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Outcome of ultrasonographic hip abnormalities in clinically stable hips
D J Sucato1, C E Johnston, J G Birch
1Texas Scottish Rite Hospital, Dallas 75219, USA.
Insights
Screening ultrasounds for newborn hip dysplasia may be overly sensitive when physical exams are normal. In these cases, ultrasounds do not accurately predict subsequent hip dysplasia, suggesting they may not be warranted.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Developmental Dysplasia of the Hip
Background:
- Developmental Dysplasia of the Hip (DDH) is a condition requiring early detection.
- Screening ultrasounds are commonly used for newborns, but their utility in specific clinical scenarios is debated.
- This study evaluates the role of ultrasound in predicting hip dysplasia when the physical examination is normal.
Observation:
- A retrospective review included 192 newborn hips with normal physical exams but abnormal ultrasounds.
- Patients were divided into those treated with a Pavlik harness (Group I) and those not treated (Group II).
- Follow-up included radiographic assessment of the acetabular index (AI).
Findings:
- No significant difference in dysplasia rates was found between treated and untreated groups at final follow-up (p > 0.10).
- Only two hips (1.3%) in the untreated group developed radiographic dysplasia.
- Ultrasound abnormalities at birth did not correlate with the development of dysplasia on radiographs.
Implications:
- For newborns with a normal hip examination, a screening ultrasound may be too sensitive and not predictive of later hip dysplasia.
- Routine screening ultrasound may not be warranted in this specific clinical setting.
- Further research could refine screening protocols for neonatal hip instability.
Abstract:
A retrospective review was performed of 192 newborn hips in 112 patients referred for hip evaluation. The average age at presentation was 12.7 days, with average radiographic follow-up of 15.9 months. Inclusion criteria for our study were a normal physical examination of the hip without evidence of instability and an ultrasound examination that was considered abnormal. Pavlik harness treatment was chosen at the discretion of the treating physician. At final follow-up, dysplasia was defined as greater than two standard deviations above the mean acetabular index (AI) for age. Group I consisted of 43 hips that had Pavlik treatment, and group II consisted of 149 hips that did not receive treatment. There was no difference in these two groups with respect to risk factors for dysplasia or the initial abnormalities seen on ultrasound evaluation, although patients in group I had less coverage of the femoral head during stress maneuvers. No hip in group I and two (1.3%) hips in group II were considered dysplastic (AI > 2 SD) at final radiographic follow-up (p > 0.10). There was no correlation between the severity of the ultrasound abnormality at birth and the subsequent presence of dysplasia (p > 0.10). The two hips considered dysplastic on radiograph were not being actively treated. When the hip examination of a newborn hip younger than 1 month is normal, a screening ultrasound does not appear to predict accurately subsequent hip dysplasia. In this specific setting, an initial screening ultrasound may be too sensitive and does not appear warranted.