The Continuing Development of Vibration Arthrometry as a Screening Method in Developmental Dysplasia of the Hip

1994 ◽  
Vol 4 (1) ◽  
pp. 41-49
Author(s):  
W. G. Kernohan ◽  
B. Trainor ◽  
P. Haugh ◽  
A. Johnston ◽  
I. Turner ◽  
...  
Keyword(s):  
Screening Method ◽  
Clinical Signs ◽  
Developmental Dysplasia ◽  
Non Invasive ◽  
Experienced Nurse ◽  
Diagnostic Modalities ◽  
Paediatric Orthopaedic ◽  
Further Development ◽  
Dysplasia Of The Hip ◽  
Vibration Arthrometry

As part of the continuing development of a non-invasive, objective screening method to achieve efficient early detection of developmental dysplasia of the hip (DDH), we determined the diagnostic sensitivity of an experienced nurse examiner and vibration arthrometry in the range of pathological anatomy of the disease. A cohort of 25 children were studied prior to commencement of their treatment. The hips were classified into four categories by an experienced paediatric orthopaedic surgeon with all diagnostic modalities available (“normal”, “stable but dysplastic”, “unstable and reducible” or “irreducible”). Of the 28 hips identified as abnormal, two hips were classified as stabledysplastic, 11 were unstable/reducible and 15 were irreducible hips. The experienced nurse examiner identified eight out of 11 unstable-reducible hips and reported clinical signs of abnormality in another 18 cases. Vibration arthrometry identified nine out of 11 unstable-reducible dislocations and detected abnormal signals from three irreducible hips. Vibration arthrometry may be of value in detecting abnormality in unstable-reducible and clicking hips. The low detection rate in the irreducible and dysplastic hips by vibration arthrometry was due to the absence of detectable vibration from mechanical events as the hips were manoeuvred. Examination by an experienced clinical examiner continues to be necessary if all degrees of mechanical abnormality in DDH are to be detected. Further development is required to achieve an objective non-invasive system of detecting all stages in the pathology of DDH.

Examining the effectiveness of examination at 6–8 weeks for developmental dysplasia: testing the safety net

2018 ◽  
Vol 104 (10) ◽  
pp. 953-955 ◽  
Author(s):  
Mike Reidy ◽  
Caitlin Collins ◽  
Jamie G B MacLean ◽  
Donald Campbell
Keyword(s):  
Safety Net ◽  
Late Presentation ◽  
Developmental Dysplasia ◽  
Positive Finding ◽  
Invasive Treatment ◽  
Early Presentation ◽  
Current Form ◽  
Non Invasive ◽  
The Uk ◽  
Dysplasia Of The Hip

ObjectiveThe ‘GP check’ at 6–8 weeks forms part of the selective surveillance system for developmental dysplasia of the hip (DDH) in the UK. It is imperative to pick up DDH within the first months of life to allow for non-invasive treatment and the avoidance of surgery. We aim to investigate the effectiveness of hip examination at 6–8 weeks.MethodsThis is a longitudinal observational study including all infants born in our region in the 5 years following 2006. Early presentation was defined as diagnosis within 14 weeks of birth and late presentation after 14 weeks. Treatment records for early and late DDH as well as referrals for ultrasound (US) following examination at 6–8 weeks were analysed. Attendance of the examination at 6–8 weeks in those patients who went on to present with a late DDH was also analysed.Results23 112 live births occurred during the study period. There were 141 confirmed cases of DDH. 400 referrals for US were received following examination at 6–8 weeks; 6 of these had a positive finding of DDH. 27 patients presented after 14 weeks and were classified as late presentations. 25 of these patients had attended examination at 6–8 weeks and no abnormality had been identified.ConclusionsThe sensitivity of examination at 6–8 weeks was only 19.4%, its specificity was 98% and it had a positive predictive value of 1.5%. For many years the check at 6–8 weeks has been thought of as a means to identify those children not identified as neonates; however, we found that four out of five children with DDH were not identified by the check at 6–8 weeks. Unfortunately, we conclude that the presumed safety net of the examination in its current form is not reliable.

scholarly journals The positive predictive value of asymmetrical skin creases in the diagnosis of pathological developmental dysplasia of the hip

2018 ◽  
Vol 100-B (5) ◽  
pp. 675-679 ◽  
Author(s):  
M. J. Anderton ◽  
G. R. Hastie ◽  
R. W. Paton
Keyword(s):  
Risk Factors ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Clinical Signs ◽  
Senior Author ◽  
Developmental Dysplasia ◽  
Inclusion Criteria ◽  
Leg Length ◽  
One Stop ◽  
Dysplasia Of The Hip

Aims The aim of this study was to identify the association between asymmetrical skin creases of the thigh, buttock or inguinal region and pathological developmental dysplasia of the hip (DDH). Patients and Methods Between 1 January 1996 and 31 December 2016, all patients referred to our unit from primary or secondary care with risk factors for DDH were assessed in a “one stop” clinic. All had clinical and sonographic assessment by the senior author (RWP) with the results being recorded prospectively. The inclusion criteria for this study were babies and children referred with asymmetrical skin creases. Those with a neurological cause of DDH were excluded. The positive predictive value (PPV) for pathological DDH was calculated. Results A total of 105 patients met the inclusion criteria. There were 71 girls and 34 boys. Only two were found to have pathological DDH. Both also had unilateral limited abduction of the hip in flexion and a positive Galeazzi sign with apparent leg-length discrepancy. Thus, if the specialist examination of a patient with asymmetrical skin creases was normal, the PPV for DDH was 0%. Conclusion Isolated asymmetrical skin creases are an unreliable clinical sign in the diagnosis of pathological DDH. Greater emphasis should be placed on the presence of additional clinical signs to guide radiological screening in babies and children. Cite this article: Bone Joint J 2018;100-B:675–9.

scholarly journals Closed Reduction in Developmental Dysplasia of the Hip in Patients Older than One Year

Folia Medica ◽  
2020 ◽  
Vol 62 (2) ◽  
pp. 276-281
Author(s):  
Zoran Bozinovski ◽  
Milena Bogojevska Doksevska ◽  
Keti P. Tokmakova
Keyword(s):  
Avascular Necrosis ◽  
Closed Reduction ◽  
Screening Method ◽  
Hip Dislocation ◽  
Developmental Dysplasia ◽  
Type I ◽  
Range Of Movement ◽  
Cast Immobilization ◽  
Recommended Treatment ◽  
Dysplasia Of The Hip

Introduction: Besides an effective screening method for developmental dysplasia of the hip, there is certain number of children in whom the condition has been overseen or they have never been screened and the parents have noticed the odd walking pattern in their toddler. Treatment of such patients is controversial. One of the recommended treatment methods because of the short-term hospitalization, but often considered unsuccessful is closed reduction of the hip followed by cast immobilization. Hypothesis: Closed hip reduction in late diagnosed developmental dysplasia of the hip gives good results.  Aim: Our aim in this retrospective study was evaluation of the success of the treatment with closed reduction of hip dislocation in children older than 12 months.  Patients and methods: In the study, we included 20 patients treated at our clinic from June 2004 to May 2017. Of these 20 patients, 8 had bilateral involvement, 12 had unilateral, in a total of 28 hips. In all patients we noted preoperatively the range of movement, the presence of limp, any limb inequality, and hip pain. We used clinical and radiological parameters for evaluation. Clinically, we examined the range of movement, limb inequality as well as limb function and we classified it according to the modified McKay’s criteria. Same examinations were done at 1, 3, and 5 years after closed reduction. Results: At the last follow-up examination, using McKey’s criteria for clinical evaluation we rated the hips in two patients (7%) as grade III, i.e. fair grade, 10 hips (36%) were grade II – rated good, and 16 hips (57%) were evaluated as grade I. In four hips, there were signs of avascular necrosis of the hip, while in one patient the avascular necrosis developed after the closed reduction. Radiographic assessment (Figs 3, 4) using Severin’s scoring system showed no hips with types V and VI, type IV was observed in 7%, type III in 21%, type II in 29%, while most of the hips (12, 43%) were type I. Conclusion: We concluded that the procedure was justified. An advantage of this method is that it is inexpensive; it entails no direct operative changes of the bone structures and gives good results.

scholarly journals Day-case pelvic osteotomy for developmental dysplasia of the hip

2020 ◽  
Vol 14 (6) ◽  
pp. 508-512
Author(s):  
Dave M. Moore ◽  
Gerard A. Sheridan ◽  
Paula M. Kelly ◽  
David P. Moore
Keyword(s):  
Pelvic Osteotomy ◽  
Models Of Care ◽  
Developmental Dysplasia ◽  
Point Of View ◽  
Day Case ◽  
Level Of Evidence ◽  
Patient Resources ◽  
Bed Days ◽  
Paediatric Orthopaedic ◽  
Dysplasia Of The Hip

Purpose: In this article we report the results of a pilot study analysing the implications of performing pelvic osteotomies for developmental dysplasia of the hip (DDH) as a day case. We assess the advantages of performing paediatric pelvic osteotomies as day-case procedures from a financial perspective and from an in-patient bed resource point of view. Methods: This was a prospective cohort study analysing Salter and Pemberton pelvic osteotomies performed for DDH over a three-year period from 1st January 2017 to 30th September 2019. All patients residing within 50 km of the hospital were eligible for day-case procedures. All other cases were performed as in-patients. A detailed financial costing analysis was performed and the in-patient resources utilized were documented and compared between the two models of care. Results: In total, 84 Salter and Pemberton osteotomies were performed between 1st January 2017 to 30th September 2019. Of these cases, 35 were performed as day-case procedures. A total reduction in 70 in-patient bed days was reported. Total costs for a single in-patient requiring two nights of admission amounted to €5,752, whereas the discharge cost of a day case was reported at €2,670. The savings made by our institution amounted to €3,082 per day case. A total saving of €102,696 was made over three years. In all, seven day-case patients re-attended due to inadequate pain control. They required overnight admission and were discharged uneventfully the following day. Conclusion: Day-case pelvic osteotomies significantly reduce the number of in-patient bed days used in an elective paediatric orthopaedic setting. Significant financial savings in excess of €3,000 per case are possible. The introduction of day-case pelvic osteotomy procedures can significantly improve the cost-effectiveness of managing DDH provided there are clear protocols in place with close clinical follow-up. Level of evidence: IV

scholarly journals Diagnostic and treatment preferences for developmental dysplasia of the hip: a survey of EPOS and POSNA members

2018 ◽  
Vol 12 (3) ◽  
pp. 236-244 ◽  
Author(s):  
C. Alves ◽  
W. H. Truong ◽  
M. V. Thompson ◽  
J. R. Suryavanshi ◽  
C. L. Penny ◽  
...  
Keyword(s):  
Developmental Dysplasia ◽  
Diagnosis And Treatment ◽  
Treatment Preferences ◽  
Level Of Evidence ◽  
Hip Abduction ◽  
Frequent Response ◽  
Radiology Technicians ◽  
Paediatric Orthopaedic ◽  
Orthopaedic Society ◽  
Dysplasia Of The Hip

Purpose The aim of this study was to elucidate developmental dysplasia of the hip (DDH) diagnosis and treatment preferences among members of the Pediatric Orthopaedic Society of North America (POSNA) and European Paediatric Orthopaedic Society (EPOS). Methods A 54-question survey on DDH diagnosis and treatment preferences was distributed to POSNA and EPOS members. Descriptive statistics were performed. Results A total of 459 responses were analyzed. Ultrasound was the preferred modality for diagnosing DDH in infants less than six months old; few surgeons preferred radiographs. In all, 57% of POSNA members had radiology technicians perform ultrasounds, only 7% of EPOS members did. The percent coverage defining a dislocated hip varied greatly, the most frequent response being < 20% for POSNA and < 40% for EPOS members. Pavlik harnesses were the most popular harness/brace, used by 90% of POSNA and 71% of EPOS members. POSNA members were more likely than EPOS members to use a rigid abduction brace following initial harness/brace failure. For residual acetabular dysplasia, POSNA members were twice as likely as EPOS members to institute hip abduction bracing. Most surgeons would not perform closed reduction at less than three months of age or open reduction at less than six months of age. Most EPOS ­members used traction prior to reduction; few POSNA members did. Few POSNA and EPOS members believed that reduction should be delayed until the ossific nucleus was visible. Conclusion There is great variation in the preferred methods for diagnosing and treating DDH. This survey is the largest transcontinental survey to compile diagnostic and treatment preferences for DDH. With wide variations in practice, there is room for quality improvement. Level of Evidence II

scholarly journals Diagnosis and treatment of developmental dysplasia of the hip: A current practice of paediatric orthopaedic surgeons

2017 ◽  
Vol 25 (2) ◽  
pp. 230949901771719 ◽  
Author(s):  
Rakan S Al-Essa ◽  
Fares H Aljahdali ◽  
Rakan M Alkhilaiwi ◽  
Winnie Philip ◽  
Ayman H Jawadi ◽  
...  
Keyword(s):  
Current Practice ◽  
Developmental Dysplasia ◽  
Diagnosis And Treatment ◽  
Orthopaedic Surgeons ◽  
Paediatric Orthopaedic ◽  
Dysplasia Of The Hip ◽  
A Current

Age as a predictor of additional surgeries following initial closed reduction for children with developmental dysplasia of the hip: the 10-year experience of a national paediatric orthopaedic unit

2021 ◽  
pp. 112070002110620
Author(s):  
Robert J Hurley ◽  
Martin S Davey ◽  
Matthew G Davey ◽  
Patrick Groarke ◽  
Jim Kennedy ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Surgical Intervention ◽  
Neuromuscular Disorders ◽  
Multivariable Analysis ◽  
Significant Proportion ◽  
Female Gender ◽  
Developmental Dysplasia ◽  
Operative Intervention ◽  
Paediatric Orthopaedic ◽  
Dysplasia Of The Hip

Background and purpose: Dislocated and unstable hip joints which do not stabilize in an orthosis in the neonatal period require operative intervention to achieve a stable concentric joint. The aim of this study is to assess the requirement for further operative intervention in patients who have undergone successful closed reduction to treat developmental dysplasia of the hip (DDH). Methods: We identified all patients who had undergone closed reduction of an unstable hip joint at our institution within 10 years, with further identification of patients who underwent a second procedure. We used logistic regression to evaluate correlation between age at closed reduction and the probability of secondary procedures. Results: A total of 694 patients (84.5% females) who underwent a closed reduction in the study period were identified. 235 were excluded (patients with underlying genetic conditions, neuromuscular disorders, syndromic disorders). 250 patients had closed reductions only. 209 patients (45.5%) had at least 1 secondary procedure after their initial closed reduction. In multivariable analysis, female gender (OR 0.310; 95% CI, 0.108–0.885; p = 0.029) and patients aged ⩽12 months at the time of first surgery (OR 0.055; 95% CI, 0.007–0.423; p = 0.005) independently predicted being less likely to require a second surgery for their DDH. Discussion: In conclusion, we found that a significant proportion of children (45.5%) who underwent closed reduction of a dislocated hip required additional surgical intervention in early childhood. Our data show that those children who undergo later closed reduction of a dislocated hip in DDH after 12 months of age, and male infants, have a significantly higher incidence of additional surgical intervention.

scholarly journals Does the gestation age of newborn babies influence the ultrasonic assessment of hip condition?

2009 ◽  
Vol 137 (7-8) ◽  
pp. 402-408 ◽  
Author(s):  
Slavica Simic ◽  
Zoran Vukasinovic ◽  
Janko Samardzic ◽  
Iris Pejcic ◽  
Marija Lukavac-Tesin ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Screening Method ◽  
Breech Presentation ◽  
Premature Baby ◽  
Developmental Dysplasia ◽  
Systematic Screening ◽  
Premature Babies ◽  
Gestation Age ◽  
Ultrasonic Assessment ◽  
Dysplasia Of The Hip

Introduction. Ultrasound represents a method of examination of hips of newborn babies capable of defining hip condition and distinguishing stable and unstable hips based on morphological elements. It is accepted in a large number of countries as a method of examination of high risk newborns, or as a method of systematic screening. Objective. The objective of this study was to investigate correlation between ultrasonically estimated hip maturity and respective gestation maturity both in premature and term-born babies, and to investigate the influence of different delivery types on hips condition. Methods. In our study 2045 patients, 1141 males and 904 females, were examined in at the Institute of Neonatology over a period of 5 years. The average age was 34.04 gestation weeks. There were significantly more premature (1698 or 83.03%) than term-born babies (347 or 16.97%). Ultrasound hip examination, as a screening method, was carried out according to Graf. It was followed by clinical examination. Results were analyzed by appropriate statistical methods (?2-test, one-way ANOVA, multifactor ANOVA). Results. The overall frequency of unstable hips was 3.2%, 1.88% in males and 4.87% in females (p<0.05). 96.8% babies had stable hips, out of which 35.21% were mature and 61.59% immature. In the study of the breech presentation, out of 183 babies, unstable hips were found in 1.58% of male cases, and in 10.23% of female cases. Conclusion. Clinical screening of developmental dysplasia of the hip is insufficient for early diagnosis and decision about the treatment of premature babies. The high frequency of unstable hip type IIc (risky) and IId (decentralized) in premature babies requires early diagnosis and therapy. Wide swaddling for prematures should be applied up to eight months of age. Gentle manipulation is necessary while nursing and conducting physiotherapy of a premature baby.

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