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Is it worthwhile to routinely ultrasound screen children with idiopathic clubfoot for hip dysplasia?
Susan T Mahan1, Mahsa M Yazdy, James R Kasser
1*Department of Orthopaedic Surgery, Boston Children's Hospital †Department of Orthopaedic Surgery, Harvard Medical School ‡Slone Epidemiology Center, Boston University, Boston, MA.
Insights
Routine hip screening for infants with idiopathic clubfoot is not necessary. Developmental dysplasia of the hips (DDH) occurred at similar rates in clubfoot patients and controls, and standard screening would detect most cases.
Area of Science:
- Orthopedics
- Pediatric Medicine
- Developmental Biology
Background:
- Idiopathic clubfoot is often associated with an increased risk of developmental dysplasia of the hips (DDH).
- Current clinical practice frequently involves routine hip screening (ultrasound or radiograph) for infants with idiopathic clubfoot.
- Previous studies on this association have been limited by small sample sizes.
Purpose of the Study:
- To evaluate the actual risk of DDH in a large cohort of infants with idiopathic clubfoot.
- To compare the incidence of DDH in clubfoot patients versus a control group of infants without clubfoot.
- To determine if standard DDH screening protocols would effectively identify cases of DDH in infants with clubfoot.
Main Methods:
- A large cohort of infants diagnosed with clubfoot was identified through birth defects registries in three states.
- A control group of infants without clubfoot was established for comparison.
- Computer-assisted telephone interviews were conducted with mothers to gather data on hip condition treatments and diagnoses, with follow-up at 3.3 years for clubfoot cases.
Main Results:
- The study interviewed 677 clubfoot patients and 2037 controls.
- Treatment for hip problems (brace or harness) was reported in 0.74% of clubfoot patients and 0.25% of controls (P=0.134), a statistically insignificant difference.
- Of clubfoot patients with DDH, two did not require treatment, and two would have been identified by standard screening; no serious late hip dysplasia was observed at follow-up.
Conclusions:
- The incidence of developmental dysplasia of the hips requiring treatment was low and not significantly different between infants with and without idiopathic clubfoot.
- Standard infant hip screening methods are sufficient for identifying DDH in clubfoot patients who require intervention.
- Routine, universal hip screening for all infants with idiopathic clubfoot is not recommended unless indicated by standard screening criteria.
Purpose:
Patients with idiopathic clubfoot are considered at increased risk for having developmental dysplasia of the hips (DDH). However, the studies showing this association have been relatively small. Many clinicians who treat idiopathic clubfoot routinely screen the hips of these patients with ultrasound or radiograph due to the concerns of increased risk of DDH. We evaluated a large clubfoot population to determine the risk of DDH and compare this to a population of children without clubfoot. We also evaluated if the clubfoot patients found to have DDH would have been discovered by standard DDH screening.
Methods:
We identified infants in 3 states (MA, NY, NC), who were reported to each state's birth defects registry as having a clubfoot. A second cohort of infants without clubfoot was also identified as a control group. Mothers of these children were contacted to be included in the study, and a computer-assisted telephone interview was administered by one of the study nurses, including questions about treatment of DDH. The child's median age at interview was 7 months. Mothers of clubfoot cases were also contacted for follow-up at mean age of 3.3 years.
Results:
Families of 677 patients with clubfoot and 2037 controls were interviewed. A total of 5/677 (0.74%) patients with clubfoot and 5/2037 (0.25%) controls reported having their infant treated with a brace or harness for hip problems (P=0.134). Of the patients with clubfoot, 2 of them did not need treatment for their DDH and 2 would have been discovered by standard hip screening. Follow-up study at 3.3 years of age found no serious late hip dysplasia.
Conclusions:
Treatment of DDH was uncommon in all children; the higher proportion in infants with clubfoot was not statistically different than controls. Of the patients with clubfoot and DDH, standard hip screening would have been appropriate and others did not need treatment. These data suggest that routine hip ultrasound or radiographic screening of idiopathic clubfoot patients is not necessary unless indicated by the standard infant hip screening.
Level Of Evidence:
Level 3 study.
