Wrodzona dysplazja stawu biodrowego – Diagnostyka i diagnoza

Wrodzona dysplazja stawu biodrowego
Diagnostyka i diagnoza

Wrodzona dysplazja stawu biodrowego (DDH) obejmuje spektrum patologii od niestabilności do zwichnięcia stawu biodrowego, najczęściej diagnozowanych u niemowląt bez innych schorzeń współistniejących. Wczesne rozpoznanie, idealnie w pierwszych 6 miesiącach życia, jest kluczowe dla skutecznego leczenia i zapobiegania powikłaniom takim jak przetrwałe zwichnięcie czy wczesna choroba zwyrodnieniowa. Diagnostyka opiera się na badaniu klinicznym (testy Ortolaniego i Barlowa) oraz badaniach obrazowych, głównie USG do 4-6 miesiąca życia i RTG po tym okresie. Metoda Grafa w USG ocenia kąty alfa (>60° prawidłowy) i beta (<55° prawidłowy), co pozwala na klasyfikację bioder i ocenę stopnia dysplazji. USG jest preferowaną metodą u niemowląt, natomiast RTG po 6 miesiącach umożliwia ocenę linii Hilgenreinera, Perkinsa, linii Shentona oraz kąta CE Wiberga (prawidłowy ≥25°).

Diagnostyka wrodzonej dysplazji stawu biodrowego

Wrodzona dysplazja stawu biodrowego (Developmental Dysplasia of the Hip, DDH) obejmuje spektrum nieprawidłowości stawu biodrowego, począwszy od niestabilności stawu, poprzez panewki-stawowej/” title=”dysplazja panewki stawowej” class=”to-tag” data-termid=”58115″>dysplazję panewki stawowej, podwichnięcie, aż do całkowitego zwichnięcia. Choroba ta zazwyczaj występuje u dzieci bez innych współistniejących schorzeń. Dokładna identyfikacja konkretnego zaburzenia stawu biodrowego jest kluczowa dla określenia odpowiedniego sposobu postępowania i prognozy.¹

Znaczenie wczesnej diagnostyki

Wczesne rozpoznanie i leczenie są niezwykle istotne, aby zapobiec długotrwałym powikłaniom, takim jak przetrwałe zwichnięcie i wczesna choroba zwyrodnieniowa stawu biodrowego.¹ Przy wczesnym rozpoznaniu i leczeniu dzieci rzadziej wymagają interwencji chirurgicznej i mają większe szanse na prawidłowy rozwój.¹ Badania wykazały, że wczesne wykrycie i leczenie wykorzystuje maksymalny potencjał wzrostowy biodra niemowlęcia, co zwiększa prawdopodobieństwo skutecznego leczenia, zmniejsza liczbę inwazyjnych procedur i ogranicza powikłania.¹

Wykrywanie DDH powinno odbywać się jak najwcześniej, idealnie w okresie noworodkowym, kiedy możliwe jest zastosowanie najprostszych metod leczenia. Celem jest rozpoznanie i leczenie w pierwszych miesiącach życia, zwłaszcza w ciągu pierwszych sześciu miesięcy, kiedy leczenie jest bezpieczniejsze i bardziej skuteczne niż po rozpoczęciu chodzenia przez dziecko.¹

Badanie kliniczne w diagnostyce DDH

Diagnostyka wrodzonej dysplazji stawu biodrowego obejmuje badanie kliniczne (przesiewowe) oraz badania obrazowe. Badanie kliniczne jest generalnie wykonywane u noworodków i dzieci z czynnikami ryzyka zaburzeń stawu biodrowego.¹ Badanie kliniczne pozostaje najważniejszym elementem oceny i podstawowym narzędziem przesiewowym.¹

Test Ortolaniego i Barlow

Główne techniki badania klinicznego wrodzonej dysplazji stawu biodrowego obejmują test Ortolaniego, test Barlowa oraz obserwację specyficznych objawów fizykalnych.¹ Test Ortolaniego, w którym podwichnięta lub zwichnięta głowa kości udowej jest delikatnie nastawiana do panewki przez odwiedzenie biodra przez badającego, jest najważniejszym testem klinicznym wykrywającym dysplazję u noworodka.¹

Testy Ortolaniego i Barlowa powinny być częścią rutynowego badania przesiewowego, a każde biodro powinno być badane oddzielnie pod kątem niestabilności.¹ Oba testy są zalecane u niemowląt w wieku do 6 miesięcy, chociaż ich czułość zmniejsza się po 3 miesiącach życia.¹ Badania prowokacyjne wykonywane podczas tych testów wskazują na niestabilność biodra, gdy głowa kości udowej przesuwa się do wewnątrz (objaw Ortolaniego) lub na zewnątrz (objaw Barlowa) z łagodnym przesunięciem lub kliknięciem.¹

Inne objawy kliniczne

U noworodków ze zwichnięciem biodra może występować wyczuwalna niestabilność biodra, nierówna długość kończyn oraz asymetryczne fałdy skórne uda.¹ Natomiast u starszych dzieci częściej występują zaburzenia chodu i ograniczone odwiedzenie biodra.¹

Po 2-3 miesiącach życia tkanki miękkie wokół biodra zaczynają się napinać, więc testy Barlowa i Ortolaniego stają się mniej wiarygodne.¹ U starszych niemowląt i dzieci objawami sugerującymi DDH są: ograniczone lub asymetryczne odwiedzenie biodra, asymetryczne fałdy skórne uda/pachwiny oraz różnica długości kończyn dolnych.¹²

Gdy dziecko z DDH zaczyna chodzić, zwichnięte biodro będzie powodować utykanie. Jeśli oba biodra są zwichnięte, dziecko będzie kołysać się na boki podczas chodzenia.¹ U dzieci starszych objawem DDH może być kaczkowaty chód, objaw Trendelenburga, zmniejszone odwiedzenie biodra i ból biodra, a w niektórych przypadkach rozdarcia obrąbka stawowego biodra.¹

Częstość i efektywność badań klinicznych

Zgodnie z zaleceniami, badanie bioder powinno być wykonywane u każdego noworodka w ciągu 72 godzin od urodzenia, a następnie ponownie w wieku 6-8 tygodni.¹ AAP, AAOS, POSNA i Canadian Task Force zalecają badanie przesiewowe noworodków w kierunku wrodzonej dysplazji stawu biodrowego.¹

Wielokrotne, starannie wykonane badania kliniczne bioder od okresu noworodkowego do wieku, w którym dziecko zaczyna chodzić, pozostają najlepszą metodą wczesnego wykrywania DDH.¹² Zasada wielokrotnych badań do wieku, w którym dziecko zaczyna chodzić, jest ważniejsza niż dokładny czas badań.¹

Należy jednak zwrócić uwagę, że programy przesiewowe polegające głównie na technikach badania fizykalnego dla wczesnego wykrywania i leczenia wrodzonych nieprawidłowości biodra nie były tak konsekwentnie skuteczne, jak oczekiwano.¹ Ponadto najnowsze dowody sugerują, że kliniczne testy przesiewowe nie są wystarczająco wiarygodne do diagnozy rozwojowej dysplazji stawu biodrowego.¹

Diagnostyka obrazowa DDH

Nieprawidłowe wyniki badania klinicznego powinny być dalej oceniane za pomocą badania RTG lub USG, w zależności od wieku pacjenta.¹ Badania obrazowe stały się kluczowym elementem diagnostyki DDH, szczególnie w przypadkach niejasnych klinicznie lub przy obecności czynników ryzyka.

Ultrasonografia w diagnostyce DDH

USG jest metodą z wyboru u niemowląt od urodzenia do 4-6 miesiąca życia.¹ Amerykański Instytut Ultrasonografii w Medycynie i Amerykańskie Kolegium Radiologii zalecają USG stawu biodrowego do wizualizacji dysplazji panewki, zwichnięcia biodra, anatomii głowy kości udowej, więzadła obłego i torebki stawowej.¹

USG jest szczególnie wartościowa ze względu na możliwość szczegółowej statycznej i dynamicznej wizualizacji stawu biodrowego przed pojawieniem się jądra kostnienia głowy kości udowej.¹ USG pozwala ocenić morfologię głowy kości udowej i panewki stawowej.¹

Istnieją dwie główne metody oceny ultrasonograficznej:

Metoda Grafa – ocena oparta na pomiarze kątów, przede wszystkim kąta alfa, który określa nachylenie sklepienia kostnego panewki, oraz kąta beta, który obrazuje składową chrzęstną panewki. Kąt alfa większy niż 60° jest uważany za prawidłowy, podczas gdy kąt beta mniejszy niż 55° również świadczy o prawidłowym rozwoju.¹²
Badanie dynamiczne – ocena stabilności stawu biodrowego podczas wykonywania ruchów, promowane przez metodologię Harcke.¹

Kąt alfa, który jest miarą kostnego sklepienia panewki, głównie determinuje typ biodra według Grafa:¹

Biodra typu I – kąt alfa powyżej 60 stopni – prawidłowe
Biodra typu IIa (u dzieci poniżej 3 miesięcy) – kąt alfa 50-59 stopni – niedojrzałe biodro
Biodra typu IIb (u dzieci powyżej 3 miesięcy) – kąt alfa 50-59 stopni – dysplazja
Typ III i IV – poważniejsze formy dysplazji z podwichnięciem lub zwichnięciem¹

Wskazania do badania USG

AAP zaleca badanie USG w 6. tygodniu życia u pacjentów, którzy są uważani za obarczonych wysokim ryzykiem (wywiad rodzinny lub położenie miednicowe) pomimo prawidłowego badania.¹ Według zaleceń amerykańskich, niemowlęta można rozważyć do badania USG w wieku od 6 tygodni do 6 miesięcy, jeśli uznano je za obarczone wysokim ryzykiem dysplazji stawu biodrowego, pomimo prawidłowych wyników badania fizykalnego.¹

Badanie USG staje się metodą diagnostyczną z wyboru po 4-6 miesiącu życia, kiedy głowa kości udowej zaczyna kostnieć.¹ Niska wartość progowa dla USG jest wskazana, aby zapewnić wczesną diagnozę i leczenie.¹²

Wykazano, że wyniki badania USG i badania klinicznego mogą się różnić – badanie USG jest bardziej czułe w wykrywaniu wszystkich dzieci z DDH.¹ Jednak należy zachować ostrożność przy stosowaniu USG jako wstępnego testu przesiewowego ze względu na dużą liczbę wyników fałszywie dodatnich.¹

Diagnostyka RTG w DDH

Badanie RTG staje się najbardziej użyteczne w wieku od 4 do 6 miesięcy, kiedy tworzą się wtórne ośrodki kostnienia głowy kości udowej, co występuje wcześniej u niemowląt płci żeńskiej.¹ Po 6 miesiącach życia, zdjęcie RTG miednicy w projekcji AP jest najlepszym badaniem do oceny dysplazji stawu biodrowego i dostarcza bardziej wiarygodnych obrazów niż USG.¹²

Standardowe projekcje RTG dla DDH obejmują projekcję przednio-tylną (AP) miednicy, z biodrami w neutralnej pozycji, oraz projekcję fałszywego profilu, w której pacjent stoi pod kątem 65° od płyty rentgenowskiej.¹

Ocena radiologiczna DDH

Na zdjęciu RTG w projekcji AP wyznacza się linię poziomą (linia Hilgenreinera) łączącą chrząstki trójpromieniowe. Następnie rysuje się linie prostopadłe do linii Hilgenreinera poprzez górno-boczną krawędź panewki (linie Perkina), dzieląc biodro na cztery kwadranty. Przyśrodkowa część proksymalna szyjki powinna znajdować się w dolnym przyśrodkowym kwadrancie, podobnie jak jądro kostnienia głowy kości udowej, jeśli jest obecne (zazwyczaj obserwowane u pacjentów w wieku 4-7 miesięcy).¹

Dodatkowo można zmierzyć wskaźniki panewkowe. Odnoszą się one do kąta między linią Hilgenreinera a linią poprowadzoną od chrząstki trójpromieniowej do bocznej krawędzi panewki. Zazwyczaj kąt zmniejsza się z wiekiem i powinien wynosić mniej niż 20° do czasu, gdy dziecko osiągnie wiek 2 lat.¹

Oceniana jest również linia Shentona. Linia ta powinna tworzyć gładki łuk, który nie jest przerwany. Przerwanie linii Shentona wskazuje na obecność pewnego stopnia podwichnięcia biodra.¹²

Innym ważnym pomiarem jest kąt CE Wiberga (centrum-krawędź), który jest tworzony przez linię Perkina i linię od środka głowy kości udowej do bocznej panewki.¹ Prawidłowy kąt CE wynosi 25° lub więcej.¹

Inne metody obrazowania

Tomografia komputerowa (TK) może być pomocna w określeniu antetorsji szyjki kości udowej oraz w określeniu zakresu pokrycia tylnej części panewki. Obrazowanie metodą rezonansu magnetycznego (MRI) może być korzystne w identyfikacji anatomii kostnej i tkanek miękkich.¹

Artrografia jest badaniem dynamicznym, wykonywanym przez wstrzyknięcie środka kontrastowego do stawu biodrowego, a następnie przeprowadzenie badania fluoroskopowego, zwykle w znieczuleniu. Może być pomocna w określeniu profilu chrzęstnego i dynamicznej stabilności biodra.¹

Diagnostyka DDH w różnych grupach wiekowych

Noworodki i niemowlęta do 6 miesiąca życia

U dzieci poniżej 6 miesięcy życia, po badaniu klinicznym, USG jest preferowaną techniką diagnostyczną. Chociaż badanie przesiewowe USG wszystkich niemowląt nie jest zalecane, niemowlęta z identyfikowanymi czynnikami ryzyka lub wątpliwymi wynikami badania powinny być rutynowo badane.¹

Badanie USG umożliwia ocenę stawu biodrowego podczas ruchu, co stanowi znaczącą przewagę nad konwencjonalnym RTG. Jest to dokładne i bezpieczne narzędzie diagnostyczne, ponieważ nie wykorzystuje promieniowania.¹

Łagodne przypadki DDH mogą być trudne do zdiagnozowania i mogą nie zacząć powodować problemów, dopóki dziecko nie stanie się młodym dorosłym. Jeśli zespół medyczny podejrzewa dysplazję stawu biodrowego, może zasugerować badania obrazowe, takie jak RTG lub rezonans magnetyczny (MRI).¹²

Niemowlęta i dzieci powyżej 6 miesiąca życia

U dzieci w wieku 6 miesięcy lub starszych stosuje się ocenę radiograficzną. Na radiogramie AP można narysować i zmierzyć linie, które lokalizują głowę kości udowej w stosunku do panewki – linie Hilgenreinera, Perkinsa i wskaźnik panewkowy.¹

Gdy u dziecka zostanie zdiagnozowana DDH, zalecane jest szybkie skierowanie do ortopedy dziecięcego.¹ Powodzenie leczenia zależy od wieku dziecka i skuteczności repozycji stawu.¹

Nastolatki i młodzi dorośli

Czasami DDH nie jest diagnozowana aż do okresu dojrzewania. Zwykle dzieje się tak u dziewcząt, które zaczynają odczuwać ból biodra podczas aktywności fizycznej, na przykład podczas uprawiania sportu.¹

Dysplazja stawu biodrowego jest zwykle diagnozowana przez doświadczonego lekarza przy użyciu kombinacji objawów, badania biodra i wyników RTG. RTG może identyfikować dysplazję stawu biodrowego przez płytką panewkę (acetabulum) oraz przez przemieszczenie głowy kości udowej (femoral head) z panewki.¹

MRI może również być pomocny w diagnozowaniu dysplazji stawu biodrowego i dostarczaniu lekarzowi informacji o uszkodzeniach chrząstki i obrąbka.¹

Wpływ diagnostyki na leczenie i rokowanie

Cel leczenia DDH zależy od wieku pacjenta w momencie diagnozy i wymaga koncentrycznej redukcji głowy kości udowej do panewki.¹ Pacjenci powinni być idealnie diagnozowani i leczeni w okresie niemowlęcym.¹

Rozpoczęcie leczenia jest zalecane po trzech tygodniach, jeśli istnieją dowody na podwichnięcie w badaniu fizykalnym i ultrasonograficznym.¹ Szelki Pavlika są najszerzej stosowanym podejściem w leczeniu pediatrycznej DDH od urodzenia do sześciu miesięcy, zgodnie z różnymi publikacjami, i pozostają standardowym leczeniem.¹

Dla dzieci, u których leczenie przy użyciu szelek Pavlika nie powiodło się, zalecana jest zamknięta lub otwarta redukcja.¹ Pooperacyjna obserwacja radiologiczna jest obowiązkowa w przypadku resztkowej dysplazji panewki (RD), która jest często spotykana jako powikłanie leczenia DDH.¹

Im wcześniej rozpocznie się leczenie, tym większa szansa na pomyślny wynik, co oznacza biodro, które wydaje się anatomicznie prawidłowe zarówno podczas badania fizykalnego, jak i na RTG.¹ Dzieci leczone z powodu dysplazji stawu biodrowego są badane w regularnych odstępach czasu, aż do osiągnięcia dojrzałości szkieletowej (gdy wzrost zostanie zakończony), aby zapewnić kontynuację prawidłowego rozwoju.¹

Kontrowersje i wyzwania w diagnostyce DDH

Nie istnieje standardowa definicja i nie ma konsensusu co do tego, które wyniki badania klinicznego i obrazowania wymagają leczenia, aby umożliwić prawidłowy rozwój stawu biodrowego.¹ Obecne praktyki badań przesiewowych DDH są krytykowane za nieprzestrzeganie ogólnych zasad badań przesiewowych zdrowotnych, a w australijskich wytycznych dotyczących badań przesiewowych stawu biodrowego u noworodków występuje zmienność.¹

U.S. Preventive Services Task Force (USPSTF) niedawno stwierdziła, że dowody są niewystarczające, aby zalecić rutynowe badania przesiewowe w kierunku DDH u niemowląt jako środek zapobiegania niepożądanym skutkom. Dowody pokazują, że badania przesiewowe prowadzą do wcześniejszej identyfikacji DDH; jednakże USPSTF doszedł do wniosku, że 60-80% bioder noworodków zidentyfikowanych przez badanie fizykalnie i ponad 90% zidentyfikowanych przez USG jako nieprawidłowe lub podejrzane o DDH ulega samoistnej poprawie i nie wymaga interwencji.¹

Stosowanie USG w ocenie DDH podlega ciągłej debacie.¹ Zwiększone selektywne badanie przesiewowe USG dla niemowląt z czynnikami ryzyka DDH zostało powiązane ze wzrostem późno diagnozowanej DDH u dzieci południowoaustralijskich bez tradycyjnych czynników ryzyka.¹

Diagnostyka DDH pozostaje wyzwaniem, a wiele przypadków nadal jest diagnozowanych późno.¹ Nadal brakuje konsensusu wśród świadczeniodawców opieki zdrowotnej co do metod diagnostycznych pod względem interpretacji, dokładności i odpowiedniego czasu.¹ Praktyka kliniczna wydaje się szeroko różnić między świadczeniodawcami opieki zdrowotnej w różnych częściach świata.¹

Podsumowanie diagnostyki DDH

Diagnostyka DDH musi zaczynać się w bardzo wczesnym wieku poprzez powtarzane badania z wykorzystaniem konkretnych testów klinicznych, szukając głównie oznak znacznej niestabilności. Badanie USG jest badaniem z wyboru w badaniach przesiewowych i wczesnej diagnostyce, a metoda Grafa wydaje się być najbardziej wiarygodną metodą.¹

Zdjęcia RTG nie są wiarygodne we wczesnej diagnostyce, zwłaszcza w pierwszych czterech miesiącach życia, i mogą prowadzić do nadrozpoznawania, szczególnie gdy wskaźnik panewkowy jest używany jako jedyne narzędzie pomiarowe.¹

Wśród zaleceń dotyczących postępowania diagnostycznego można wymienić:

Wszystkie noworodki muszą przejść badanie kliniczne bioder przez neonatologa lub pediatrę przy urodzeniu; badanie musi być odpowiednio udokumentowane.¹
Badanie kliniczne bioder musi być powtarzane podczas ocen zdrowotnych w pierwszych 6 miesiącach życia przez pediatrę rodzinnego i odpowiednio udokumentowane.¹
Wszystkie noworodki, które prezentują objaw kliknięcia (clunk sign) podczas badania klinicznego, muszą przejść badanie USG bioder przed wypisaniem z punktu urodzenia lub, w każdym razie, w ciągu pierwszego tygodnia życia; badanie musi być odpowiednio udokumentowane.¹

W podejściu holistycznym do oceny DDH uznaje się, że kombinacja oceny czynników ryzyka, badania klinicznego i badań obrazowych może pozwolić na wczesne wykrycie DDH.¹ Wyniki badania klinicznego powinny być udokumentowane i przekazane szczegółowo, opisując biodro jako zwichnięte, zwichliwe, podwichlnięte lub stabilne oraz dokumentując zakres odwiedzenia.¹

Wczesne rozpoznanie i leczenie DDH wykorzystuje maksymalny potencjał wzrostowy niemowlęcego biodra, co zwiększa prawdopodobieństwo sukcesu leczenia, zmniejsza liczbę inwazyjnych procedur i powikłań. Późne rozpoznanie może wystąpić w wyniku niepowodzeń badań przesiewowych, niewłaściwego owijania w pieluchy lub progresji patologii; wysiłki zmierzające do zminimalizowania późnych przypadków mogą być utrudnione przez brak konsensusu w wytycznych dotyczących badań przesiewowych.¹

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Materiały źródłowe

#1 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK563157/
Developmental dysplasia of the hip encompasses several hip abnormalities, including instability, acetabular dysplasia, subluxation, and dislocation. It typically occurs in children with no other comorbid or underlying conditions. […] Accurate identification of the specific hip disorder is crucial for determining the appropriate management and expected prognosis. […] Diagnosing developmental dysplasia of the hip involves clinical screening and imaging studies. Clinical examination, including the Ortolani test, the Barlow maneuver, and observation of specific physical signs, aids in early detection. […] Early diagnosis and management are paramount to prevent long-term complications such as persistent dislocation and early hip osteoarthritis. […] Diagnosing developmental dysplasia of the hip consists of clinical screening and imaging studies. Clinical screening is generally done in newborns and children with risk factors for hip abnormalities. […] Abnormal findings on clinical screening should be further evaluated with x-ray or ultrasound imaging, depending on the patient’s age.
#1 Developmental dysplasia of the hip
https://www.nhs.uk/conditions/developmental-dysplasia-of-the-hip/
With early diagnosis and treatment, children are less likely to need surgery, and more likely to develop normally. […] Your baby’s hips will be checked as part of the newborn physical screening examination within 72 hours of being born, and again at 6 to 8 weeks of age. […] If a doctor, midwife or nurse thinks your baby’s hip feels unstable, they should have an ultrasound scan of their hip between 4 and 6 weeks old. […] Babies should also have an ultrasound scan of their hip between 4 and 6 weeks old if there have been childhood hip problems in your family. […] Your child will be referred to an orthopaedic specialist in hospital for an ultrasound scan if your doctor thinks there’s a problem with their hip.
#1 Improving early detection of developmental dysplasia of the hip through general practitioner assessment and surveillance
https://www1.racgp.org.au/ajgp/2018/september/improving-early-detection-of-developmental-dysplas
The principle of multiple assessments until walking age is more important than the exact timing of the examinations. […] The GP can order medical imaging when indicated and refer promptly for treatment, minimising communication breakdowns and treatment delays that occur with screening programs generally. […] Early DDH detection and treatment harnesses the maximal growth potential of the infant hip, with increased likelihood of treatment success, fewer invasive procedures and fewer complications. […] Late diagnosis may occur as a result of screening failures, inappropriate swaddling or progression of pathology; efforts to minimise late cases may be hampered by lack of consensus in screening guidelines.
#1 Developmental Dysplasia of the Hip | AAFP
https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html
No first-line method exists for diagnosing DDH during the newborn period. However, a careful physical examination is recommended as a screening tool, particularly for high-risk infants. […] The U.S. Preventive Services Task Force (USPSTF) recently concluded that evidence is insufficient to recommend routine screening for DDH in infants as a means to prevent adverse outcomes. Evidence shows that screening leads to earlier identification of DDH; however, the USPSTF concluded that 60 to 80 percent of the newborn hips identified by physical examination and more than 90 percent identified by ultrasonography as abnormal or as suspicious for DDH resolve spontaneously and require no intervention. […] In general, the goal of the family physician in examining for DDH should be early diagnosis and referral. This is because treatment earlier in life, especially within the first six months, is safer and more successful than treatment after the child is walking.
#1 Improving early detection of developmental dysplasia of the hip through general practitioner assessment and surveillance
https://www1.racgp.org.au/ajgp/2018/september/improving-early-detection-of-developmental-dysplas
As well as maximising the chance of successful treatment with an abduction splint or Pavlik harness, early DDH detection lowers the age at diagnosis for children who develop progressive signs outside the newborn period. […] A holistic approach to DDH assessment acknowledges that a combination of risk factor assessment, clinical examination and imaging studies may permit early detection of DDH. […] Clinical examination remains the most important component of assessment. […] The GP may be the first practitioner to make an adequate assessment, even if they are not considered the usual clinician responsible for newborn hip examination. […] Clinical examination findings should be documented and communicated specifically, describing the hip as dislocated, dislocatable, subluxatable or stable and documenting the abduction range.
#1 Evaluation and Treatment of Developmental Hip Dysplasia in the Newborn and Infant | Obgyn Key
https://obgynkey.com/evaluation-and-treatment-of-developmental-hip-dysplasia-in-the-newborn-and-infant/
Developmental dysplasia of the hip (DDH) encompasses a spectrum of physical and imaging findings. The childs hip will not develop normally if it remains unstable and anatomically abnormal by walking age. Therefore, careful physical examination of all infants to diagnosis and treat significant DDH is critical to provide the best possible functional outcome. Regardless of the practice setting, all health professionals who care for newborns and infants should be trained to evaluate the infant hip for instability and to provide appropriate and early conservative treatment or referral. […] The Ortolani maneuver, in which a subluxated or dislocated femoral head is gently reduced into the acetabulum with hip abduction by the examiner, is the most important clinical test for detecting dysplasia in the newborn.
#1 Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management
https://pmc.ncbi.nlm.nih.gov/articles/PMC10488138/
Clinical Examination […] In newborns: All neonates, in particular those displaying the risk factors for DDH, should go through a thorough clinical assessment. […] The Ortolani test and the Barlow maneuver should both be included in routine screening, and each hip should be checked separately for instability. […] Ultrasonography is the investigation of choice for DDH in the first six months of life. […] Radiography: The radiographic examination is a more useful method of evaluating hip development. […] The angle formed at the intersection of Hilgenreiners line and the line drawn along the surface of the acetabulum is called the acetabular index. […] However, it is important to consider the variations in normal indices among the various research papers. […] The Wiberg centre-edge angle (CEA) is formed by the Perkin’s line and the line from the centre of the femoral head to the lateral acetabulum.
#1 Developmental dysplasia of the hip – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/developmental-dysplasia-of-the-hip/
Individuals with clinical DDH can be referred to orthopedics before imaging is performed. […] The following provocative tests are recommended in infants 6 months of age; sensitivity decreases after 3 months of age. Positive findings indicate hip instability. […] Bilateral ultrasound hip (static and dynamic) […] Bilateral hip x-ray (AP and/or frog-leg) […] Refer to orthopedics for any feature highly suggestive of DDH or if there are abnormal findings on imaging.
#1 Developmental Dysplasia of the Hip: Modern Approaches to Diagnosis and Treatment | Minnesota Chapter of the American Academy of Pediatrics
https://wp.mnaap.org/developmental-dysplasia-of-the-hip-modern-approaches-to-diagnosis-and-treatment/
Making the diagnosis in the newborn depends primarily on the hip exam, which should be performed routinely at each visit in infants. […] The sensation of the femoral head moving in (Ortolani sign) or out (Barlow sign) of the femoral head with a soft shifting or clunk should be the trigger for treatment or further imaging. […] Limited hip abduction on one or both sides is another physical exam finding which should prompt ultrasound. […] A low threshold for ultrasound is prudent to ensure early diagnosis and treatment, and it is helpful for providers to know that this is an ultrasound study that requires significant skill. […] After 6 months of age, an AP pelvis x-ray is the best study to evaluate for hip dysplasia and provides more reliable images than ultrasound. […] For clinically unstable or dislocated hips, the optimal initiation of treatment with the Pavlik harness is as early as possible which is successful in over 85 percent of the patients.
#1 Developmental Dysplasia of the Hip | AAFP
https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html
Developmental dysplasia of the hip refers to a continuum of abnormalities in the immature hip that can range from subtle dysplasia to dislocation. The identification of risk factors, including breech presentation and family history, should heighten a physicians suspicion of developmental dysplasia of the hip. Diagnosis is made by physical examination. Palpable hip instability, unequal leg lengths, and asymmetric thigh skinfolds may be present in newborns with a hip dislocation, whereas gait abnormalities and limited hip abduction are more common in older children. […] The term developmental dysplasia of the hip (DDH) has replaced congenital dislocation of the hip because it more accurately reflects the full spectrum of abnormalities that affect the immature hip. DDH can predispose a child to premature degenerative changes and painful arthritis. Careful physical examination is recommended as a screening tool; early diagnosis helps improve treatment results and decrease the risk of complications.
#1 Congenital Hip Dysplasia | PM&R KnowledgeNow
https://now.aapmr.org/congenital-hip-dysplasia/
The Barlow and Ortolani tests are now frequently done in conjunction and with the assistance of ultrasound guidance. Ultrasound is utilized to ensure that bilateral dislocations are not missed during the execution of these tests as bilateral dislocations may feel symmetric dislocation and reduction. After 2 to 3 months of age, the soft tissues around the hip tighten, so the Barlow and Ortolani tests become less reliable. […] Clinical practice guidelines on early detection and management have been published by the American Academy of Pediatrics in 2016. This report includes a clinical algorithm for screening and recommended actions based on age and presence of risk factors. […] If conservative treatment with reduction and splinting fails, surgical management is recommended to prevent worsening progression of disease and address current complications. Open reduction has been a selected surgical option occurring more frequently in those presenting with progressed disease or delayed diagnosis of dysplasia.
#1 Clinical Examination Findings Can Accurately Diagnose Developmental Dysplasia of The HipâA Large, Single-Center Cohort
https://www.mdpi.com/2227-9067/10/2/304
Clinical Examination Findings Can Accurately Diagnose Developmental Dysplasia of The HipâA Large, Single-Center Cohort […] Background: Physical examination findings such as limited hip abduction (LHA), asymmetric skin creases (ASC), and a popping sensation in the hip facilitate the diagnosis of developmental dysplasia of the hip (DDH). […] Screening for DDH with physical examination is the first step towards recognizing the condition. Limited hip abduction (LHA), asymmetric skin creases (ASCs), and a popping sensation in the hip (Barlow and Ortolani tests) can help during diagnosis. […] The current gold standard for a diagnosis of DDH is a hip ultrasound performed according to the method described by Graf. […] The aim of this study was to determine the correlation of easily recognizable physical examination findings such as LHA, thigh/groin ACSs and Ortolani and Barlow tests with ultrasound findings for the diagnosis of DDH in a large single-center cohort.
#1 Developmental Dysplasia of the Hip (DDH) | Conditions | UCSF Benioff Children’s Hospitals
https://www.ucsfbenioffchildrens.org/conditions/developmental-dysplasia-of-the-hip
A physical exam may be sufficient to diagnose developmental dysplasia of the hip. A doctor can detect hip instability when the ball is able to come out of the socket by feeling for a „clunk” when the child moves their hips. With a dislocated hip, the child has reduced range of motion and the affected lower limb appears shorter than the other side. […] Once a child with DDH begins to walk, the dislocated hip will cause them to limp. If both hips are dislocated, the child will waddle from side to side. […] Sometimes DDH isn’t diagnosed until the teenage years. This typically happens in girls who begin to experience hip pain during physical activity, such as playing sports. […] If your child’s doctor suspects developmental dysplasia of the hip, the next step is a test to confirm the diagnosis.
#1 Hip dysplasia – Wikipedia
https://en.wikipedia.org/wiki/Hip_dysplasia
All newborns should be screened for congenital hip dysplasia. The screening examination techniques to detect hip dysplasia in newborns include observation for asymmetry of legs and asymmetrical gluteal folds, limb length discrepancy (evaluated by placing the child in a supine position with the hips and knees flexed [unequal knee heights might be noticed the Galeazzi sign]), and restricted hip abduction. […] Two maneuvers commonly employed for diagnosis in neonatal exams are the Ortolani maneuver and the Barlow maneuver. […] Overall, the latest evidence suggests that clinical screening tests are not sufficiently reliable for diagnosing developmental dysplasia of the hip. […] Physical examination of newborns followed by appropriate use of hip ultrasound is widely accepted. […] Hip dysplasia can develop in older age. Adolescents and adults with hip dysplasia may present with a waddling gait, Trendelenburg’s sign, decreased hip abduction, hip pain and in some cases hip labral tears. X-rays are used to confirm a diagnosis of hip dysplasia. CT scans and MRI scans are occasionally used too.
#1 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK563157/
The AAP, the American Academy of Orthopaedic Surgeons (AAOS), POSNA, and the Canadian Task Force recommend screening newborns for developmental dysplasia of the hip. […] Clinical examination is crucial in identifying developmental dysplasia of the hip, especially in babies with risk factors. […] The American Institute of Ultrasound in Medicine and the American College of Radiology recommend hip US to visualize acetabular dysplasia, hip dislocation, femoral head anatomy, ligament teres, and the hip capsule. […] If x-ray studies are used to evaluate developmental dysplasia of the hip, the following findings can help identify hip abnormalities. […] Management of developmental hip dysplasia consists of conservative treatments (eg, activity modification, physical therapy, and splinting) or surgical interventions. […] Treatment modalities like abduction splinting, closed reduction, and open reduction are available to establish optimal contact between the femoral head and the acetabulum.
#1 Improving early detection of developmental dysplasia of the hip through general practitioner assessment and surveillance
https://www1.racgp.org.au/ajgp/2018/september/improving-early-detection-of-developmental-dysplas
Cases of late diagnosed developmental dysplasia of the hip (DDH) have increased in Australia in recent years despite an ongoing clinical screening program and increasing use of selective ultrasonography screening. […] The aim of this paper is to discuss an evidence-based approach that involves prevention and early detection of DDH using assessment and surveillance that is suitable for general practitioners (GPs) who see young children in their practices. […] Repeated, carefully performed clinical examinations of the paediatric hip from newborn to walking age remain the best method for early detection of DDH. […] GPs are ideally placed to conduct regular assessments to maximise detection of dislocated hips in early infancy and lower the age at detection for children who develop progressive signs of DDH outside the newborn period.
#1 Screening for Developmental Dysplasia of the Hip | AAFP
https://www.aafp.org/pubs/afp/issues/1999/0701/p177.html
Screening programs relying primarily on physical examination techniques for the early detection and treatment of congenital hip abnormalities have not been as consistently successful as expected. […] Although ultrasound examination may not provide advantages over careful repeated physician examination for universal screening, a growing body of evidence indicates that ultrasound surveillance of mild abnormalities can reduce the need for bracing without worsening outcomes. Radiographic documentation of hip normality after the femoral nucleus of ossification has appeared (at three to five month of age) is still appropriate to rule out hip dysplasia. […] The term late diagnosis, which appears frequently in the literature on developmental dysplasia of the hip, implies a failure to screen or a failure to diagnose on early screening. The time frame referred to is generally not explicit. For some investigators, late diagnosis denotes any time beyond the newborn physical examination. The general consensus is that diagnosis after three months of age is late.
#1
https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh
Developmental Dysplasia of the Hip is a disorder of abnormal development resulting in dysplasia, subluxation, and possible dislocation of the hip secondary to capsular laxity and mechanical instability. […] Diagnosis can be confirmed with ultrasonography in the first 4 months and then with radiographs after femoral head ossification occurs (~ 4-6 months). […] Imaging indications become primary imaging modality at 4-6 mo after the femoral head begins to ossify. […] Ultrasound is the primary imaging modality from birth to 4 months. […] AAP recommends an US study at 6 weeks in patients who are considered high risk (family history or breech presentation) despite normal exam. […] Radiographic findings include failure of appearance or growth of the ossific nucleus 1 year after the reduction.
#1 Evaluation and Treatment of Developmental Hip Dysplasia in the Newborn and Infant | Obgyn Key
https://obgynkey.com/evaluation-and-treatment-of-developmental-hip-dysplasia-in-the-newborn-and-infant/
Plain radiography becomes most useful by 4 to 6 months of age, when the femoral heads secondary center of ossification forms, a finding that occurs earlier in female infants. A single anteroposterior (AP) view of the entire pelvis is obtained, with positioning of the pelvis without rotation. Acetabular dysplasia, subluxation, and dislocation are easily detected on the radiographs if taken after the femoral heads ossific nucleus has appeared. […] The American Institute of Ultrasound in Medicine (AIUM) and the American College of Radiology (ACR) have published a joint guideline for the standardized performance of the infantile hip ultrasound. Ultrasonography can provide detailed static and dynamic imaging of the hip before femoral head ossification.
#1 Developmental Dysplasia Of The Hip – OrthoPaedia
https://www.orthopaedia.com/developmental-dysplasia-of-the-hip/
Developmental dysplasia of the hip (DDH) is a condition characterized by varying degrees of hip instability in a developing hip joint. DDH is often idiopathic but hip dislocations may also be caused by an underlying congenital disorder. In the first few months of life, infants are screened using the Ortolani and Barlow tests. The Ortolani test reduces a dislocated hip, whereas the Barlow test attempts to dislocate an unstable hip. Both tests are performed on a supine infant. For infants younger than 6 months, ultrasonography is the diagnostic imaging modality of choice. Ultrasound evaluates the morphology of the femoral head and acetabulum. In children older than 6 months, the femoral head begins to ossify, and thus plain radiographs can be used to evaluate for DDH. DDH is a common abnormality of skeletal development. Some form of DDH occur in about 1.3 out of 1000 births. The goal of treatment is to reduce and maintain the femoral head in the acetabulum as early as possible to allow the hip joint to develop normally. The standard of care for DDH diagnosed before 6 months of age is treatment in a dynamic hip brace (eg, Pavlik harness) that maintains the hips in a flexed and abducted position. Long-term follow up is essential as residual dysplasia may occur as often as 10-20% even after successful treatment of DDH. […] The exact causes of DDH are unknown, but it is likely a combination of several environmental and genetic factors. Known risk factors include inadequate intra-uterine space, female sex, family history, and breech presentation.
#1 Developmental Dysplasia of the Hip (DDH) Workup: Ultrasonography, Plain Radiography, CT and MRI
https://emedicine.medscape.com/article/1248135-workup
Ultrasonography (US) has been of substantial benefit in the assessment and treatment of children with developmental dysplasia of the hip (DDH). The benefit of screening all children with US is controversial. Even with US screening, children with hip dysplasia can be diagnosed late, and one concern with routine US evaluation of newborns is overdiagnosis of hip dysplasia (ie, increased false-positive results). […] However, most authors agree that US is an excellent tool for assessing children with suspected hip instability and a useful aid in the treatment of children with DDH, especially in monitoring reduction by closed methods. […] An ultrasound evaluation is typically performed either by assessing the alpha and beta angles or by performing a dynamic evaluation. An alpha angle outlines the slope of the superior aspect of the bony acetabulum, with an angle greater than 60 considered normal. The beta angle, which is considered normal if less than 55, depicts the cartilaginous component of the acetabulum. Many institutions now use a dynamic form of US, as heralded by Harcke.
#1 The Radiology Assistant : Developmental Dysplasia of the Hip
https://radiologyassistant.nl/pediatrics/hip/developmental-dysplasia-of-the-hip-ultrasound
Developmental dysplasia of the hip is a common musculoskeletal disorder in newborns. […] Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal problems in newborns. […] Treatment is easier and complications are less likely to occur when DDH is diagnosed early. […] The alpha-angle, which is a measurement of the bony roof of the acetabulum, mainly determines the hip type. […] At the age of 3 months the decision has to be made whether the hip is normal or not. […] Type I hips have an alpha angle of more than 60 degrees and are normal. […] If a child is less than 3 months old, then an alpha angle of 50-59 degrees is considered an immature hip. […] If a child is older than 3 months or 13 weeks, then an alpha angle of 50-59 degrees is considered a sign of dysplasia, i.e type IIb.
#1 The Radiology Assistant : Developmental Dysplasia of the Hip
https://radiologyassistant.nl/pediatrics/hip/developmental-dysplasia-of-the-hip-ultrasound
About 90 % of newborns with Graf type IIa hips do not develop DDH. […] A type D hip is much like a type IIC hip, but the main difference is a decentring hip with a displaced cartilage roof. […] In type III hips the femoral head dislocated. […] In Graf type IV there is a severe dislocation of the femoral head which obscures most of the bony roof.
#1 Developmental Dysplasia of the Hip: Navigating the Spectrum in Primary Care
https://www.clinicaladvisor.com/features/developmental-dysplasia-hip-navigating-spectrum-in-primary-care/
Early diagnosis of developmental dysplasia of the hip (DDH) in childhood presents challenges for the primary care provider. […] The advent of neonatal ultrasound imaging has made the diagnosis of hip instability much easier. […] What is needed, therefore, is a more rational approach to the use of ultrasound for imaging newborn hips to bring more balance to the problem of overdiagnosis. […] The American Academy of Pediatrics recommends that infants can be considered for ultrasound testing between 6 weeks to 6 months of age if they are determined to be at high risk for hip dysplasia despite having normal findings on physical examination. […] Ultimately, many of ultrasound tests ordered for clinically normal hips are the result of these misinterpreted physical findings. […] Developmental dysplasia of the hip is not one condition but rather a broad continuum of instability. Considering each stage of this continuum will help guide the evaluation and treatment of this condition.
#1 Recommendations for early diagnosis of Developmental Dysplasia of the Hip (DDH): working group intersociety consensus document | Italian Journal of Pediatrics | Full Text
https://ijponline.biomedcentral.com/articles/10.1186/s13052-020-00908-2
Clinical examination of the hips, at birth and in the first month of life, continues to play a fundamental role in the diagnosis of DDH, particularly in the severe forms of the disease. […] The introduction of the ultrasound technique for the study of childhood hip diseases is undoubtedly the most important novelty for the diagnosis of DDH in the past 30 years. […] Hip X-ray still plays a role in the diagnosis of DDH. However, the method is useful only from the 3rd 4th month of life of the child, when the skeletal structures reach a sufficient degree of mineralization and may be visualized by X-rays. […] Studies comparing the results of clinical and ultrasound examinations have shown that the latter is more sensitive to detect all children with DDH. […] The need for DDH screening, aimed at an early diagnosis is now widely shared.
#1 Developmental dysplasia of the hip – Symptoms, diagnosis and treatment | BMJ Best Practice
https://bestpractice.bmj.com/topics/en-gb/742?locale=zh_TW
Developmental dysplasia of the hip (DDH) represents a spectrum of conditions affecting the proximal femur and acetabulum, ranging from acetabular immaturity to hip subluxation and frank hip dislocation. […] The Barlow and Ortolani screening tests are recommended up to 6 months of age, although they begin to lose their sensitivity and usefulness around 3-6 months of age due to increased musculature. Thereafter, limited and/or asymmetric hip abduction suggests the diagnosis. […] Ultrasound may be used to confirm an abnormal hip examination, but should be used with caution as a preliminary screening test due to the high number of false positive results. […] Frank dislocations and persistently abnormal examinations should be referred to a paediatric orthopaedist. […] Key diagnostic factors include positive Ortolani test, positive Barlow test, and limited hip abduction. […] 1st investigations to order include ultrasound of hips and hip x-ray.
#1 Developmental Dysplasia of the Hip (DDH) Workup: Ultrasonography, Plain Radiography, CT and MRI
https://emedicine.medscape.com/article/1248135-workup
Standard radiographic views for DDH include a standing anteroposterior (AP) view of the pelvis, with the hips in neutral position, and a false profile view in which the patient is standing angled at 65 from the x-ray plate. The radiograph is then taken, profiling the anterior aspect of the acetabulum. If any evidence of hip subluxation is present, an abducted internal rotation view can help determine if the hip reduces and better determines the true neck-shaft angle of the proximal femur. […] Radiographic evaluation is typically carried out as follows. From an AP radiograph of the hips, a horizontal line (Hilgenreiner line) is drawn between each triradiate cartilage. Next, lines perpendicular to the Hilgenreiner line are drawn through the superolateral edge of the acetabulum (Perkin lines), dividing the hip into four quadrants. The proximal medial femur should be in the lower medial quadrant, or the ossific nucleus of the femoral head, if present (usually observed in patients aged 4-7 months), should be in the lower medial quadrant.
#1 Developmental Dysplasia of the Hip (DDH) Workup: Ultrasonography, Plain Radiography, CT and MRI
https://emedicine.medscape.com/article/1248135-workup
Additionally, the acetabular indices can be measured. These refer to the angle between the Hilgenreiner line and a line drawn from the triradiate cartilage to the lateral edge of the acetabulum. Typically, the angle decreases with age and should measure less than 20 by the time the child is aged 2 years. The Shenton line can also be evaluated. This line should create a smooth arc that is not disrupted. Disruption of the Shenton line indicates the presence of some degree of hip subluxation. […] Computed tomography (CT) can also be helpful in determining femoral anteversion and in determining the extent of posterior acetabular coverage. Magnetic resonance imaging (MRI) can be beneficial in identifying the underlying bony and soft-tissue anatomy. One study evaluated MRI findings in pediatric orthopedic patients who showed residual subluxation after reduction of DDH.
#1 Diagnosis – International Hip Dysplasia Institute
https://hipdysplasia.org/adults/diagnosis/
Hip Dysplasia is usually diagnosed by an experienced physician using the combination of symptoms, hip examination, and x-ray findings. […] An x-ray can identify hip dysplasia by the shallow socket (acetabulum), and by displacement of the ball (femoral head) from the socket. […] X-rays can determine the severity of dysplasia, which helps to establish the need for surgery. […] A common measurement for the depth of the socket is the center-edge angle (C-E angle). The normal C-E angle is 25 or more. […] An MRI may also be helpful to diagnose hip dysplasia and give the physician information on any damage to the cartilage and labrum.
#1 Developmental Dysplasia of the Hip (DDH) Workup: Ultrasonography, Plain Radiography, CT and MRI
https://emedicine.medscape.com/article/1248135-workup
Arthrography is a dynamic study, performed by injecting radiopaque dye into the hip joint and then carrying out a fluoroscopic examination, usually with the patient under anesthesia. Although it can be performed independently, it is routinely performed in conjunction with a closed reduction. Arthrography can be helpful in determining the underlying cartilaginous profile and dynamic stability of the hip. It has also been used in conjunction with a hip MRI study to facilitate demonstration of labral tears.
#1 Hip Dysplasia (DDH): Symptoms, Testing and Treatment
https://www.nationwidechildrens.org/conditions/hip-dysplasia
Ideally, DDH is detected by routine history and physical exam in the neonatal period. Clinical screening is the gold standard for diagnosis with dynamic hip examinations carried out at birth and at subsequent pediatrician visits throughout childhood. […] Children under 6 months of age: Beyond clinical screening exams, US (ultrasound) is the preferred technique. Though US screening of all infants is not advised, infants with identified risk factors or questionable exams should be routinely screened. […] Children 6 months of age or older: Plain radiographic evaluation is used. On an AP radiograph, lines which localize the femoral head in relationship to the acetabulum– Hilgenreiners, Perkins, and the acetabular index–can be drawn and measured. […] Once DDH is identified, prompt referral to a pediatric orthopedist is suggested. […] Treatment success depends on the child’s age and the success of repositioning.
#1 Treatment for Developmental Dysplasia of the Hip or DDH | HSS
https://www.hss.edu/conditions_developmental-dysplasia-of-the-hip-ddh.asp
Developmental dysplasia of the hip (DDH), also known as developmental pediatric dysplasia of the hip or hip dysplasia, describes a spectrum of hip joint abnormalities that vary in severity from a complete dislocation of the hip joint to mild irregularities of the located hip joint. […] To confirm a diagnosis of developmental hip dysplasia in children up to four to six months of age, an orthopedist uses ultrasound imaging. This technology offers a significant advantage over conventional a X-ray because images may be taken while the hip is in motion. „This is an accurate and safe diagnostic tool since there is no radiation,” according to Ernest L. Sink, MD, Chief of the Hip Preservation Service at HSS. In children older than six months, X-rays, which show bone detail better, are used to confirm the diagnosis.
#1 Hip dysplasia – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/hip-dysplasia/diagnosis-treatment/drc-20350214
During well-baby visits, healthcare professionals typically check for hip dysplasia by moving an infant’s legs into a variety of positions that help indicate whether the hip joint fits together well. If hip dysplasia is suspected, a hip ultrasound might be ordered to check the hip joint for signs of dysplasia. […] Mild cases of hip dysplasia can be difficult to diagnose and might not start causing problems until you’re a young adult. If your healthcare team suspects hip dysplasia, they might suggest imaging tests, such as X-rays or magnetic resonance imaging (MRI).
#1 Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management
https://pmc.ncbi.nlm.nih.gov/articles/PMC10488138/
The aim of DDH treatment depends on the patient’s age at the time of diagnosis and requires concentric reduction of the femoral head into the acetabulum. […] Patients should ideally be diagnosed and managed during infancy. […] The commencement of treatment is recommended after three weeks if the evidence of subluxation on physical and ultrasonographic assessment is present. […] The Pavlik harness is the most widely used approach in managing pediatric DDH from birth to six months, according to various publications, and it remains the standard treatment. […] For children who have failed Pavlik harness treatment, a closed or OR is recommended. […] Post-surgical radiological follow-up is mandatory for residual AD, which is a frequently encountered complication of DDH treatment.
#1 Treatment for Developmental Dysplasia of the Hip or DDH | HSS
https://www.hss.edu/conditions_developmental-dysplasia-of-the-hip-ddh.asp
The earlier the condition is treated, the better the chance of a successful outcome, meaning a hip that appears anatomically normal both during physical examination and on X-ray. Children who are treated for hip dysplasia are examined at regular intervals until they are skeletally mature (when growth is completed), to ensure that normal development continues. In some cases, a dislocated hip that was successfully reduced may still develop dysplasia in later years, requiring additional treatment.
#1 Improving early detection of developmental dysplasia of the hip through general practitioner assessment and surveillance
https://www1.racgp.org.au/ajgp/2018/september/improving-early-detection-of-developmental-dysplas
There is no standard definition and no consensus regarding which clinical examination and imaging findings require treatment to permit normal hip development. […] Current DDH screening practices are criticised for failure to adhere to the general principles of health screening, and there is variability in Australian neonatal hip screening guidelines. […] This paper presents an evidence-based approach to DDH prevention and early detection using assessment and surveillance, suitable for general practitioners (GPs). […] Early detection for any condition seeks to identify and treat individuals who have developed pathology but not yet sought medical attention. […] DDH treatment harnesses the ossification potential of the hip to achieve a reduced, stable and mature hip, while attempting to avoid treatment complications including growth disturbance and avascular necrosis.
#1 Improving early detection of developmental dysplasia of the hip through general practitioner assessment and surveillance
https://www1.racgp.org.au/ajgp/2018/september/improving-early-detection-of-developmental-dysplas
The use of ultrasonography in DDH assessment is subject to ongoing debate. […] The GP may consider medical imaging in patients with an equivocal examination, for selective screening for infants with risk factors or to provide further anatomical information regarding the diagnosis. […] Increased selective ultrasonography screening for babies with DDH risk factors has been associated with an increase in late-diagnosed DDH in South Australian children without traditional risk factors. […] Recommendations for specialist referral following DDH assessment are presented in Table 1. […] Screening usually refers to a short-term, cross-sectional process in a population at risk, whereas surveillance describes a long-term process where screening examinations are repeated at intervals of time. […] More frequent doctor-initiated assessments can reduce the age at diagnosis.
#1 DDH Diagnosis: What do we Know so Far?
https://openpublichealthjournal.com/VOLUME/14/PAGE/469/
Developmental Dysplasia of the Hip (DDH) is a common disease worldwide. The success of treatment depends on making an early and accurate diagnosis using clinical examination and imaging. Diagnosis of DDH patients is challenging and controversial, and many cases still present late. […] There is still a lack of consensus among health care providers regarding the diagnostic methods in terms of interpretation, accuracy and appropriate timing. The clinical practice seems to widely vary between healthcare providers in different parts of the world. […] DDH diagnosis must start at a very young age by repeated examination using specific clinical tests looking mainly for signs of major instability. Ultrasound scanning is the investigation of choice in screening and early diagnosis, and the Graf method seems to be the most reliable method.
#1 DDH Diagnosis: What do we Know so Far?
https://openpublichealthjournal.com/VOLUME/14/PAGE/469/
X-rays are not reliable in early diagnosis, especially in the first four months of life, and can lead to over-diagnosis, particularly when using the Acetabular Index as the sole measurement tool. […] DDH Diagnosis can be made by one or more of the following: Clinical examination, ultrasound scanning and X-Rays radiographs. […] Most cases of neonatal hip dysplasia identified by USS will resolve in the first few weeks of life, as discussed above. […] The use of USS reduces treatment rates for over-diagnosed DDH and its associated physical and psychological complications on the baby and the parents. […] X-ray is used for late diagnosis of DDH, and its use in screening for DDH is now historical. […] The reliability of X-ray increases with the increasing age of the baby. […] There is still a lack of consensus on the definition of clinically relevant DDH on radiographs.
#1 Recommendations for early diagnosis of Developmental Dysplasia of the Hip (DDH): working group intersociety consensus document | Italian Journal of Pediatrics | Full Text
https://ijponline.biomedcentral.com/articles/10.1186/s13052-020-00908-2
All newborns must undergo a clinical examination of their hips by a neonatologist or paediatrician at birth; the examination must be properly recorded. […] The clinical examination of the hips must be repeated during health assessments in the first 6 months of life by the family paediatrician, and properly recorded. […] All newborns who present a clunk sign at clinical examination must undergo an ultrasound examination of their hips before being discharged from the birth point or, in any case, within the first week of life; the examination must be properly recorded.
#2 Improving early detection of developmental dysplasia of the hip through general practitioner assessment and surveillance
https://www1.racgp.org.au/ajgp/2018/september/improving-early-detection-of-developmental-dysplas
As well as maximising the chance of successful treatment with an abduction splint or Pavlik harness, early DDH detection lowers the age at diagnosis for children who develop progressive signs outside the newborn period. […] A holistic approach to DDH assessment acknowledges that a combination of risk factor assessment, clinical examination and imaging studies may permit early detection of DDH. […] Clinical examination remains the most important component of assessment. […] The GP may be the first practitioner to make an adequate assessment, even if they are not considered the usual clinician responsible for newborn hip examination. […] Clinical examination findings should be documented and communicated specifically, describing the hip as dislocated, dislocatable, subluxatable or stable and documenting the abduction range.
#2 Update on the management of infant and toddler developmental dysplasia of the hip
https://www1.racgp.org.au/ajgp/2021/april/infant-and-toddler-developmental-dysplasia-of-the
Developmental dysplasia of the hip (DDH) encompasses the pathological spectrum of hip instability that produces subluxation or dislocation and radiological features of abnormal acetabular development. […] The management of DDH requires accurate diagnosis of the pathoanatomy and depends on the age of the child. […] GPs are essential for the early detection of DDH, which then allows for harnessing of the remodelling potential of the hip cartilaginous anlage to achieve a stable and mature hip. […] As previously stated by Williams, repeated, carefully performed clinical examinations of the paediatric hip from newborn to walking age remain the best method for early detection of DDH. […] The priority is differentiating between neonatal hip instability, acetabular dysplasia and subluxation or dislocation of the hip, as severity of involvement determines the treatment required to obtain a concentric reduction.
#2 The Radiology Assistant : Developmental Dysplasia of the Hip
https://radiologyassistant.nl/pediatrics/hip/developmental-dysplasia-of-the-hip-ultrasound
Developmental dysplasia of the hip is a common musculoskeletal disorder in newborns. […] Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal problems in newborns. […] Treatment is easier and complications are less likely to occur when DDH is diagnosed early. […] The alpha-angle, which is a measurement of the bony roof of the acetabulum, mainly determines the hip type. […] At the age of 3 months the decision has to be made whether the hip is normal or not. […] Type I hips have an alpha angle of more than 60 degrees and are normal. […] If a child is less than 3 months old, then an alpha angle of 50-59 degrees is considered an immature hip. […] If a child is older than 3 months or 13 weeks, then an alpha angle of 50-59 degrees is considered a sign of dysplasia, i.e type IIb.
#2 Modern approach to developmental dysplasia of the hip – Mayo Clinic
https://www.mayoclinic.org/medical-professionals/pediatrics/news/modern-approach-to-developmental-dysplasia-of-the-hip/mac-20538657
A low threshold for ultrasound is prudent to ensure early diagnosis and treatment. […] Patients at 6 to 8 weeks of age with ultrasound abnormalities also generally should be referred for pediatric orthopedic evaluation. […] After 6 months of age, an anteroposterior pelvis X-ray is the best study to evaluate for hip dysplasia, and it provides more-reliable images than ultrasound. […] For clinically unstable or dislocated hips, the optimal initiation of treatment with the Pavlik harness is as early as possible. […] DDH is a common condition with reliable nonoperative treatment options if detected early. Surgery is required for older patients with dislocated or unstable hips. […] The treatment options for DDH are expanding, and physicians are learning how to better assess the patient’s anatomy, thus leading to the right intervention at the right time.
#2 Developmental Dysplasia of the Hip (DDH): Practice Essentials, Anatomy, Pathophysiology
https://emedicine.medscape.com/article/1248135-overview
Early diagnosis is the most crucial aspect of the treatment of children with DDH. […] The use of ultrasonography (US) and other diagnostic imaging modalities and the implementation of improved educational programs will most likely decrease the number of children with DDH who are diagnosed late. […] Typical radiographic evaluation of developmental dysplasia of hip (DDH). From anteroposterior radiograph of hips, horizontal line (Hilgenreiner line) is drawn between each triradiate cartilage. […] Shenton line is drawn from medial aspect of femoral neck to inferior border of pubic rami. It should create smooth arc that is not disrupted. Disruption of Shenton line indicates presence of some degree of hip subluxation. […] Ultrasound diagnosis of neonatal congenital dislocation of the hip. A decision analysis assessment.
#2
https://www.parkwayeast.com.sg/conditions-diseases/developmental-hip-dysplasia/diagnosis-treatment
Your doctor will screen for developmental dysplasia of the hip (DDH) when you bring your child in for his or her regular health checks. Your doctor will gently manoeuvre your child’s hip and legs into a variety of positions to see whether the hip joint fits together well. […] Mild cases of DDH can be difficult to diagnose. You may not notice any problems until you are a young adult. If your doctor suspects DDH, he or she might recommend imaging tests, such as X-rays or magnetic resonance imaging (MRI) for you.