Comparative Evaluation of Clinical and Ultrasound Examination in Neonatal Hip Screening for the Detection of Developmental Dysplasia of the Hip – A Hospital-Based Cross-Sectional Study

Journal of Clinical Orthopaedics | Vol 7 | Issue 2 |  Jul-Dec 2022 | page: 59-65 | Viveksheel Kashyap, Rajeev Reddy Kikkuri, Anmol Mittal, Karri Sandeep Reddy, Richa Singhal

DOI: 10.13107/jcorth.2022.v07i02.533


Author: Viveksheel Kashyap [1], Rajeev Reddy Kikkuri [2], Anmol Mittal [3], Karri Sandeep Reddy [2], Richa Singhal [4]

[1] Department of Orthopaedics, Paras HMRI Hospital, Patna, Bihar, India,
[2] Department of Orthopaedics, Sunshine Hospitals, Telangana, Hyderabad, India,
[3] Department of Orthopaedics, J.N. Medical College, KLE University, Belgaum, Karnataka, India,
[4] Department of Pediatrics, Safdarjung Hospital, New Delhi, India.

Address of Correspondence
Dr. Rajeev Reddy Kikkuri,
Department of Orthopaedics, Sunshine Hospitals, Telangana, Hyderabad, India.
E-mail: rajeevkikkuri@gmail.com


Abstract

Background: During infancy, among developmental abnormalities of the hip joint, a broad-spectrum anomaly is developmental dysplasia of the hip (DDH). To examine this abnormality, no standardized screening protocol is available. Clinical examination is most frequently followed, and in doubtful cases, ultrasound (US) examination is used to confirm the diagnosis.

Aims: The present study aims to compare the sensitivity and specificity of clinical to US examination in neonatal hip screening to detect DDH.

Materials and Methods: This is a 1-year hospital-based cross-sectional study. Newborns who were referred to the Department of Orthopaedics with suspected DDH and examined by both clinical examination and US examination were included in the study. The Chi-square test and Fisher’s t-test were used for statistical analysis.

Results: Out of the 75 babies, referred two-thirds were girls. The mean age of the babies was 6.25 ± 3.50 days. The breech presentation was the common risk factor (85.33%) for DDH, and LSCS was the standard mode of delivery. Clinical diagnosis of DDH was positive among babies, more on the left side than the right side. Eight babies (10.67%) were diagnosed to have DDH based on Graf’s test using USG. Among them, 4 (50%) babies had a clinical diagnosis of DDH. The sensitivity of the clinical trial with USG as reference standard was 50%

Conclusion: Due to the lower sensitivity of clinical examination, USG screening should be done to detect DDH.

Keywords: Hip dislocation, infant, newborn, ultrasonography, mass screening


References

1. Karmazyn BK, Gunderman RB, Coley BD, Blatt ER, Bulas D, Fordham L, et al. ACR appropriateness criteria® on developmental dysplasia of the hip-child. JACR 2009;6:551-7.
2. McKibbin B. Anatomical factors in the stability of the hip joint in the newborn. J Bone Joint Sur Br 1970;52:148-59.
3. Singh M, Sharma NK. Spectrum of congenital malformations in the newborn. Indian J Pediatr 1980;47:239-44.
4. Gupta AK, Kumari S, Arora PL, Kumar R, Mehtani AK. Hip instability in newborns in an urban community. N Med J India 1992;5:269-72.
5. Kaushal V, Kaushal SP, Bhakoo ON. Congenital dysplasia of the hip in Northern India. Int Surg 1976;61:29.
6. Kutlu A, Memik R, Mutlu M, Kutlu R, Arslan A. Congenital dislocation of the hip and its relation to swaddling used in Turkey. J Pediatr Orthop 1992;12:598-602.
7. Zdravković N, Stojanović S. Early diagnosis of developmental hip dysplasia in the district of pirot, serbia. Med Biol 2004;11:26-30.
8. Mulpuri K, Song KM, Goldberg MJ, Sevarino K. Detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age. J Am Acad Orthop Surg 2015;23:202-5.
9. Barlow T. Early diagnosis and treatment of congenital dislocation of the hip. J Bone Jt Surg 1962;4:292-301.
10. Rosendahl K, Markestad T, Lie RT, Sudmann E, Geitung J. Cost-effectiveness of alternative screening strategies for developmental dysplasia of the hip. Arch Pediatr Adolesc Med 1995;149:643-8.
11. Harcke HT, Kumar S. The role of ultrasound in the diagnosis and management of congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 1991;73:622-8.
12. Arti H, Mehdinasab SA, Arti S. Comparing results of clinical versus ultrasonographic examination in developmental dysplasia of hip. J Res Med Sci 2013;18:1051-5.
13. Graf R. Hip Sonography: Diagnosis and Management of Infant Hip Dysplasia. Berlin, Germany: Springer Science and Business Media; 2006. p. 114.
14. Graf R. The use of ultrasonography in developmental dysplasia of the hip. Acta Orthop Traumatol Turc 2004;41:6-13.
15. Storer SK, Skaggs D. Developmental dysplasia of the hip. Am Fam Physician 2006;74:1310-6.
16. Screening for the detection of congenital dislocation of the hip. Arch Dis Child 1986;61:921-6.
17. Roovers EA, Boere-Boonekamp MM, Castelein RM, Zielhuis GA, Kerkhoff TH. Effectiveness of ultrasound screening for developmental dysplasia of the hip. Arch Dis Child Fetal Neonatal Ed 2005;90:F25-30.
18. Price CT, Ramo B. Prevention of hip dysplasia in children and adults. Orthop Clin North Am 2012;43:269-79.
19. Smergel E, Losik SB, Rosenberg H. Sonography of hip dysplasia. Ultrasound Q 2004;20:201-16.
20. Tomà P, Valle M, Rossi U, Brunenghi G. Paediatric hip–ultrasound screening for developmental dysplasia of the hip: A review. Eur J Ultrasound 2001;14:45-55.
21. Rosenberg HK, Losik SB, Smergel E. Developmental dysplasia of the infant hip. Contemp Diagn Radiol 2006;29:1-7.
22. Akgün S, Bakar C, Budakoglu II, Tuncay C, Cemil T. Is clinical examination reliable in diagnosis of developmental dysplasia of the hip? Gazi Med J 2008;19:56-9.
23. Dogruel H, Atalar H, Yavuz OY, Sayli U. Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. Int Orthop 2008;32:415-9.
24. Imrie M, Scott V, Stearns P, Bastrom T, Mubarak S. Is ultrasound screening for DDH in babies born breech sufficient? J Child Orthop 2010;4:3-8.
25. Geertsema D, Meinardi JE, Kempink DR, Fiocco M, van de Sande M. Screening program for neonates at risk for developmental dysplasia of the hip: Comparing first radiographic evaluation at five months with the standard twelve week ultrasound. A prospective cross-sectional cohort study. Int Orthop 2019;43:1933-8.
26. Herring J. Developmental Dysplasia of the Hip. Tachdjian’s Pediatric Orthopaedics. Philadelphia, PA: WB Saunders; 2008.

27. Hegde D, Powers N, Nathan EA, Rakshasbhuvankar A. Developmental dysplasia of the hip in preterm breech infants. Arch Dis Child Fetal Neonatal Ed 2020;105:556-8.

28. Kumar RK, Shah P, Ramya AN, Rajan R. Diagnosing developmental dysplasia of hip in newborns using clinical screen and ultrasound of hips-An Indian experience. J Trop Pediatr 2016;62:241-5.

 

How to Cite this article: Kashyap V, Kikkuri RR, Mittal A, Reddy KS, Singhal R. Comparative Evaluation of Clinical and Ultrasound Examination in Neonatal Hip Screening for the Detection of Developmental Dysplasia of the Hip – A Hospital-Based Cross-Sectional Study. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):59-65.

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