Early detection of developmental dysplasia of the hip in The Netherlands: the validity of a standardized assessment protocol in infants (original) (raw)
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Evaluation and Referral for Developmental Dysplasia of the Hip in Infants
Pediatrics, 2016
Developmental dysplasia of the hip (DDH) encompasses a wide spectrum of clinical severity, from mild developmental abnormalities to frank dislocation. Clinical hip instability occurs in 1% to 2% of full-term infants, and up to 15% have hip instability or hip immaturity detectable by imaging studies. Hip dysplasia is the most common cause of hip arthritis in women younger than 40 years and accounts for 5% to 10% of all total hip replacements in the United States. Newborn and periodic screening have been practiced for decades, because DDH is clinically silent during the first year of life, can be treated more effectively if detected early, and can have severe consequences if left untreated. However, screening programs and techniques are not uniform, and there is little evidence-based literature to support current practice, leading to controversy. Recent literature shows that many mild forms of DDH resolve without treatment, and there is a lack of agreement on ultrasonographic diagnost...
BMJ Open
IntroductionIn the UK, a compulsory ‘6-week hip check’ is performed in primary care for the detection of developmental dysplasia of the hip (DDH). However, missed diagnoses and infants incorrectly labelled with DDH remain a problem, potentially leading to adverse consequences for infants, their families and the National Health Service. National policy states that infants should be referred to hospital if the 6-week check suggests DDH, though there is no available tool to aid examination or offer guidelines for referral. We developed standardised diagnostic criteria for DDH, based on international Delphi consensus, and a 9-item checklist that has the potential to enable non-experts to diagnose DDH in a manner approaching that of experts.Methods and analysisWe will conduct a controlled trial randomised by practice that will compare a diagnostic aid against standard care for the hip check. The primary objective is to determine whether an aid to the diagnosis of DDH reduces the number o...
Screening of Newborns and Infants for Developmental Dysplasia of the Hip: A Systematic Review
Indian Journal of Orthopaedics, 2021
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.
Is Clinical Examination Reliable in Diagnosis of Developmental Dysplasia of the Hip?
GAZI MEDICAL JOURNAL, 2008
Purpose: To assess the sensitivity and specificity of clinical examination compared with ultrasonography (USG) in diagnosing developmental dysplasia of the hip (DDH). Methods: The files of children aged 6 months or younger who were born at the Başkent University Hospitals in the years 2000-2002 were examined. After examination of 443 infants by an experienced paediatrician, an orthopaedic surgeon evaluated all neonate hips by USG. The validity of the clinical examination results versus the validity of the USG examination results was assessed and analysed. Results: Of the 443 children, 55.8% were female and 44.2% were male; 74.7% of the infants having DDH were female and 25.3% were male (P < 0.05). Of the infants with DDH, 8.8% had a family history of the disorder. Analysis of the validity of the clinical examination results compared with USG examination results showed the sensitivity, specificity, (+) and (-) predictive values of clinical assessment to be 38.5%, 84.9%, 39.8%, and 84.2%, respectively. Conclusions: We recommend USG examinations for all infants at high risk for DDH because the examination is non-invasive, repeatable, inexpensive, and has no risk of ionizing radiation. Additionally, there is no need for sedation or contrast material administration.