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Beware the syndrome in neonatal hip instability: follow up assessment is required after apparent resolution
Nick A Heywood1, Robin W Paton
1East Lancashire NHS Foundation Trust, UK. nheywood@doctors.org.uk
Insights
Early screening for developmental dysplasia of the hip (DDH) is crucial. Infants with hyperlaxity syndromes require closer monitoring, even with normal initial ultrasound findings, to ensure hip stability.
Area of Science:
- Pediatrics
- Orthopedics
- Musculoskeletal Disorders
Background:
- Developmental dysplasia of the hip (DDH) is a common congenital musculoskeletal disorder in newborns, affecting 1-3%.
- Early diagnosis and treatment of DDH are vital for preventing complex interventions and improving outcomes.
- A screening program for clinical instability and at-risk infants has been in place since 1992.
Observation:
- Over decades of screening, only two cases with initially normal clinical and ultrasound assessments subsequently deteriorated.
- These two cases were associated with underlying hyperlaxity syndromes, exhibiting unpredictable behavior compared to typical DDH.
- This highlights the unique challenges in managing hip instability in syndromic infants.
Findings:
- Infants with clinically unstable hips but normal sonographic findings at 1-2 weeks, especially those with primary syndromal causes like hyperlaxity, require careful follow-up.
- The study identified that 'true' DDH behaves differently from hip instability associated with hyperlaxity syndromes.
Implications:
- A recommended follow-up strategy for infants with suspected DDH and syndromal hyperlaxity involves clinical and sonographic reviews at 6 weeks and 3 months.
- This approach aims to confirm ongoing hip stability and guide appropriate management, ensuring optimal developmental outcomes.
- The findings underscore the importance of tailored monitoring protocols for specific pediatric musculoskeletal conditions.
Abstract:
Developmental dysplasia of the hip is one of the most common congenital musculoskeletal disorders of childhood, affecting 1-3% of newborns. An early diagnosis and prompt treatment is essential to avoid complex treatments and achieve improved results. Since 1992, we have undertaken a screening programme for clinical instability and at risk patients. During this time, there have been only two cases which have been normal on both clinical, and, static and dynamic ultrasound assessment, that have subsequently deteriorated. In these two cases there was an underlying syndrome associated with hyperlaxity, which behaves unpredictably compared to 'true' developmental dysplasia of the hip. In conclusion, if a hip has been referred as unstable but it is found to have a primary syndromal cause (especially if hyper lax) with sonographically normal hips at one to two weeks of age, it is best to review clinically and sonographically at 6 weeks and 3 months of age to confirm that the hip is maintaining stability.
