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Congenital dislocation of the hip: a prospective study comparing ultrasound and clinical examination
K Rosendahl1, T Markestad, R T Lie
1Department of Diagnostic Radiology, University Hospital, Bergen, Norway.
Insights
This study compared clinical methods and ultrasound for screening congenital dislocation of the hip in newborns. Ultrasound showed discrepancies with clinical evaluation, suggesting a need for further research into its screening role.
Area of Science:
- Pediatrics
- Orthopedic Surgery
- Diagnostic Imaging
Background:
- Congenital dislocation of the hip (CDH) is a significant pediatric condition.
- Early detection and treatment are crucial for optimal outcomes.
- Standard clinical screening and newer ultrasound methods are used for diagnosis.
Purpose of the Study:
- To prospectively compare standard clinical methods with ultrasound for screening congenital dislocation of the hip in newborns.
- To evaluate the incidence of CDH and treatment rates.
- To identify discrepancies between clinical and ultrasound findings.
Main Methods:
- Prospective comparison of clinical examination and ultrasound in 1503 newborns.
- Classification of hip development: well-developed acetabulae, shallow (immature) hips, and dysplastic hips.
- Monitoring of infants for normalization or need for therapy.
- Analysis of treatment indications and incidence rates of late CDH.
Main Results:
- 82.8% of hips were well-developed, 14.5% immature, and 2.7% dysplastic.
- 96.7% of immature hips normalized within 1-3 months; 3.3% required therapy.
- Treatment rates for CDH increased during the study period.
- Significant discrepancies were observed between clinical and ultrasound hip evaluations.
- Incidence of late CDH decreased compared to previous periods (0.9 vs 3.5 per 1000).
Conclusions:
- Major discrepancies exist between clinical and ultrasound assessments of newborn hips.
- Ultrasound's role in screening for congenital dislocation of the hip warrants further investigation.
- While late CDH incidence decreased, the variability in diagnostic methods highlights ongoing challenges.
Abstract:
Screening for congenital dislocation of the hip by standard clinical methods and ultrasound was compared prospectively in 1503 newborns (1291 girls and 212 boys). A total of 82.8% of the hips (78.8% of the infants) had well developed acetabulae, 14.5% (17.2% of the infants) were shallow (immature) and 2.7% (4.1% of the infants) were dysplastic. Within 1-3 months 96.7% of the infants with clinically stable, but immature hips normalized, while 3.3% did not improve or worsened, and therapy was therefore initiated. Indications for treatment included dysplastic and/or clinically unstable hips, and a higher number of newborns were treated during the study period than in 1982-85 (31.2 vs 19.7 per 1000, p = 0.0002). Thirty-seven percent of the patients had both clinical and ultrasound findings compatible with congenital dislocation of the hip, while the decision to treat was based on clinical findings alone in 25.0% and on ultrasound findings in 38.0%. Infants born during the study period of nine months had a low incidence of late congenital dislocation of the hip compared with our earlier reported results from 1982-85 (0.9 vs 3.5 per 1000, p = 0.012). The study demonstrated major discrepancies between clinical and ultrasound evaluation of hips in the newborn, and the role of ultrasound in the screening for congenital dislocation of the hip requires further evaluation.