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Immediate treatment versus sonographic surveillance for mild hip dysplasia in newborns
Karen Rosendahl1, Carol Dezateux, Kari Røine Fosse
1Diagnostic Radiology, Great Ormond Street Hospital for Children, London, United Kingdom. rosenk@gosh.nhs.uk
Insights
Active sonographic surveillance for mild hip dysplasia in newborns halved the need for treatment without affecting outcomes. This approach significantly reduces treatment rates, benefiting families and healthcare costs.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip (DDH)
- Neonatal Care
Background:
- Mild hip dysplasia is common in newborns.
- Early intervention versus watchful waiting is debated for stable or unstable but not dislocatable hips.
Purpose of the Study:
- To compare early abduction treatment with active sonographic surveillance for mild hip dysplasia in newborns.
- To evaluate the impact on treatment rates and long-term outcomes.
Main Methods:
- Blinded, randomized controlled trial of 128 newborns with mild hip dysplasia (alpha angle 43-49 degrees).
- Groups: 6 weeks of abduction treatment vs. active sonographic surveillance.
- Primary outcome: acetabular inclination angle at 1 year of age.
Main Results:
- No significant difference in acetabular inclination angle at 1 year between groups (24.2 degrees).
- Active surveillance halved the number of infants requiring treatment (47% vs. 100% initially).
- Improved alpha angles observed earlier in the treatment group, but overall outcomes were similar at 1 year.
Conclusions:
- Active sonographic surveillance is effective for mild hip dysplasia, reducing treatment rates by 50%.
- This strategy yields similar 1-year outcomes compared to immediate treatment.
- Implications for reduced healthcare costs and family burden.
Objective:
We conducted a blinded, randomized, controlled trial to examine whether mildly dysplastic but stable or instable hips would benefit from early treatment, as compared with watchful waiting.
Patients And Methods:
A total of 128 newborns with mild hip dysplasia (sonographic inclination angle [alpha angle] of 43 degrees -49 degrees ) and stable or instable but not dislocatable hips were randomly assigned to receive either 6 weeks of abduction treatment (immediate-treatment group) or follow-up alone (active-sonographic-surveillance group). The main outcome measurement was the acetabular inclination angle, measured by radiograph, at 1 year of age.
Results:
Both groups included 64 newborns, and there was no loss to follow-up. With the exception of a small but statistically significant excess of girls in the active-sonographic-surveillance group, there were no statistically significant differences in baseline characteristics between the 2 groups. The mean inclination angle at 12 months was 24.2 degrees for both groups (difference: 0.1 [95% confidence interval (CI): -0.8 to 0.9]), and all children had improved and were without treatment. The mean alpha angle was 59.7 degrees in the treatment group and 57.1 degrees in the active-surveillance group for a difference of 2.6 degrees evaluated after 1.5 and 3 months (95% CI: 1.8 to 3.4; P < .001). At 1.5 months of age, the hips had improved in all treated children but not in 5 children under active surveillance (P = .06). Among the sonographic-surveillance group, 47% received treatment after the initial surveillance period of 1.5 months.
Conclusions:
Active-sonographic-surveillance halved the number of children requiring treatment, did not increase the duration of treatment, and yielded similar results at 1-year follow-up. Given a reported prevalence of 1.3% for mildly dysplastic but stable hips, a strategy of active surveillance would reduce the overall treatment rate by 0.6%. Our results may have important implications for families as well as for health care costs.
