Family history in developmental dysplasia of the hip: should we follow-up?

Year 2019, Volume: 5 Issue: 6, 957 - 961, 04.11.2019

Sonay Aydın , Erdem Fatihoğlu

https://doi.org/10.18621/eurj.442402

Cited By: 1

Abstract

Objectives:
Developmental dysplasia
of the hip (DDH) is an important problem. Ultrasonography (US) is a proper
method before 6 months of age. For older children, plain radiographs can be
useful. Six risk factors are emphasized: breech
presentation, female sex, a positive family history, being first-born, left hip
affected, and mode of delivery. In some centers, clinicians prefer to
perform a control US examination or pelvic radiographs after 6 months of age
for the children having a positive family history. We aimed to evaluate the
necessity of control US/direct radiography examinations.

Methods: A total of 205 children with a positive family history for DDH are
included. US examinations are performed according to Graf’s method. We have
evaluated direct radiographs by using Hilgenreiner, Perkin, and Shenton lines,
acetabular angle.

Results: Initial US examinations are performed at a median age
of 8.3 weeks. Seventy-four patients (36%) had a repeat ultrasound scan at a
median age of 7 months; none of them demonstrated abnormal findings. One hundred
and thirty-one patients (63.9%) had control radiographs at a median age of 8.2
months. Shenton line is considered as normal, and the upper femoral epiphysis
is located in inferomedial quadrant according to Hilgenreiner and Perkin lines.

Conclusions: A positive family history for DDH may be a less
important reason for performing control US or radiographic examination.
Patients with a normal screening US result and having risk factors can be
discharged from follow up safely, so that unnecessary examinations and family
anxiety will be reduced. 

Keywords

Developmental dysplasia of the hip, Graf method, ultrasound, family history, follow-up

References

• [1] Kyung BS, Lee SH, Jeong WK, Park SY. Disparity between clinical and ultrasound examinations in neonatal hip screening. Clin Orthop Surg 2016;8:203-9.
• [2] Teixeira SR, Dalto VF, Maranho DA, Zoghbi-Neto OS, Volpon JB, Nogueira-Barbosa MH. Comparison between Graf method and pubo-femoral distance in neutral and flexion positions to diagnose developmental dysplasia of the hip. Eur J Radiol 2015;84:301-6.
• [3] Thallinger C, Pospischill R, Ganger R, Radler C, Krall C, Grill F. Long-term results of a nationwide general ultrasound screening system for developmental disorders of the hip: the Austrian hip screening program. J Child Orthop 2014;8:3-10.
• [4] Shorter D, Hong T, Osborn DA. Cochrane Review: Screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health 2013;8:11-54.
• [5] Orak MM, Onay T, Cagirmaz T, Elibol C, Elibol FD, Centel T. The reliability of ultrasonography in developmental dysplasia of the hip: How reliable is it in different hands? Indian J Orthop 2015;49:610-4.
• [6] Mahan ST, Katz JN, Kim YJ. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am 2009;91:1705-19.
• [7] Schwend RM, Schoenecker P, Richards BS, Flynn JM, Vitale M, Pediatric Orthopaedic Society of North A. Screening the newborn for developmental dysplasia of the hip: now what do we do? J Pediatr Orthop 2007;27:607-10.
• [8] Sewell MD, Eastwood DM. Screening and treatment in developmental dysplasia of the hip-where do we go from here? Int Orthop 2011;35:1359-67.
• [9] Roposch A, Moreau NM, Uleryk E, Doria AS. Developmental dysplasia of the hip: quality of reporting of diagnostic accuracy for US. Radiology 2006;241:854-60.
• [10] Ortiz-Neira CL, Paolucci EO, Donnon T. A meta-analysis of common risk factors associated with the diagnosis of developmental dysplasia of the hip in newborns. Eur J Radiol 2012;81:e344-51.
• [11] Garvey M, Donoghue VB, Gorman WA, O'Brien N, Murphy JF. Radiographic screening at four months of infants at risk for congenital hip dislocation. J Bone Joint Surg Br 1992;74:704-7.
• [12] Tafazal S, Flowers MJ. Do we need to follow up an early normal ultrasound with a later plain radiograph in children with a family history of developmental dysplasia of the hip? Eur J Orthop Surg Traumatol 2015;25:1171-5.
• [13] Keller MS, Nijs EL. The role of radiographs and US in developmental dysplasia of the hip: how good are they? Pediatr Radiol 2009;39 Suppl 2:S211-5.
• [14] Holen KJ, Tegnander A, Bredland T, Johansen OJ, Saether OD, Eik-Nes SH, et al. Universal or selective screening of the neonatal hip using ultrasound? A prospective, randomised trial of 15,529 newborn infants. J Bone Joint Surg Br 2002;84:886-90.
• [15] Bache CE, Clegg J, Herron M. Risk factors for developmental dysplasia of the hip: ultrasonographic findings in the neonatal period. J Pediatr Orthop B 2002;11:212-8.
• [16] Arumilli BR, Koneru P, Garg NK, Davies R, Saville S, Sampath J, et al. Is secondary radiological follow-up of infants with a family history of developmental dysplasia of the hip necessary? J Bone Joint Surg Br 2006;88:1224-7.
• [17] Price KR, Dove R, Hunter JB. The use of X-ray at 5 months in a selective screening programme for developmental dysplasia of the hip. J Child Orthop 2011;5:195-200.
• [18] Osarumwense D, Popple D, Kershaw IF, Kershaw CJ, Furlong AJ. What follow-up is required for children with a family history of developmental dysplasia of the hip? J Pediatr Orthop B 2007;16:399-402.
• [19] Lee YK, Chung CY, Koo KH, Lee KM, Kwon DG, Park MS. Measuring acetabular dysplasia in plain radiographs. Arch Orthop Trauma Surg 2011;131:1219-26.