Advertisement

Pediatric Radiology

, Volume 47, Issue 13, pp 1787–1792 | Cite as

Changes in femoral head size and growth rate in young children with severe developmental dysplasia of the hip

  • Matthew R. WannerEmail author
  • Randall T. Loder
  • S. Gregory Jennings
  • Fangqian Ouyang
  • Boaz Karmazyn
Original Article

Abstract

Background

Developmental dysplasia of the hip (DDH) is known to result in smaller femoral head size in toddlers; however, alterations in femoral head size and growth have not been documented in infants.

Objective

To determine with ultrasound (US) whether femoral head size and growth are altered in infants (younger than 1 year of age) with severe DDH.

Materials and methods

We identified all patients at our tertiary care children’s hospital from 2002 to 2014 who underwent US for DDH. We included studies with at least one hip with severe DDH, defined as <25% coverage of the femoral head, and excluded teratological DDH. We constructed a control group of randomized patients with normal US studies. Two pediatric radiologists blinded to diagnosis measured bilateral femoral head diameter. Inter-reader variability and femoral head diameter difference between dislocated and contralateral normal femoral heads were evaluated. Mean femoral head diameters were compared across types of hip joint; femoral head growth rates per month were calculated.

Results

Thirty-seven children with DDH (28 female) were identified (median age: 33 days). The control group contained 75 children (47 female) with a median age of 47 days. Fifty-three of the 74 hips in the study group had severe DDH. Twenty-four children with DDH had completely dislocated hips (nine bilateral, five with contralateral severe subluxations). Thirteen other children had severe subluxation, two bilaterally. There was good inter-reader agreement in the normal femoral head group and moderate agreement in the severe DDH group. In the study group, severe DDH femoral head diameter was significantly smaller than their contralateral normal hip. Severe DDH femoral head diameter was significantly smaller than normal femoral head diameter in the control group. The severe DDH femoral head growth rate was slightly less but not significantly slower than normal femoral head growth rate in the study group.

Conclusion

On US during infancy, femoral head size is significantly reduced in severe cases of DDH.

Keywords

Children Developmental dysplasia of the hip Femoral head Hip Ultrasound 

Notes

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    American Academy of Pediatrics (2000) Clinical practice guideline: early detection of developmental dysplasia of the hip. Committee on quality improvement, subcommittee on developmental dysplasia of the hip. Pediatrics 105:896–905CrossRefGoogle Scholar
  2. 2.
    Guille JT, Pizzutillo PD, MacEwen GD (2000) Development dysplasia of the hip from birth to six months. J Am Acad Orthop Surg 8:232–242CrossRefPubMedGoogle Scholar
  3. 3.
    Loder RT, Skopelja EN (2011) The epidemiology and demographics of hip dysplasia. ISRN Orthop 2011:238607PubMedPubMedCentralGoogle Scholar
  4. 4.
    Kotlarsky P, Haber R, Bialik V et al (2015) Developmental dysplasia of the hip: What has changed in the last 20 years? World J Orthop 6:886–901Google Scholar
  5. 5.
    Clarke NM, Harcke HT, McHugh P et al (1985) Real-time ultrasound in the diagnosis of congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Br) 67:406–412Google Scholar
  6. 6.
    Graf R (1980) The diagnosis of congenital hip-joint dislocation by the ultrasonic combound treatment. Arch Orthop Trauma Surg 97:117–133CrossRefPubMedGoogle Scholar
  7. 7.
    Vitale MG, Skaggs DL (2001) Developmental dysplasia of the hip from six months to four years of age. J Am Acad Orthop Surg 9:401–411CrossRefPubMedGoogle Scholar
  8. 8.
    Shipman SA, Helfand M, Moyer VA et al (2006) Screening for developmental dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force. Pediatrics 117:e557–e576Google Scholar
  9. 9.
    Vane AG, Gwynne Jones DP, Dunbar JD et al (2005) The diagnosis and management of neonatal hip instability: results of a clinical and targeted ultrasound screening program. J Pediatr Orthop 25:292–295Google Scholar
  10. 10.
    Sankar WN, Neubuerger CO, Moseley CF (2010) Femoral head sphericity in untreated developmental dislocation of the hip. J Pediatr Orthop 30:558–561CrossRefPubMedGoogle Scholar
  11. 11.
    Fabry G, MacEwen GD, Shands AR Jr (1973) Torsion of the femur. A follow-up study in normal and abnormal conditions. J Bone Joint Surg Am 55:1726–1738CrossRefPubMedGoogle Scholar
  12. 12.
    Shefelbine SJ, Carter DR (2004) Mechanobiological predictions of growth front morphology in developmental hip dysplasia. J Orthop Res 22:346–352CrossRefPubMedGoogle Scholar
  13. 13.
    Portney LG, Watkins MP (2000) Foundations of clinical research. Applications to practice, 2nd edn. Upper Saddle River, Prentice Hall HealthGoogle Scholar
  14. 14.
    Crowe JF, Mani VJ, Ranawat CS (1979) Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 61:15–23CrossRefPubMedGoogle Scholar
  15. 15.
    Sugano N, Noble PC, Kamaric E et al (1998) The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg (Br) 80:711–719CrossRefGoogle Scholar
  16. 16.
    Steppacher SD, Tannast M, Werlen S et al (2008) Femoral morphology differs between deficient and excessive acetabular coverage. Clin Orthop Relat Res 466:782–790Google Scholar
  17. 17.
    Clohisy JC, Nunley RM, Carlisle JC et al (2009) Incidence and characteristics of femoral deformities in the dysplastic hip. Clin Orthop Relat Res 467:128–134Google Scholar
  18. 18.
    Okano K, Yamaguchi K, Ninomiya Y et al (2013) Femoral head deformity and severity of acetabular dysplasia of the hip. Bone Joint J 95-B:1192–1196CrossRefPubMedGoogle Scholar
  19. 19.
    O'Brien T, Salter RB (1985) Femoral head size in congenital dislocation of the hip. J Pediatr Orthop 5:299–301CrossRefPubMedGoogle Scholar
  20. 20.
    Harcke HT, Lee MS, Sinning L et al (1986) Ossification center of the infant hip: sonographic and radiographic correlation. AJR Am J Roentgenol 147:317–321CrossRefPubMedGoogle Scholar
  21. 21.
    Poyhia TH, Lamminen AE, Peltonen JI et al (2010) Brachial plexus birth injury: US screening for glenohumeral joint instability. Radiology 254:253–260CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Matthew R. Wanner
    • 1
    Email author
  • Randall T. Loder
    • 2
  • S. Gregory Jennings
    • 3
  • Fangqian Ouyang
    • 4
  • Boaz Karmazyn
    • 1
  1. 1.Department of Radiology and Imaging Sciences, Riley Hospital for ChildrenIndiana University School of MedicineIndianapolisUSA
  2. 2.Department of Orthopaedic Surgery, Riley Hospital for ChildrenIndiana University School of MedicineIndianapolisUSA
  3. 3.Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisUSA
  4. 4.Department of BiostatisticsIndiana University School of MedicineIndianapolisUSA

Personalised recommendations