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Disparity between Clinical and Ultrasound Examinations in Neonatal Hip Screening
Bong Soo Kyung1, Soon Hyuck Lee2, Woong Kyo Jeong2
1Joint Center, Barunsesang Hospital, Seongnam, Korea.
Insights
Clinical examination and ultrasound show limited agreement for detecting developmental dysplasia of the hip (DDH). Both sonographic morphology and stability should be assessed alongside clinical exams for improved DDH screening.
Area of Science:
- Pediatric Orthopedics
- Medical Imaging
- Neonatal Care
Background:
- Neonatal hip screening for developmental dysplasia of the hip (DDH) often involves clinical examination and ultrasound.
- Controversy exists regarding optimal screening strategies, specifically clinical versus selective or universal ultrasound screening.
Purpose of the Study:
- To assess the agreement between clinical examination, sonographic morphology, and sonographic stability in neonatal hip screening.
- To inform optimal screening strategies for developmental dysplasia of the hip.
Main Methods:
- A single experienced pediatric orthopedic surgeon performed clinical hip screenings on 2,686 infants.
- 156 high-risk infants underwent selective bilateral hip ultrasound using the modified Graf method.
- Statistical analysis was used to correlate clinical and sonographic findings.
Main Results:
- Limited correlation was found between clinical and ultrasound examinations, even by a single experienced surgeon.
- Significant discrepancies existed: e.g., 93% of clinically subluxatable hips were normal/immature on static ultrasound.
- Clinical stability showed low coefficients with ultrasound findings (0.39 for stability, 0.37 for morphology).
Conclusions:
- Discrepancies between clinical and ultrasound assessments for DDH are notable, even with experienced practitioners.
- Comprehensive DDH screening should integrate clinical examination with assessments of both sonographic morphology and stability.
Background:
For early detection of developmental dysplasia of the hip (DDH), neonatal hip screening using clinical examination and/or ultrasound has been recommended. Although there have been many studies on the reliability of both screening techniques, there is still controversy in the screening strategies; clinical vs. selective or universal ultrasound screening. To determine the screening strategy, we assessed the agreement among the methods; clinical examination by an experienced pediatric orthopedic surgeon, sonographic morphology, and sonographic stability.
Methods:
From January 2004 to June 2009, a single experienced pediatric orthopedic surgeon performed clinical hip screenings for 2,686 infants in the neonatal unit and 43 infants who were referred due to impressions of hip dysplasia before 3 months of age. Among them, 156 clinically unstable or high-risk babies selectively received bilateral hip ultrasound examinations performed by the same surgeon using the modified Graf method. The results were analyzed statistically to detect any correlations between the clinical and sonographic findings.
Results:
Although a single experienced orthopedic surgeon conducted all examinations, we detected only a limited relationship between the results of clinical and ultrasound examinations. Ninety-three percent of the clinically subluxatable hips were normal or immature based on static ultrasound examination, and 74% of dislocating hips and 67% of limited abduction hips presented with the morphology below Graf IIa. A total of 80% of clinically subluxatable, 42% of dislocating and 67% of limited abduction hips appeared stable or exhibited minor instability on dynamic ultrasound examination. About 7% of clinically normal hips were abnormal upon ultrasound examination; 5% showed major instability and 3% showed dysplasia above Graf IIc. Clinical stability had small coefficients between ultrasound examinations; 0.39 for sonographic stability and 0.37 for sonographic morphology. Between sonographic stability and morphology, although 71% of hips with major instability showed normal or immature morphology according to static ultrasound examination, the coefficient was as high as 0.64.
Conclusions:
Discrepancies between clinical and ultrasound examinations were present even if almost all of the exams were performed by a single experienced pediatric orthopedic surgeon. In relation to screening for DDH, it is recommended that both sonographic morphology and stability be checked in addition to clinical examination.
