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Early Screening for Developmental Dysplasia of the Hip: Sonographic Reference Values, Risk Factors, and Treatment
Bjoern Vogt1, Stella S Tureck1,2, Georg Gosheger2
1Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
Insights
This study establishes reference values for early developmental dysplasia of the hip (DDH) screening in newborns. Female sex and abnormal birth presentation are confirmed as key risk factors for DDH.
Area of Science:
- Neonatal musculoskeletal disorders
- Pediatric orthopedics
- Diagnostic imaging in neonates
Background:
- Developmental dysplasia of the hip (DDH) is a prevalent neonatal musculoskeletal condition.
- Current German guidelines recommend early sonographic screening for neonates with specific risk factors.
- Establishing precise reference values for early screening is crucial for timely diagnosis and intervention.
Purpose of the Study:
- To determine reference values for early hip ultrasound screening in neonates.
- To identify and evaluate risk factors associated with DDH.
- To assess the efficacy of universal versus risk-based screening strategies.
Main Methods:
- Hip ultrasound examinations were performed on 3383 neonates (6766 hips) between 2007 and 2022 using the Graf method.
- Neonates were screened universally (2007-2015) or based on predefined risk factors (2015-2022).
- Logistic regression analysis was used to evaluate risk factors, with DDH defined as Graf type IIc or worse.
Main Results:
- The mean alpha angle was 61.2° ± 5.3° and the mean beta angle was 70.8° ± 8.6°.
- DDH prevalence was comparable between universal (2.5%) and risk-based (3.2%) screening cohorts.
- Abnormal birth presentation (OR=3.09) and female sex (OR=3.77) were significantly associated with DDH, while Cesarean section and family history were not.
Conclusions:
- This study provides essential reference values for early DDH screening using hip ultrasound.
- Abnormal birth presentation and female sex are confirmed as significant risk factors for DDH.
- The findings support the ongoing use of risk-factor-based screening for DDH in neonates.
Abstract:
Developmental dysplasia of the hip (DDH) is a common neonatal musculoskeletal disorder. In Germany, sonographic screening is recommended at 1-10 days of life for neonates with specific risk factors. This study aims to determine reference values for early sonographic screening and to evaluate associated risk factors. Between 2007 and 2022, 3383 neonates (6766 hips) underwent hip ultrasound according to Graf. Of these, 967 neonates were screened universally (2007-2015) and 1900 based on predefined risk factors (2015-2022). DDH was defined as ≥type IIc, according to Graf. A subgroup of 20 neonates with borderline alpha angles (51-52°) was followed up after 3-6 weeks. The mean alpha angle was 61.2° ± 5.3° (range 50.5-71.9°), and beta angle 70.8° ± 8.6° (range 53.6-88.0°). DDH prevalence was 2.5% in the universal and 3.2% in the risk-based cohort (p = 0.350). Logistic regression revealed associations with abnormal birth presentation (OR = 3.09, p < 0.001) and female sex (OR = 3.77, p < 0.001), not with Cesarean section or familial predisposition. In the follow-up subgroup, all hips showed a sufficient maturation to an alpha angle of 61.0° (range 57-66°). This study provides reference values for early DDH screening and confirms abnormal birth presentation and female sex as relevant risk factors.
