Dec 2013
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