Family history in developmental dysplasia of the hip: should we follow-up?

Objectives: Developmental dysplasia of the hip (DDH) is an important problem. Ultrasonography (US) is aproper method before 6 months of age. For older children, plain radiographs can be useful. Six risk factors areemphasized: breech presentation, female sex, a positive family history, being first-born, left hip affected, andmode of delivery. In some centers, clinicians prefer to perform a control US examination or pelvic radiographsafter 6 months of age for the children having a positive family history. We aimed to evaluate the necessity ofcontrol US/direct radiography examinations.Methods: A total of 205 children with a positive family history for DDH are included. US examinations areperformed according to Graf’s method. We have evaluated direct radiographs by using Hilgenreiner, Perkin,and Shenton lines, acetabular angle.Results: Initial US examinations are performed at a median age of 8.3 weeks. Seventy-four patients (36%)had a repeat ultrasound scan at a median age of 7 months; none of them demonstrated abnormal findings. Onehundred and thirty-one patients (63.9%) had control radiographs at a median age of 8.2 months. Shenton lineis considered as normal, and the upper femoral epiphysis is located in inferomedial quadrant according toHilgenreiner and Perkin lines.Conclusions: A positive family history for DDH may be a less important reason for performing control US orradiographic examination. Patients with a normal screening US result and having risk factors can be dischargedfrom follow up safely, so that unnecessary examinations and family anxiety will be reduced.

PDF

___

[1] Kyung BS, Lee SH, Jeong WK, Park SY. Disparity between clinical and ultrasound examinations in neonatal hip screening. Clin Orthop Surg 2016;8:203-9.
[2] Teixeira SR, Dalto VF, Maranho DA, Zoghbi-Neto OS, Volpon JB, Nogueira-Barbosa MH. Comparison between Graf method and pubo-femoral distance in neutral and flexion positions to diagnose developmental dysplasia of the hip. Eur J Radiol 2015;84:301-6.
[3] Thallinger C, Pospischill R, Ganger R, Radler C, Krall C, Grill F. Long-term results of a nationwide general ultrasound screening system for developmental disorders of the hip: the Austrian hip screening program. J Child Orthop 2014;8:3-10.
[4] Shorter D, Hong T, Osborn DA. Cochrane Review: Screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health 2013;8:11-54.
[5] Orak MM, Onay T, Cagirmaz T, Elibol C, Elibol FD, Centel T. The reliability of ultrasonography in developmental dysplasia of the hip: How reliable is it in different hands? Indian J Orthop 2015;49:610-4.
[6] Mahan ST, Katz JN, Kim YJ. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am 2009;91:1705-19.
[7] Schwend RM, Schoenecker P, Richards BS, Flynn JM, Vitale M, Pediatric Orthopaedic Society of North A. Screening the newborn for developmental dysplasia of the hip: now what do we do? J Pediatr Orthop 2007;27:607-10.
[8] Sewell MD, Eastwood DM. Screening and treatment in developmental dysplasia of the hip-where do we go from here? Int Orthop 2011;35:1359-67.
[9] Roposch A, Moreau NM, Uleryk E, Doria AS. Developmental dysplasia of the hip: quality of reporting of diagnostic accuracy for US. Radiology 2006;241:854-60.
[10] Ortiz-Neira CL, Paolucci EO, Donnon T. A meta-analysis of common risk factors associated with the diagnosis of developmental dysplasia of the hip in newborns. Eur J Radiol 2012;81:e344-51.
[11] Garvey M, Donoghue VB, Gorman WA, O'Brien N, Murphy JF. Radiographic screening at four months of infants at risk for congenital hip dislocation. J Bone Joint Surg Br 1992;74:704-7.
[12] Tafazal S, Flowers MJ. Do we need to follow up an early normal ultrasound with a later plain radiograph in children with a family history of developmental dysplasia of the hip? Eur J Orthop Surg Traumatol 2015;25:1171-5.
[13] Keller MS, Nijs EL. The role of radiographs and US in developmental dysplasia of the hip: how good are they? Pediatr Radiol 2009;39 Suppl 2:S211-5.
[14] Holen KJ, Tegnander A, Bredland T, Johansen OJ, Saether OD, Eik-Nes SH, et al. Universal or selective screening of the neonatal hip using ultrasound? A prospective, randomised trial of 15,529 newborn infants. J Bone Joint Surg Br 2002;84:886- 90.
[15] Bache CE, Clegg J, Herron M. Risk factors for developmental dysplasia of the hip: ultrasonographic findings in the neonatal period. J Pediatr Orthop B 2002;11:212-8.
[16] Arumilli BR, Koneru P, Garg NK, Davies R, Saville S, Sampath J, et al. Is secondary radiological follow-up of infants with a family history of developmental dysplasia of the hip necessary? J Bone Joint Surg Br 2006;88:1224-7.
[17] Price KR, Dove R, Hunter JB. The use of X-ray at 5 months in a selective screening programme for developmental dysplasia of the hip. J Child Orthop 2011;5:195-200.
[18] Osarumwense D, Popple D, Kershaw IF, Kershaw CJ, Furlong AJ. What follow-up is required for children with a family history of developmental dysplasia of the hip? J Pediatr Orthop B 2007;16:399-402.
[19] Lee YK, Chung CY, Koo KH, Lee KM, Kwon DG, Park MS. Measuring acetabular dysplasia in plain radiographs. Arch Orthop Trauma Surg 2011;131:1219-26.