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.

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.

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.

Clinical examination for developmental dysplasia of the hip in neonates: how to stay out of trouble

BMJ ◽  
2010 ◽  
Vol 340 (may12 1) ◽  
pp. c1965-c1965 ◽  
Author(s):  
D. M. Eastwood ◽  
A. de Gheldere
Keyword(s):  
Clinical Examination ◽  
Developmental Dysplasia ◽  
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.

The ‘clicky hip’

2018 ◽  
Vol 100-B (9) ◽  
pp. 1249-1252 ◽  
Author(s):  
S. Humphry ◽  
D. Thompson ◽  
N. Price ◽  
P. R. Williams
Keyword(s):  
Service Provision ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Ultrasound Screening ◽  
Ultrasound Scan ◽  
Type Iv ◽  
Referral Practices ◽  
Adductor Tenotomy ◽  
The Mean ◽  
Dysplasia Of The Hip

Aims The significance of the ‘clicky hip’ in neonatal and infant examination remains controversial with recent conflicting papers reigniting the debate. We aimed to quantify rates of developmental dysplasia of the hip (DDH) in babies referred with ‘clicky hips’ to our dedicated DDH clinic. Patients and Methods A three-year prospective cohort study was undertaken between 2014 and 2016 assessing the diagnosis and treatment outcomes of all children referred specifically with ‘clicky hips’ as the primary reason for referral to our dedicated DDH clinic. Depending on their age, they were all imaged with either ultrasound scan or radiographs. Results There were 69 ‘clicky hip’ referrals over the three-year period. This represented 26.9% of the total 257 referrals received in that time. The mean age at presentation was 13.6 weeks (1 to 84). A total of 19 children (28%) referred as ‘clicky hips’ were noted to have hip abnormalities on ultrasound scan, including 15 with Graf Type II hips (7 bilateral), one Graf Type III hip, and three Graf Type IV hips. Of these, ten children were treated with a Pavlik harness, with two requiring subsequent closed reduction in theatre; one child was treated primarily with a closed reduction and adductor tenotomy. In total, 11 (15.9%) of the 69 ‘clicky hip’ referrals required intervention with either harness or surgery. Conclusion Our study provides further evidence that the ‘clicky hip’ referral can represent an underlying diagnosis of DDH and should, in our opinion, always lead to further clinical and radiological assessment. In the absence of universal ultrasound screening, we would encourage individual units to carefully assess their own outcomes and protocols for ‘clicky hip’ referrals and tailor ongoing service provision to local populations and local referral practices. Cite this article: Bone Joint J 2018;100-B:1249–52.

Developmental dysplasia of the hip

2011 ◽  
Author(s):  
Anish Sanghrajka ◽  
Deborah M Eastwood
Keyword(s):  
Femoral Head ◽  
Early Diagnosis ◽  
Surgical Approach ◽  
Developmental Dysplasia ◽  
Ultrasound Screening ◽  
Hip Instability ◽  
Appropriate Treatment ◽  
Aggressive Surgical Approach ◽  
Dysplasia Of The Hip ◽  
All Treatment

♦ Developmental dysplasia of the hip represents a spectrum of hip pathology with or without hip instability♦ Controversy continues regarding the relative roles of clinical and ultrasound screening programmes♦ Early diagnosis and prompt, appropriate treatment is important♦ All treatment methods risk compromising the vascularity of the developing femoral head♦ Residual dysplasia may require an aggressive surgical approach.

scholarly journals Developmental dysplasia of the hip: update of management

2019 ◽  
Vol 4 (9) ◽  
pp. 548-556 ◽  
Author(s):  
Alfonso Vaquero-Picado ◽  
Gaspar González-Morán ◽  
Enrique Gil Garay ◽  
Luis Moraleda
Keyword(s):  
Physical Examination ◽  
Open Reduction ◽  
Acetabular Dysplasia ◽  
Wide Spectrum ◽  
Positive Family History ◽  
Developmental Dysplasia ◽  
Ultrasound Screening ◽  
Spontaneous Correction ◽  
Hip Reduction ◽  
Dysplasia Of The Hip

The term ‘developmental dysplasia of the hip’ (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. DDH alters hip biomechanics, overloading the articular cartilage and leading to early osteoarthritis. DDH is the main cause of total hip replacement in young people (about 21% to 29%). Development of the acetabular cavity is determined by the presence of a concentrically reduced femoral head. Hip subluxation or dislocation in a child will cause an inadequate development of the acetabulum during the remaining growth. Clinical screening (instability manoeuvres) should be done universally as a part of the physical examination of the newborn. After two or three months of life, limited hip abduction is the most important clinical sign. Selective ultrasound screening should be performed in any child with abnormal physical examination or in those with high-risk factors (breech presentation and positive family history). Universal ultrasound screening has not demonstrated its utility in diminishing the incidence of late dysplasia. Almost 90% of patients with mild hip instability at birth are resolved spontaneously within the first eight weeks and 96% of pathologic changes observed in echography are resolved spontaneously within the first six weeks of life. However, an Ortolani-positive hip requires immediate treatment. When the hip is dislocated or subluxated, a concentric and stable reduction without forceful abduction needs to be obtained by closed or open means. Pavlik harness is usually the first line of treatment under the age of six months. Hip arthrogram is useful for guiding the decision of performing a closed or open reduction when needed. Acetabular dysplasia improves in the majority due to the stimulus provoked by hip reduction. The best parameter to predict persistent acetabular dysplasia at maturity is the evolution of the acetabular index. Pelvic or femoral osteotomies should be performed when residual acetabular dysplasia is present or in older children when a spontaneous correction after hip reduction is not expected. Avascular necrosis is the most serious complication and is related to: an excessive abduction of the hip; a force closed reduction when obstacles for reduction are present; a maintained dislocated hip within the harness or spica cast; and a surgical open reduction.Cite this article: EFORT Open Rev 2019;4:548-556. DOI: 10.1302/2058-5241.4.180019

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