Impact of the coronavirus disease 2019 pandemic on ultrasound screening of developmental dysplasia of the hip and follow-up imaging: a report from southeastern Turkey.

OBJECTIVE: To investigate the effect of coronavirus disease 2019 restrictions on ultrasound (US) screening of developmental dysplasia of the hip (DDH) in a children's hospital. METHODS: The records of US screening of DDH were retrospectively evaluated in the pandemic period (April 2020 to July 2021) and the pre-pandemic period (January 2019 to February 2020). The monthly US number, sex, radiologist number, and age at the initial examination were recorded. RESULTS: A total of 6107 US scans were performed during the pre-pandemic period, which significantly decreased to 3340 during the pandemic. The number of monthly US scans performed did not change between the pre-pandemic (142.7/month) and pandemic (128.2/month) periods. The number of delayed examinations in the total population did not significantly change between the two periods. However, the number of delayed examinations in patients with abnormal hips was significantly increased during the pandemic compared with that in the pre-pandemic period. CONCLUSIONS: Coronavirus disease 2019 restrictions decreased the US screening rate of DDH by almost half, but the number of US scans performed by each radiologist was unchanged. The compliance with follow-up recommendations was reduced by half, which may lead to an increase in the incidence of delayed and untreated DDH cases.

A Virtual Clinic for DDH Pavlik Harness Monitoring.

BACKGROUND: Pavlik harness (PH) treatment is successful in treating over 90% of newborns with developmental dysplasia of the hip (DDH). There is a need for close supervision, frequent adjustments, size changes, and monitoring of complications. This paper aims to provide a safe criterion for remote follow-up of DDH patients treated in a PH to reduce the risk of COVID-19 (coronavirus disease 2019) exposure to patients, parents, and health practitioners. METHODS: All infants with stable hips (Graf I, IIa/b/c/d, treated III/IV) with consenting parents after appropriate counseling were enrolled in a virtual clinic. Clinics were conducted using the NHS "Attend anywhere" virtual link service by an extended scope practitioner-specialist physiotherapist and a clinical nurse specialist. The virtual clinic group was compared with a matched cohort of patients from 2018/2019. RESULTS: A total of 141 patients were referred to the neonatal hip clinic; 45 patients were eligible for harness treatment and 20 patients were selected for virtual clinics. In total, there were 35 virtual clinic appointments. Each of the patients had an average of 1.7 virtual appointments ranging from 1 to 3 (26.3% of total number of clinics). Age at presentation of the treated group was 7±4.2 weeks and control group 5.7±5.5 weeks (P=0.59). PH duration of the study group was 9±2.6 weeks and the control group, 7.8±2.5 weeks (P=0.12). There were no missed complications at the follow-up face-to-face appointment. Patients saved an average of 76 km total travel distance. CONCLUSIONS: This study demonstrates adequate evidence that children requiring routine follow-up appointments involving PH adjustment, skincare, and identification of clinical anomalies, can be treated and followed up safely using virtual clinics. Clinical triage of suitable patients for virtual clinic provision must always be made by experienced clinicians. Children presenting with Graf IIa, IIb, IIc, IId, as well as those with stable and improving Graf III at initial diagnoses, had successful treatment with virtual clinic follow-up appointments in this study. LEVEL OF EVIDENCE: Level IV.

Does the COVID-19 pandemic cause late diagnosis and delay in treatment in developmental dysplasia of hip patients?

BACKGROUND: The aim of the current study was to search the effect of COVID-19 restriction on developmental dysplasia of hip (DDH) screening. MATERIAL AND METHODS: We retrospectively reviewed the patients who brought to DDH screening in April-May and June-July 2020 and compared with the same period of 2019. We recorded age, gender, DDH type and risk factors of the patients. RESULTS: The number of patients taken for DDH screening was 430 and 400 in April-May 2019 and June-July 2019, respectively. In 2020, the number of patients taken for DDH screening was 159 and 776 in the same period, respectively. Thirteen patients were diagnosed with DDH older than 3 months age in June-July 2020. There were only two patients in same period in 2019. In 2020, 6 of 13 patients who applied to the hospital late for the routine US and had pathologic hips were not taken to orthopaedics or follow-up by their families. CONCLUSION: In the era of COVID-19, the number of late diagnosis and lost follow-up for DDH are increased. To prevent future morbidities and reduce surgical interventions, special measures should be taken.

Infected hip prosthesis in patient with suspected Covid-19 infection (preprint)

Background: Infections following arthroplasty are one of the major risks during this type of surgery.Case presentation: Four and half years after right hip arthroplasty surgery, the patient came back to our attention with pain at the same hip. The instrumental examinations showed signs of cup detachment and therefore, after carefully analyzing the case, we decided to perform a sterile aspiration of the hip in the operating room under C-arm fluoroscopy. Microbiological examinations showed positivity for E.Coli. The patient underwent to surgery to remove the prosthesis and implant a spacer. A therapy with Cefotaxim 2g 1-1-1 for 6 weeks was then set, after which a total arthroplasty was implanted. During this period, the Covid-19 pandemic occurred and therefore the patient performed two nasal-throat swabs, both negative. However, one week after the final surgery, respiratory conditions worsened and we performed a chest X-ray and CT scan, with suggestive images of ground-glass opacification patterns (GGO). Due to the clinic and the characteristic images of the instrumental examinations, the patient was transferred to the observation ward, waiting for the response of two additional swabs, also negative. The patient was then transferred to the ward for patients with typical symptoms of Covid-19 but with negative swabs for two weeks and subsequently discharged at home.Conclusion: Despite the concomitant Covid-19 pandemic, the guidelines in case of periprosthetic hip infection further confirm the correct management of the patient.