Detecting hip joint dysplasia in high risk group infants

ABSTRACT

Early diagnosis of Developmental Dysplasia of the Hip [DDH] in newborns is essential if treatment is to be successful. Despite the introduction of clinical screening and early treatment of DDH the prevalence of subluxated / luxated hips in later infancy is still reported. For babies at risk, some authors suggest ultrasonography [US] combined with clinical examination. In this prospective study we compared clinical and ultrasonographic findings of 180 high risk neonates during two weeks of their birth a maternity hospital which is referral for high risk pregnancies. We could perform US in 180 cases with one or more risk factors of DDH, or with positive physical examination. Among them 28[15%] had immature and 13 [7.2%] had dysplastic hips. All the babies with immature hip had normal hip in follow up studies at 4 to 6 weeks of age. Ten [77%] out of 13 infants with dysplastic hip, had positive clinical findings. Twenty [33%] infants out of 59 infants with positive physical examination had normal sonography. The accuracy, specificity and sensitivity of physical examination were 71.1%, 70.6%, positive and negative predictive values were also 16.9% and 97.5% respectively that were similar to the other studies. Although most of dysplastic hips were recognized by primary clinical examination, but 3 cases were missed. In the presence of risk factors, further caution and follow up clinical examination might be exercised and another level of screening could be considered