Value of the ‘clicky hip’ in selective screening for developmental dysplasia of the hip

2019 ◽  
Vol 101-B (6) ◽  
pp. 635-638 ◽  
Author(s):  
B. A. Marson ◽  
J. B. Hunter ◽  
K. R. Price
Keyword(s):  
Risk Factors ◽  
Hip Dysplasia ◽  
Screening Programme ◽  
Developmental Dysplasia ◽  
Selective Screening ◽  
Ultrasound Scan ◽  
Additional Risk ◽  
Hip Ultrasound ◽  
Dysplasia Of The Hip ◽  
Prospective Database

Aims The aim of this study was to review the value of accepting referrals for children with ‘clicky hips’ in a selective screening programme for hip dysplasia. Patients and Methods A single-centre prospective database of all referrals to the hip clinic was examined to identify indication for referrals, diagnosis, and treatment. All patients referred received a standardized ultrasound scan and clinical examination by an orthopaedic consultant. Results There were 5716 children referred to the orthopaedic hip clinic between 1 June 2014 and 26 September 2018. In all, 1754 children (30.1%) were referred due to ‘clicky hip’ with no additional risk factors or indications for ultrasound scan. A total of 123 children (7.1%) referred with ‘clicky hip’ and no additional risk factors or examination findings had an abnormal initial hip ultrasound, including 16 children (0.9%) with dysplastic hips. Of the 141 children who required treatment in a Pavlik harness during the study period, 23 (16%) had been referred with a ‘clicky hip’ and no additional risk factors or examination findings, including six children with Graf 3 or 4 hips. Conclusion There is significant value in reviewing children with an isolated ‘clicky hip’. Many children who require treatment are referred to the orthopaedic service as ‘clicky hip’ with no additional risk factors. In a pragmatic pathway with a diverse population of clinicians performing baby checks, ‘clicky hip’ is an important indication for referral and should not be discarded. Cite this article: Bone Joint J 2019;101-B:635–638.

scholarly journals Should We Continue to Screen for Developmental Dysplasia of the Hip in Clubfoot? Our Experience and Review of the Literature

2021 ◽  
Vol 7 (2) ◽  
Keyword(s):  
Clinical Examination ◽  
Hip Dysplasia ◽  
Screening Programme ◽  
Developmental Dysplasia ◽  
The Other ◽  
Idiopathic Clubfoot ◽  
Ultrasound Screening ◽  
Review Of The Literature ◽  
Targeted Ultrasound ◽  
Dysplasia Of The Hip

Objective: The association between clubfoot and developmental dysplasia of the hip (DDH) remains uncertain, with only a few studies linking both. However, clubfoot is considered as a risk factor for DDH. The aim of this study was to determine the incidence of DDH and evaluate the need for routine hip imaging in our population of children with clubfoot. Methods: Retrospective analysis of all patients treated for clubfoot in our center between 2010 and 2019. We included patients with hip imaging for DDH in the first 12 months of life. Results: There were 108 children with clubfoot who underwent DDH screening. 92 had idiopathic clubfoot and 16 had syndromic clubfoot. Of the patients with idiopathic clubfoot, 2 (2.2%) had DDH; one had a clinically unstable hip and the other patient underwent hip screening on account of the clubfoot alone. Among patients with syndromic clubfoot, 3 (18.8%) had developmental dysplasia of the hip. Two of them had an abnormal hip examination while the other had normal hip clinical examination but other established risk factors for DDH. Conclusion: A targeted ultrasound or radiological screening programme for DDH in idiopathic clubfoot diagnosed hip dysplasia in only 1 child that would have otherwise been missed by clinical examination alone. We conclude that hip imaging is not warranted in children with idiopathic clubfoot and regular clinical screening may suffice. In syndromic clubfoot, due to the higher incidence of DDH, we recommend specific ultrasound screening even in the presence of a normal hip examination. Keywords: Clubfoot, Screening, Developmental dysplasia of the hip.

Prevalence of Hip Ultrasound Abnormalities in Newborns With a Hip Click

2020 ◽  
Vol 59 (8) ◽  
pp. 773-777
Author(s):  
John T. Gaffney ◽  
John Spellman
Keyword(s):  
Family History ◽  
Confidence Interval ◽  
Physical Examination ◽  
Prospective Studies ◽  
Hip Dysplasia ◽  
Developmental Dysplasia ◽  
Inclusion Criteria ◽  
History Of ◽  
Hip Ultrasound ◽  
Dysplasia Of The Hip

A hip click on examination of the newborn hip is believed to be the result of a ligament or myofascial structure and thought to be benign. Some studies suggest a link between hip clicks and developmental dysplasia of the hip. The purpose of our study is to estimate the prevalence of ultrasound hip abnormalities in newborns with a hip click and an otherwise normal physical examination. Results. Ninety patients meeting inclusion criteria of a hip click with an otherwise normal physical examination underwent diagnostic ultrasound with a 17.8% prevalence of hip abnormalities found (95% confidence interval ±7.9% [range of 9.9% to 25.7%]). Our study had 64 (71%) females and 26 (29%) males. The prevalence of hip pathology for females was 18.8% (12 of 64 patients) and for males was 15.4% (4 of 26 patients). Thirty-three patients were found to have bilateral hip clicks on presentation, with 21.2% (7 of 33) of those patients found to have hip pathology on ultrasound (3 of the 7 had pathology of both hips). Six patients had a family history of hip dysplasia and 1 of these patients (16.7%) had pathology on ultrasound. The average age to hip sonography was 6.6 weeks. Conclusions. In all, 17.8% of newborns with a hip click were found to have hip abnormalities on ultrasound. The prevalence of hip pathology, on ultrasound, suggests that additional larger, prospective studies are needed to clarify the association between a hip click and abnormal ultrasound found at 6 weeks of age or greater.

scholarly journals Associations between risk factors and developmental dysplasia of the hip and ultrasonographic hip type: a retrospective case control study

2019 ◽  
Vol 13 (2) ◽  
pp. 161-166 ◽  
Author(s):  
H. Ömeroğlu ◽  
A. Akceylan ◽  
N. Köse
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Family History ◽  
Hip Dysplasia ◽  
Positive Family History ◽  
Significant Risk ◽  
Breech Presentation ◽  
Developmental Dysplasia ◽  
Type I ◽  
Dysplasia Of The Hip

Purpose We aimed to revisit the correlation between the previously defined risk factors and the occurrence of developmental dysplasia of the hip (DDH) and to assess the influence of these factors on the ultrasonographic type of hip dysplasia according to the Graf’s classification in patients with DDH. Methods Data of healthy infants (mean age 33 days) who had bilateral mature (normal) hips (Graf type I) were compared with the data of infants (mean age 105 days) who were treated by abduction brace due to unilateral or bilateral DDH (Graf type IIa- and worse hips). Results Infants with at least one risk factor had a significantly higher rate of DDH than those with no risk factors (p < 0.001). Likewise, infants with more than one risk factor had a significantly higher rate of DDH than those with only one risk factor (p = 0.008). Family history, breech presentation and swaddling were found to be the three significant risk factors related to the development of DDH. Family history, swaddling and oligohydramnios were found to be the three significant risk factors correlated with a higher rate of unstable/decentred hip(s) (Graf types D/III/IV) in patients with DDH. Conclusion The risk of DDH significantly increases in infants who have more than one risk factor for DDH. Positive family history and postnatal traditional swaddling are the two main factors both in the aetiology of DDH and in development of a more severe hip dysplasia in patients with DDH. Besides, breech presentation increases the risk of development of DDH and oligohydramnios leads to development of a more severe hip dysplasia in patients with DDH. By introducing these four variables as ‘absolute risk factors for DDH’ to the selective newborn hip screening programmes, the sensitivity and specificity of these programmes may be optimized and the risk of delayed diagnosis may be lessened. Level of Evidence Level III prognostic study

scholarly journals Developmental dysplasia of the hip - clinical management and ultrasound screening

2001 ◽  
Vol 3 (10) ◽  
pp. 324-328
Author(s):  
P Marshall ◽  
S Wildon
Keyword(s):  
Hospital Care ◽  
Hip Dysplasia ◽  
Screening Programme ◽  
Developmental Dysplasia ◽  
Ultrasound Screening ◽  
National Guidelines ◽  
Developmental Hip Dysplasia ◽  
Clinical Screening ◽  
Health Visitors ◽  
Dysplasia Of The Hip

Although there is an agreed national protocol for the clinical screening of developmental hip dysplasia (DDH) there are no national guidelines for the use of ultrasound to detect this condition. The increased incidence of babies requiring surgery for this condition across the bay has led us to institute a selective screening programme in line with best clinical practice. This article describes care pathways in primary and hospital care in some detail and will therefore be of direct clinical relevance to the midwive , health visitors, general practitioners, physiotherapists, paediatricians, and orthopaedic surgeons involved in the management of babies at higher risk of DDH. We also outline the physiotherapy and orthopaedic management of children with this condition. Feedback or suggestions relating to the recently introduced screening programme would be welcomed.

scholarly journals Early detection of developmental dysplasia of hip by ultrasound

2019 ◽  
pp. 112070001987968 ◽  
Author(s):  
Zita Gyurkovits ◽  
Gellért Sohár ◽  
Anna Baricsa ◽  
Gábor Németh ◽  
Hajnalka Orvos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Positive Family History ◽  
Breech Presentation ◽  
Female Gender ◽  
Developmental Dysplasia ◽  
Developmental Dysplasia Of Hip ◽  
Graf Method ◽  
Hip Ultrasound ◽  
A Prospective Study ◽  
Dysplasia Of The Hip

Objective: To assess the effectiveness of early universal ultrasound (US) screening of developmental dysplasia of the hip (DDH). Study design: A prospective study of universal hip screening of all mature neonates was conducted from 2012 to 2013, at the Department of Obstetrics and Gynaecology, University of Szeged; 1636 newborns (3272 hips) had clinical examinations and hip ultrasound by the Graf method within the1st 3 days of life. Prevalence of DDH, risk factors, sensitivity and specificity of clinical examinations were evaluated. Results: At the 1st US, 70 of the examined 3272 hips (2.14%) were found to be positive. According to Graf categories, the following distribution was observed: type II C, 21 hips (30.0%); D, 24 hips (34.28%); III, 24 hips (34.28%); IV, 1 hip (1.44%). Regarding the risk factors, female gender, breech presentation and positive family history proved to be significant. Interestingly, 28 (50.90%) of the 55 newborns with DDH had neither positive physical signs nor any risk factors, except being female. The physical examination was calculated for sensitivity (20.0%) and specificity (98.34%). Conclusions: In our 1-year period study, 50.9% of the newborns with DDH had neither any positive physical signs nor any risk factors, except being a female. In contrast, early universal US screening of the hip facilitated to diagnose all cases with hip dysplasia. Hip sonography is an effective mode of prevention in orthopaedics, however further studies are needed to compare the rates of operative procedures in selective versus universal screening models.

Developmental dysplasia of the hip

2020 ◽  
Vol 81 (7) ◽  
pp. 1-8
Author(s):  
Stella Zhang ◽  
Konstantinos J Doudoulakis ◽  
Anita Khurwal ◽  
Khaled M Sarraf
Keyword(s):  
Femoral Head ◽  
Physical Examination ◽  
Screening Programme ◽  
Developmental Dysplasia ◽  
Monitoring Tool ◽  
Newborn Screening Programme ◽  
Hip Stability ◽  
Hip Ultrasound ◽  
The Uk ◽  
Dysplasia Of The Hip

Developmental dysplasia of the hip encompasses a range of hip abnormalities in which the femoral head and acetabulum fail to develop and articulate anatomically. Developmental dysplasia of the hip is a clinically important condition, with a prevalence of 1–2/1000 in unscreened populations and 5–30/1000 in clinically screened populations. The pathology is incongruence between the femoral head and the acetabulum, which can be caused by an abnormally shaped femoral head, acetabulum, or both. This results in a spectrum of different hip abnormalities. The precise aetiology behind developmental dysplasia of the hip is unclear, but there are a number of established risk factors. In the UK, universal clinical examination of newborns and 6–8-week-old babies is performed under the national UK newborn screening programme for developmental dysplasia of the hip (part of the Newborn and Infant Physical Examination). The physical examination of the newborn hip involves initial inspection of the infant for any of the clinical features of developmental dysplasia of the hip, followed by hip stability tests (Barlow's and Ortolani's tests). Hip ultrasound is the gold standard diagnostic and monitoring tool for developmental dysplasia of the hip in newborns and infants under 6 months of age, or until ossification of the femoral head. Some mild cases of developmental dysplasia of the hip (and the immature hip) resolve without requiring intervention; however, there are a number of treatments, both non-operative and operative, that may be used at various stages of this condition.

Description of the ‘pronation manoeuvre’ for the diagnosis of developmental hip dysplasia

2021 ◽  
Author(s):  
José Fernando de-la-Garza-Salazar ◽  
Julieta Rodríguez-de-Ita ◽  
Bárbara M Garza-Ornelas ◽  
Jorge A Martínez-Cardona
Keyword(s):  
Physical Examination ◽  
Developmental Dysplasia ◽  
Clinical Tool ◽  
Developmental Hip Dysplasia ◽  
Cross Sectional ◽  
Diagnosis And Prognosis ◽  
Screening Strategies ◽  
Hip Ultrasound ◽  
Low Sensitivity ◽  
Dysplasia Of The Hip

Abstract Introduction Without a prompt diagnosis, developmental dysplasia of the hip (DDH) in infants can lead to severe sequelae. Current screening strategies emphasize the use of Ortolani and Barlow physical examination manoeuvres, yet they exhibit low sensitivity. The purpose of this study is to evaluate the performance of a new physical examination tool (the pronation manoeuvre) as a screening tool for DDH. Methods To evaluate the new manoeuvre, a cross-sectional and analytic study was performed with a nonprobabilistic sampling method. Patients with either a positive Ortolani or Barlow manoeuver were evaluated with the new manoeuvre and hip ultrasound. Controls were infants with negative Ortolani, Barlow and pronation manoeuvres and also had ultrasound performed. Results DDH was confirmed in 83 of 130 cases (64%) and 2 of 130 controls (2%). The new pronation manoeuvre had a sensitivity of 76% and a specificity of 94% as compared to the Ortolani and Barlow manoeuvres (sensitivity 31 to 32%, specificity 93 to 100%) (P&lt;0.05). Conclusion This new physical examination manoeuvre could serve as another clinical tool for the initial screening of DDH in newborns. Its promising results against traditional screening procedures might potentially impact diagnosis and prognosis for patients with DDH.

Developmental Hip Dysplasia

2019 ◽  
pp. 297-300
Author(s):  
Dorothy L. Gilbertson-Dahdal
Keyword(s):  
Risk Factors ◽  
Problem Solving ◽  
Imaging Modality ◽  
Treatment Options ◽  
Hip Dislocation ◽  
Clinical Findings ◽  
Developmental Dysplasia ◽  
Developmental Hip Dysplasia ◽  
Hormonal Factors ◽  
Dysplasia Of The Hip

Chapter 112 focuses on developmental dysplasia of the hip, which includes a spectrum of abnormalities ranging from a stable hip with a mildly dysplastic acetabulum to complete hip dislocation. Pathophysiology, clinical findings, and screening studies are explored. The pathophysiology is multifactorial including mechanical, genetic and hormonal factors. Imaging strategies, findings, and treatment options are also discussed. Screening US, which is the imaging modality of choice, is performed on infants with predisposing risk factors. Outcome is quite variable with many cases resolving spontaneously without treatment whereas others stabilize with acetabular dysplasia. Treatment options include immobilization and surgery. MRI is used for problem solving in postoperative patients.

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