Early neonatal universal ultrasound screening for developmental dysplasia of the hip: a single institution observational study

Abstract

Objective

We evaluated the effect of early universal ultrasound (US) screening program for developmental dysplasia of the hip (DDH).

Methods

A total of 21,676 newborns between 2006 and 2015 were included in the study. All hips were examined by US within the first week of life. The incidence of sonographic hip-types according to the Graf method was analyzed, and then followed prospectively. Risk factors for DDH and treatment measures were also recorded, together with the number of first surgical procedures before the age of three years.

Results

Overall, 92.5% of hips were mature (Graf types Ia, Ib) at first examination, 7.2% were mature (Graf type IIa) and 0.3% were pathological (Graf types IIc to IV). A total of 146 pathological hips were detected in 118 of newborns (0.6%). Only 0.26% of screened population was treated with an orthosis. The rate of first surgical procedures and the rate of late detected DDH were 0.23 and 0.09 per 1000 live births, respectively. Regarding risk factors, positive family history, female gender, breech presentation, and high birth weight were significantly more common in newborns with pathological hips.

Conclusion

Early neonatal universal US screening using Graf method is recommended to timely detect DDH and to provide the optimal conservative approach of management. It seems to be effective in reducing the overall treatment rate, together with the rate of surgical procedures and late detected cases.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Dezateux C, Rosendahl K (2007) Developmental dysplasia of the hip. Lancet 5:1541–1552

    Article  Google Scholar 

  2. 2.

    Loder RT, Skopelja EN (2011) The epidemiology and demographics of hip dysplasia. ISRN Orthop. https://doi.org/10.5402/2011/238607

  3. 3.

    Moraleda L, Bravo C, Forriol F et al (2019) Does orientation of the femoral head affect acetabular development? An experimental study in lamb. J Pediatr Orthop 39:416–421

    Article  Google Scholar 

  4. 4.

    De Hundt M, Vlemmix F, Bais JMJ et al (2012) Risk factors for developmental dysplasia of the hip: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 165:8–17

    Article  Google Scholar 

  5. 5.

    Shorter D, Hong T, Osborn DA (2013) Cochrane Review: screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health 8:11–54

    Article  Google Scholar 

  6. 6.

    Graf R (1984) Classification of hip joint dysplasia by means of sonography. Arch Orthop Trauma Surg 102:248–255

    CAS  Article  Google Scholar 

  7. 7.

    Graf R (2017) Hip sonography: background; technicque and common mistakes; results; debate and politics; challenges. Hip Int 27:215–219

    Article  Google Scholar 

  8. 8.

    American Institute of ultrasound in Medicine (2013) AIUM Practice guideline for the performance of an ultrasound examination for detection and assessment of developmental dysplasia of the hip. J Ultrasound Med 32:1307–1317

    Article  Google Scholar 

  9. 9.

    Thalinger C, Pospischill R, Ganger R et al (2014) Long-term results of a nationwide general ultrasound screening system for developmental disorder of the hip: the Austrian hip screening program. J Child Orthop 8:3–10

    Article  Google Scholar 

  10. 10.

    Biedermann R, Riccabona J, Giesinger JM et al (2018) Results of universal ultrasound screening for developmental dysplasia of the hip: a prospective follow up of 28 092 consecutive infants. Bone Joint J 100-B:1399–1404

    CAS  Article  Google Scholar 

  11. 11.

    Güler O, Seker A, Mutlu S et al (2016) Results of a universal ultrasonographic hip screening progam at a single institution. Acta Orthop Traumatol Turc 50:42–48

    PubMed  Google Scholar 

  12. 12.

    Holen KJ, Tegnander A, Bredland T et al (2002) Universal or selective screening of the neonatal hip using ultrasound? A prospective, randomised trial of 15,529 newborn infants. J Bone Joint Surg 84:886–890

    CAS  Article  Google Scholar 

  13. 13.

    Laborie LB, Engesaeter IO, Lehmann TG et al (2013) Screening strategies for hip dysplasia: long-term outcome of a randomized controlled trial. Pediatrics 132:492–501

    Article  Google Scholar 

  14. 14.

    O'Beirne JG, Chlapoutakis K, Alshryda S et al (2019) International interdisciplinary consensus meeting on evaluation of developmental dysplasia of the hip. Ultrashall Med 40:454–464

    Article  Google Scholar 

  15. 15.

    Treiber M, Tomažič T, Tekauc-Golob et al (2008) Ultrasound screening for developmental dysplasia of the hip in the newborn: a population-based study in the Maribor region 1997-2005. Wien Klin Wochenschr 120:31–36

    Article  Google Scholar 

  16. 16.

    Kolb A, Schweiger N, Mailath Pokorny M et al (2016) Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. Int Orthop 40:123–127

    Article  Google Scholar 

  17. 17.

    Eastwood DM (2003) Neonatal hip screening. Lancet 361:595–597

    Article  Google Scholar 

  18. 18.

    Falliner A, Schwinzer D, Hahne HJ et al (2006) Comparing ultrasound measurements of neonatal hips using the methods of Graf and Terjesen. J Bone Joint Surg 88:104–106

    CAS  Article  Google Scholar 

  19. 19.

    Ortiz-Neira CL, Paolucci EO, Donnon T (2012) A meta-analysis of common risk factors associated with the diagnosis of developmental dysplasia of the hip in newborns. Eur J Radiol 81:344–351

    Article  Google Scholar 

  20. 20.

    Schams M, Labruyere R, Zuse A et al (2017) Diagnosing developmental dysplasia of the hip using the Graf ultrasound method: risk and protective factor analysis in 11.820 universally screened newborns. Eur J Pediatr 176:1193–1200

    Article  Google Scholar 

  21. 21.

    Laborie LB, Markestad TJ, Davidsen H et al (2014) Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991-2006. Pediatr Radiol 44:410–424

    Article  Google Scholar 

  22. 22.

    Riad JP, Cundy P, Gent RJ et al (2005) Longitudinal study of normal hip development by ultrasound. J Pediatr Orthop 25:5–9

    PubMed  Google Scholar 

  23. 23.

    Von Kries R, Ihme N, Altenhofen L et al (2012) General ultrasound screening reduces the rate of first operative procedures for developmental dysplasia of the hip: a case control study. J Paediatr 160:271–275

    Article  Google Scholar 

  24. 24.

    Wirth T, Stratmann L, Hinrichs F (2004) Evolution of late presenting developmental dysplasia of the hip and associated surgical procedures after 14 years of neonatal ultrasound screening. J Bone Joint Surg 86:585–589

    CAS  Article  Google Scholar 

  25. 25.

    Talbot C, Adam J, Paton R (2017) Late presentation of developmental dysplasia of the hip - a 15-year observational study. Bone Joint J 99:1250–1255

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Bojan Korpar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Treiber, M., Korpar, B., Sirše, M. et al. Early neonatal universal ultrasound screening for developmental dysplasia of the hip: a single institution observational study. International Orthopaedics (SICOT) (2021). https://doi.org/10.1007/s00264-020-04915-0

Download citation

Keywords

  • Developmental dysplasia of the hip
  • Hip ultrasound
  • Screening
  • Newborn