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Late Hip Dysplasia After Normal Ultrasound in Breech Babies: Implications on Surveillance Recommendations
William Z Morris1,2, Laura Mayfield1, Terri Beckwith1
1Texas Scottish Rite Hospital for Children.
Insights
Late hip dysplasia in breech babies after normal ultrasound is less common than thought. Prolonged follow-up after 12 months is recommended for surveillance, as earlier checks may not be beneficial.
Area of Science:
- Orthopedics
- Pediatric imaging
- Developmental dysplasia of the hip
Background:
- Controversy exists regarding the incidence of late-developing hip dysplasia in breech infants following normal screening ultrasounds, with reported rates ranging from 7% to 29%.
- This study aimed to determine the actual rates of radiographic hip dysplasia in breech babies who initially presented with normal ultrasound findings.
Purpose of the Study:
- To investigate the incidence of late-developing hip dysplasia in breech babies with initially normal screening ultrasounds.
- To assess the long-term radiographic outcomes of breech infants with normal initial hip evaluations.
Main Methods:
- A prospective study included breech infants with normal clinical examinations and ultrasounds, excluding those with abnormal findings or less than 12 months of follow-up.
- Anterior-posterior pelvis X-rays were taken after 12 months, with acetabular indices (AIs) measured and compared to normative data.
- Dysplasia was defined as an AI greater than 2 standard deviations above the mean.
Main Results:
- Of 504 breech infants with normal initial evaluations, 133 (26.4%) were followed for over 12 months.
- At final follow-up (mean age 20.7 months), only 3 out of 133 infants (2.2%) showed radiographic evidence of hip dysplasia.
- No infants required treatment beyond observation during the study period.
Conclusions:
- While 1 in 5 breech babies may have hip dysplasia at initial presentation, late-onset dysplasia after a normal screening ultrasound appears less frequent than previously reported.
- The study suggests that prolonged radiographic surveillance beyond 12 months of age is beneficial for breech babies.
- Earlier follow-up visits may provide limited benefits for detecting late-developing hip dysplasia in this population.
Background:
There is significant controversy in the literature over rates of late-developing dysplasia following normal screening ultrasound in breech babies, with reported rates varying from 7% to 29%. The purpose of this study is to investigate the rates of radiographic dysplasia in breech babies after a normal ultrasound with a minimum of 1 year of radiographic follow-up.
Methods:
This study was an institutional review board-approved prospective study of all patients referred by their pediatrician for concern for developmental dysplasia of the hip between July 2008 and August 2014. We identified all subjects with breech presentation and excluded those with an abnormal initial examination/ultrasound or with <12 months of radiographic follow-up. Anterior-posterior pelvis films were obtained after >12 months and acetabular indices (AIs) were measured and compared with contemporary normative data. Dysplasia was diagnosed as >2 SDs above the mean.
Results:
A total of 654 patients were referred with a history of a breech presentation, and 150 (22.9%) were found to have clinical instability or sonographic evidence of dysplasia on initial presentation and were observed with serial imaging or treated. Of the remaining 504 subjects with a normal clinical examination and screening ultrasound, 133 (26.4%; 74.4% females, 25.6% males) were followed until at least 12 months of age. Of those presenting at age 12 to 14 months, the mean AI was 0.42±0.83 SD above the mean with a skew towards elevated AIs. At the final follow-up (mean: 20.7±6.7 mo), the mean AI was 0.05±0.92 SD above the mean, and only 3/133 (2.2%) patients had a dysplastic hip. No patients underwent treatment other than an observation during the study period.
Conclusions:
One in 5 breech babies have dysplasia at presentation, but late dysplasia following normal screening ultrasound may be less common than previously reported and may be due to our prolonged follow-up period. We recommend surveillance of breech babies with follow-up visits after 12 months of age since earlier visits may offer limited benefits.
Level Of Evidence:
Level II-prospective prognostic study.
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