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Validation of parameters recommended for secondary screening for developmental dysplasia of the hip in Japan
Tomohiro Shimizu1, Daisuke Takahashi1, Hisataka Suzuki1
1Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan.
Insights
The Japanese Pediatric Orthopaedic Association
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
- Diagnostic Imaging
Background:
- Current guidelines recommend screening for developmental dysplasia of the hip (DDH) in infants with limited hip abduction or specific risk factors.
- The clinical utility of these Japanese guidelines for DDH screening requires further investigation.
Purpose of the Study:
- To assess the association between established risk factors and DDH diagnosis via ultrasound and radiography.
- To evaluate the effectiveness of the Japanese Pediatric Orthopaedic Association's screening guidelines.
Main Methods:
- 356 infants underwent ultrasonography and radiography for DDH screening.
- Risk factors were documented, and a "recommended item score" was calculated.
- Infants with a score of 2 or more were classified as high-risk.
Main Results:
- The high-risk group (280/356 infants) had a higher incidence of abnormal imaging findings.
- Female sex, skin asymmetry, and limb limitation were independent predictors of abnormal imaging and need for Pavlik harness treatment.
Conclusions:
- The risk factors identified by the Japanese guidelines are valuable for identifying infants requiring treatment for DDH.
- These recommended screening items appear useful for targeted DDH management.
Background:
Based on the Japanese Pediatric Orthopaedic Association's guidelines, secondary screening and imaging including ultrasonography and radiography, are recommended in infants with limited hip abduction (<70°) or in those with multiple risk factors including the following: asymmetrical skin creases, a family history of developmental dysplasia of the hip, female sex, and pelvic position at delivery. However, there is still little information regarding the usefulness of this guideline. The objective of this study was to investigate the association between the risk factors and developmental dysplasia of the hip diagnosed using ultrasound and radiography.
Methods:
A total of 356 infants (67 boys and 289 girls) underwent secondary ultrasonographic and radiological screening for developmental dysplasia of the hip in our hospital. Risk factors were documented from their medical records. The recommended item score, which we defined as an integrated value of the recommended item, was calculated for each patient. The limitation of hip abduction alone was a criterion for secondary screening; therefore, we defined the scores as follows: the limitation of hip abduction scored 2 points and other recommended scores were assigned 1 point. If the recommended item score was 2 points or more, we classified the infants as high-risk.
Results:
A total of 280 of 356 infants were included in the high-risk group, which showed a higher ratio of cases with abnormal imaging findings than the low-risk group. According to the multivariate logistic regression analyses among the recommended items, being female, skin asymmetry, and limb limitation were identified as independent risk factors for imaging abnormality and the need for Pavlik harness treatment.
Conclusions:
The recommended items for secondary screening based on the Japanese Pediatric Orthopaedic Association's guidelines could be useful for screening infants in need of treatment.
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