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Neonatal Ultrasound and Radiographic Markers of Hip Dysplasia in Young Adults
Lene B Laborie1,2, Hanne Rasmussen3,4, Kaya K Jacobsen5
1Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Insights
Neonatal hip dysplasia screening shows long-term risks in females. Early hip dysplasia in newborns is linked to adult hip dysplasia, especially in females, suggesting different developmental pathways.
Area of Science:
- Orthopedics
- Pediatric Radiology
- Developmental Biology
Background:
- Developmental dysplasia of the hip (DDH) is a common pediatric condition.
- Early detection and management of DDH are crucial for preventing long-term complications.
- Neonatal hip screening via ultrasound is widely used but its long-term predictive value requires further study.
Purpose of the Study:
- To investigate the long-term radiologic outcomes at skeletal maturity in individuals with varying degrees of hip dysplasia identified neonatally via ultrasound.
- To compare outcomes between males and females with different neonatal hip phenotypes.
- To explore the association between joint hypermobility and adult hip dysplasia.
Main Methods:
- A randomized controlled trial initially enrolled 11,925 newborns to assess DDH screening strategies.
- A subset of 1,735 participants with neonatal ultrasound data underwent clinical and radiologic follow-up at 18 years.
- Adult hip dysplasia was assessed using radiographic markers, including the center-edge (CE) angle.
Main Results:
- In females, neonatal hip phenotypes were significantly associated with adult hip dysplasia (P ≤ .001).
- Specifically, 10.5% of females with sonographically normal neonatal hips developed borderline or dysplastic hips by skeletal maturity.
- Adult joint hypermobility was linked to neonatal hip instability and adult acetabular dysplasia in females (P = .046 and P = .024, respectively).
Conclusions:
- Significant associations between neonatal hip phenotypes and adult dysplasia in females suggest distinct developmental pathways compared to males.
- Prolonged clinical and radiologic follow-up may be warranted for females with dysplastic neonatal hips.
- The role of joint hypermobility in hip dysplasia requires additional investigation.
Objectives:
To examine radiologic outcomes at skeletal maturity of sonographically normal, immature, mildly, and severely dysplastic newborn hips.
Methods:
During 1988 to 1990, 11 925 newborns were enrolled in a randomized controlled trial examining screening strategies for developmental hip dysplasia. In total, 4469 were invited to clinical and radiologic follow-up 18 years later, of which 1735 had received neonatal ultrasound. Radiographic markers for dysplasia in left adult hips included the center-edge (CE) angle.
Results:
At follow-up, 984 of 1735 (56.7%) with newborn ultrasound met, of which 966 (614 females) had valid radiographs and were thus included. For females, 34 (10.2%) and 1 (0.3%) of the 332 sonographically normal left neonatal hips were judged borderline (20°≤ CE <25°) or dysplastic (CE <20°) at skeletal maturity respectively. Corresponding numbers were 36 (19.7%) and 3 (1.6%) of the 183 immature, 12 (15.6%) and 2 (2.6%) of the 77 mildly dysplastic, and 3 (13.6%) and 3 (13.6%) of the 22 severely dysplastic neonatal left hips (P ≤ .001). In males, no associations were found. In females, adult joint hypermobility was associated with sonographic neonatal hip instability (P = .046), as well as with adult acetabular dysplasia (P = .024).
Conclusions:
Significant associations between neonatal hip phenotypes and adult dysplasia were revealed in females. This indicates the possibility of different mechanisms affecting the course of developmental dysplasia of the hip for females and males, prompting consideration of prolonged clinical and radiologic follow-up for females with dysplastic neonatal hips. Results in males are limited by low numbers of dysplastic hips. The significance of joint hypermobility warrants further investigation.
