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Ultrasound techniques for the detection of developmental dysplasia of the hip: a systematic review and meta-analysis
Marcio Luís Duarte1, Giovanna Galvão Braga Motta2, Natasha Vogel Majewski Rodrigues3
1MD, MSc. Musculoskeletal Radiologist, WEBIMAGEM Telerradiologia, São Paulo (SP), Brazil. Doctoral student in Evidence-based Health Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
Insights
This systematic review found the Morin ultrasound technique offers the highest sensitivity for diagnosing developmental dysplasia of the hip (DDH). The Morin technique is recommended as a complementary method to the Graf technique for accurate DDH diagnosis.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Neonatal Care
Background:
- Developmental dysplasia of the hip (DDH) is a spectrum of hip pathologies requiring accurate diagnosis.
- Ultrasonography is the preferred imaging modality for DDH detection in infants.
- Standardization of ultrasound techniques is crucial for reliable DDH assessment.
Approach:
- A systematic review was conducted to compare the diagnostic accuracy of various ultrasound techniques for DDH.
- Literature search included PubMed, EMBASE, Cochrane Library, CINAHL, and LILACS databases.
- QUADAS 2 tool assessed the methodological quality of included studies.
Key Points:
- The Graf method served as the reference standard for hip assessment.
- Morin technique demonstrated the highest sensitivity (81.12-89.47%).
- Suzuki and Stress tests achieved 100% specificity, while Harcke technique showed 18.21% sensitivity and 99.32% specificity.
Conclusions:
- No single technique consistently surpassed 90% in both sensitivity and specificity compared to the Graf method.
- The Morin technique is recommended as a secondary diagnostic tool due to its high sensitivity.
- Accurate DDH diagnosis relies on a combination of validated ultrasound techniques.
Background:
Developmental dysplasia of the hip (DDH) encompasses a broad spectrum of hip pathologies, including femoral or acetabular dysplasia, hip instability, or both. According to the medical literature, ultrasonography is the most reliable diagnostic method for DDH. Several techniques for the assessment of hips in newborns and infants, using ultrasonography, have been described.
Objective:
To compare the accuracy of the Graf technique and other diagnostic techniques for DDH.
Design And Setting:
A systematic review of studies that analyzed ultrasound techniques for the diagnosis of DDH within an evidence-based health program of a federal university in São Paulo (SP), Brazil.
Methods:
A systematic search of relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, and LILACS databases for articles published up to May 5, 2020, relating to studies evaluating the diagnostic accuracy of different ultrasound techniques for diagnosing DDH. The QUADAS 2 tool was used for methodological quality evaluation.
Results:
All hips were analyzed using the Graf method as a reference standard. The Morin technique had the highest rate of sensitivity, at 81.12-89.47%. The Suzuki and Stress tests showed 100% specificity. The Harcke technique showed a sensibility of 18.21% and specificity of 99.32%.
Conclusion:
All the techniques demonstrated at least one rate (sensibility and specificity) lower than 90.00% when compared to the Graf method. The Morin technique, as evaluated in this systematic review, is recommended after the Graf method because it has the highest sensitivity, especially with the three-pattern classification of 89.47%.
Registration Number:
Identifier: CRD42020189686 at the International Prospective Register of Systematic Reviews (identifier: CRD42020189686).
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