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Is Radiographic Imaging Necessary for Identifying Late Developmental Dysplasia of the Hip in Breech Infants with
Katherine Antoniak1, Christopher Lee1, Rachel Y Goldstein1
1Children's Hospital Los Angeles, Los Angeles, CA, USA.
Insights
Late hip dysplasia (DDH) occurred in 10% of breech infants with normal early ultrasounds. Follow-up imaging is recommended for these high-risk infants to detect developmental dysplasia of the hip.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Neonatal Screening
Background:
- Developmental Dysplasia of the Hip (DDH) is a condition affecting infants.
- Breech presentation is a known risk factor for DDH.
- Early screening aims to detect DDH, but late-onset cases can occur.
Purpose of the Study:
- To determine the incidence of late DDH in infants with breech presentation.
- To evaluate the utility of normal hip ultrasound screening in this population.
- To assess the need for follow-up imaging in breech infants.
Main Methods:
- Retrospective study of infants with breech presentation.
- Inclusion criteria: normal hip ultrasound within 3 months and follow-up X-ray within 2 years.
- Acetabular indices measured on supine AP pelvis radiographs.
Main Results:
- 10% (11/112 hips) of infants showed late DDH at 1 standard deviation above normative values.
- No cases of DDH were found at 2 standard deviations above normative values.
- Fifty-six patients met the study criteria for analysis.
Conclusions:
- Follow-up imaging is warranted for breech infants even with normal initial hip ultrasounds.
- Early screening may miss some cases of DDH that develop later.
- This supports continued vigilance for DDH in at-risk infants.
Abstract:
Purpose. The goal of our study was to investigate the prevalence of late DDH cases in breech infants who had a normal screening hip ultrasound and subsequent follow-up hip x-ray imaging. Methods. Infants with a history of intrauterine breech position, normal hip ultrasound within 3-months of birth, and follow-up hip x-rays within 2-years were included. Acetabular indices were measured on a supine AP pelvis radiograph. Results. Fifty-six patients had breech presentation at birth, a normal hip ultrasound, and returned for radiographic evaluation within 2 years. Of those, 11/112 (10%) of hips had late DDH based on their radiographic images at 1 standard deviation greater than normative values from age-adjusted controls. No infants showed hip dysplasia at 2 standard deviations greater than normative values from age-adjusted controls. Conclusions. Our results support previous studies that follow up should be considered for infants with breech presentation and normal hip ultrasounds near birth. Level of evidence. II.
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