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Ultrasonographic predictors of residual acetabular dysplasia in high-risk infants
Yusuke Ohashi1, Tomohiro Shimizu2, Hotaka Ishizu1
1Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
Insights
Femoral head coverage less than 50% at five months in infants may predict hip dysplasia. This finding could help identify high-risk infants needing further X-rays, reducing unnecessary imaging for developmental dysplasia of the hip.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Developmental Biology
Background:
- Developmental dysplasia of the hip (DDH) presents a range of hip abnormalities with potential long-term issues if not diagnosed and treated early.
- Ultrasound is the primary method for early DDH diagnosis, but guidelines for radiographic follow-up are not well-defined.
Purpose of the Study:
- To assess the predictive accuracy of ultrasound measurements at five months for identifying residual acetabular dysplasia at one and two years in infants at high risk for DDH.
- To determine if specific ultrasonographic parameters can guide decisions for radiographic follow-up in infants with DDH.
Main Methods:
- A prospective cohort study involving 278 high-risk infants.
- Infants underwent initial ultrasound, ultrasound at five months, and radiographic follow-up at one and two years.
- Analysis focused on the association between ultrasonographic parameters at five months and radiographic findings of acetabular dysplasia later.
Main Results:
- Femoral head coverage (FHC) below 50% at five months was significantly linked to an acetabular index (AI) of 30° or greater at one and two years.
- The Graf classification at five months did not reliably predict long-term hip dysplasia.
- FHC < 50% emerged as a potential indicator for selecting infants requiring radiographic follow-up.
Conclusions:
- Femoral head coverage < 50% at five months is a valuable predictor of persistent acetabular dysplasia in high-risk infants.
- This finding may help optimize the use of radiographic imaging, reducing unnecessary procedures.
- Further research is needed to refine DDH follow-up protocols and management strategies.
Abstract:
Developmental dysplasia of the hip (DDH) encompasses a spectrum of hip abnormalities that, if undiagnosed and untreated, can lead to long-term complications. While ultrasound is the gold standard for early diagnosis, the criteria for recommending radiographic follow-up remain unclear. This prospective cohort study investigated the predictive validity of ultrasonographic parameters at five months of age for residual acetabular dysplasia at one and two years of age in untreated high-risk infants. A total of 278 high-risk infants underwent ultrasound at the initial visit and at five months, with radiographic follow-up at one and two years. The findings indicate that femoral head coverage (FHC) < 50% at five months is significantly associated with an acetabular index (AI) ≥ 30° at one and two years, whereas Graf classification at five months did not reliably predict long-term dysplasia. These results suggest that FHC < 50% may be a more effective indicator for selecting infants who require radiographic follow-up, potentially reducing unnecessary imaging. Further studies are warranted to refine follow-up protocols and optimize DDH management strategies to balance early intervention with the risk of overtreatment.
