Skip to main content

Advertisement

SpringerLink
Log in

The use of X-ray at 5 months in a selective screening programme for developmental dysplasia of the hip

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Background

The methods used for any screening programme for developmental dysplasia of the hip (DDH) can be controversial. This was an opportunistic audit of our selective ultrasound screening programme using an X-ray at 5 months to prevent inappropriate discharge due to the learning curve of ultrasound.

Methods

Between 1990 and 2004 in Nottingham, UK, out of a total population of 108,500 births, approximately 11,500 neonates were screened using ultrasound. Any child with an ultrasound scan showing Graf α-angles greater than 60° (Graf Type I) with the hip in joint were discharged from the clinic. All of those discharged were subsequently X-rayed at 5 months in order to cover the learning curve of ultrasound. The X-rays were reviewed by a consultant radiologist and referred back to orthopaedics if there was lateralisation of the femoral head or an acetabular index above 30°.

Results

Of approximately 11,000 X-rays performed, only 53 patients were referred back to orthopaedics, of which 47 had a complete data set. Of these 47 children, only 8 (17%) required intervention. On review of the original ultrasounds, Graf’s α-angle did not seem to correlate well with the need for intervention, as all were Type I hips. The femoral head cover (FHC) appeared to be more predictive of the need for treatment. There have been no late presentations to our unit of DDH following a normal 5-month X-ray.

Conclusions

We now check the Graf α-angle, FHC and dynamic stability in the ultrasound assessment and only perform X-ray at 5 months if there was a low α-angle or low FHC. Since this change, there have been no late presentations of DDH from the population screened by ultrasound.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ortolani M (1937) Un segno poco noto e sua importanza per la diagnosi precoce di prelussazione congenita dell’anca. Pediatria 45:129–136

    Google Scholar 

  2. Barlow TG (1962) Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg Br 44-B:292–301

    Google Scholar 

  3. Andersson JE, Funnemark P-O (1999) Neonatal hip instability: screening with anterior-dynamic ultrasound method. J Pediatr Orthop 15:322–324

    Article  Google Scholar 

  4. Dogruel H, Atalar H, Yavuz OY, Sayli U (2008) Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. Int Orthop 32(3):415–419

    Article  CAS  Google Scholar 

  5. Paton RW, Hinduja K, Thomas CD (2005) The significance of at-risk factors in ultrasound surveillance of developmental dysplasia of the hip. A ten-year prospective study. J Bone Joint Surg Br 87-B:1264–1266

    Article  Google Scholar 

  6. Foster BK (1995) Initial screening and diagnosis of and referral for developmental dysplasia of the hip. Curr Opin Pediatr 7:80–82

    Article  CAS  Google Scholar 

  7. McKinstry B, MacNicol M, Elliot K, MacPherson S (2005) The transition from learner to provider/teacher: the learning needs of new orthopaedic consultants. BMC Med Educ 5(1):17

    Article  Google Scholar 

  8. Tredwell SJ (1992) Neonatal screening for hip joint instability. Its clinical and economic relevance. Clin Orthop Relat Res 281:63–68

    Google Scholar 

  9. Sponseller PD (1995) Screening and ultrasound for neonatal hip instability. Curr Opin Pediatr 7:77–79

    Article  CAS  Google Scholar 

  10. Peled E, Bialik V, Katzman A, Eidelman M, Norman D (2008) Treatment of Graf’s ultrasound class III and IV hips using Pavlik’s method. Clin Orthop Relat Res 466(4):825–829

    Article  Google Scholar 

  11. Elbourne D, Dezateux C, Arthur R, Clarke NM, Gray A, King A, Quinn A, Gardner F, Russell G; UK Collaborative Hip Trial Group (2002) Ultrasonography in the diagnosis and management of developmental hip dysplasia (UK Hip Trial): clinical and economic results of a multicentre randomised controlled trial. Lancet 360:2009–2017

    Article  Google Scholar 

  12. Taylor GR, Clarke NM (1997) Monitoring the treatment of developmental dysplasia of the hip with the Pavlik harness. The role of ultrasound. J Bone Joint Surg Br 79-B(5):719–723

    Article  Google Scholar 

  13. Vedantam R, Bell MJ (1995) Dynamic ultrasound assessment for monitoring of treatment of congenital dislocation of the hip. J Pediatr Orthop 15:725–728

    Article  CAS  Google Scholar 

  14. Paton RW, Hossain S, Eccles K (2002) Eight-year prospective targeted ultrasound screening program for instability and at-risk hip joints in developmental dysplasia of the hip. J Pediatr Orthop 22:338–341

    Google Scholar 

  15. Shipman SA, Helfand M, Moyer VA, Yawn BP (2006) Screening for developmental dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force. Pediatrics 117(3):e557–e576

    Article  Google Scholar 

  16. Roovers EA, Boere-Boonekamp MM, Castelein RM, Zielhuis GA, Kerkhoff TH (2005) Effectiveness of ultrasound screening for developmental dysplasia of the hip. Arch Dis Child Fetal Neonatal Ed 90(1):F25–F30

    Article  CAS  Google Scholar 

  17. Lewis K, Jones DA, Powell N (1999) Ultrasound and neonatal hip screening: the five-year results of a prospective study in high-risk babies. J Pediatr Orthop 19(6):760–762

    CAS  Google Scholar 

  18. Marks DS, Clegg J, al-Chalabi AN (1994) Routine ultrasound screening for neonatal hip instability. Can it abolish late-presenting congenital dislocation of the hip? J Bone Joint Surg Br 76-B:534–538

    Google Scholar 

  19. Holen KJ, Tegnander A, Bredland T, Johansen OJ, Saether OD, Eik-Nes SH, Terjesen T (2002) Universal or selective screening of the neonatal hip using ultrasound? A prospective, randomised trial of 15,529 newborn infants. J Bone Joint Surg Br 84-B:886–890

    Article  Google Scholar 

  20. Sucato DJ, Johnston CE 2nd, Birch JG, Herring JA, Mack P (1999) Outcome of ultrasonographic hip abnormalities in clinically stable hips. J Pediatr Orthop 19(6):754–759

    CAS  Google Scholar 

  21. Gray A, Elbourne D, Dezateux C, King A, Quinn A, Gardner F (2005) Economic evaluation of ultrasonography in the diagnosis and management of developmental hip dysplasia in the United Kingdom and Ireland. J Bone Joint Surg Am 87-A(11):2472–2479

    Article  Google Scholar 

  22. Elliman DA, Dezateux C, Bedford HE (2002) Newborn and childhood screening programmes: criteria, evidence, and current policy. Arch Dis Child 87:6–9

    Article  CAS  Google Scholar 

  23. Graf R (1980) The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg 97:117–133

    Article  CAS  Google Scholar 

  24. Falliner A, Schwinzer D, Hahne H-J, Hedderich J, Hassenpflug J (2006) Comparing ultrasound measurements of neonatal hips using the methods of Graf and Terjesen. J Bone Joint Surg Br 88-B:104–106

    Article  Google Scholar 

  25. Holen KJ, Terjesen T, Tegnander A, Bredland T, Saether OD, Eik-Nes SH (1994) Ultrasound screening for hip dysplasia in newborns. J Pediatr Orthop 14:667–673

    Article  CAS  Google Scholar 

  26. Engesaeter LB, Wilson DJ, Nag D, Benson MK (1990) Ultrasound and congenital dislocation of the hip. The importance of dynamic assessment. J Bone Joint Surg Br 72-B(2):197–201

    Google Scholar 

  27. Graf R (1987) Guide to sonography of the infant hip. Thieme Medical Publishers, New York

    Google Scholar 

  28. Morin C, Harcke HT, MacEwen GD (1985) The infant hip: real-time US assessment of acetabular development. Radiology 157:673–677

    Article  CAS  Google Scholar 

  29. Arumilli BR, Koneru P, Garg NK, Davies R, Saville S, Sampath J, Bruce C (2006) Is secondary radiological follow-up of infants with a family history of developmental dysplasia of the hip necessary? J Bone Joint Surg Br 88-B:1224–1227

    Article  Google Scholar 

  30. [No authors listed] (1992) Conclusions of Consensus Conference on the screening or congenital hip dislocation. Paris, 4 November 1991. Arch Fr Pediatr 49(2):145–146

Download references

Acknowledgments

We would like to make the following acknowledgement: Dr. P. Twining, Consultant Radiologist at the University Hospital of Nottingham, UK. Dr. Twining was a highly respected radiologist at this institution for a number of years and helped to set up the hip screening programme in this region. Although he sadly passed away last year, his contribution to the hip service and in the setting up of this paper will always be remembered.

Author information

Authors and Affiliations

  1. Specialty Registrar in Trauma and Orthopaedics, Nottingham University Hospital, 1 Bessemer Drive, Mansfield, Nottinghamshire, NG18 4FY, UK

    Kathryn R. Price

  2. Associate Specialist in Paediatrics, Nottingham University Hospital, Derby Road, Nottingham, NG7 2UH, UK

    Rosemary Dove

  3. Consultant in Paediatric Orthopaedics, Nottingham University Hospital, Derby Road, Nottingham, NG7 2UH, UK

    James B. Hunter

Authors
  1. Kathryn R. Price
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rosemary Dove
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James B. Hunter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathryn R. Price.

About this article

Cite this article

Price, K.R., Dove, R. & Hunter, J.B. The use of X-ray at 5 months in a selective screening programme for developmental dysplasia of the hip. J Child Orthop 5, 195–200 (2011). https://doi.org/10.1007/s11832-011-0338-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11832-011-0338-2

Keywords

Search

Navigation