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Chavoshi M, Soltani G, Shafiei Zargar S, Wyles CC, Kremers HM, Rouzrokh P. Diagnostic Performance of Clinical Examination Versus Ultrasonography in the Detection of Developmental Dysplasia of Hip: A Systematic Review and Meta-Analysis. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:403-412. [PMID: 35755788 PMCID: PMC9194706 DOI: 10.22038/abjs.2021.60504.2984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/11/2021] [Indexed: 01/24/2023]
Abstract
Background Developmental dysplasia of the hip (DDH) is a spectrum of diseases involving the femoroacetabular joint. Due to the controversies over the value of different strategies used for DDH screening, this systematic review and meta-analysis aimed to assess the diagnostic performance of standard physical examination maneuvers on the diagnosis of DDH, compared to the Graf ultrasonography (US) method. Methods PubMed, Web of Science, and SCOPUS databases were searched until the end of October 2020. Studies that (i) used the Ortolani test, Barlow test, or limited hip abduction (LHA) test to assess the risk of DDH in physical examination, (ii)used the Graf US method to examine DDH in sonography, and (iii) provided adequate data to extract the diagnostic performance were included. Pooled sensitivity and specificity were calculated for clinical examinations. Results A total of 25 studies (72,079 patients in total) were considered eligible to enter the present study. The pooled data of the Ortolani-Barlow test demonstrated a sensitivity of 36% (95% CI:0.25-0.48) and specificity of 98% (95% CI:0.93-0.99). Calculated pooled sensitivity and specificity for the limited hip abduction exam were obtained at 45% (95% CI:0.24-0.69) and 78% (95% CI:0.62-0.88) respectively. A separate analysis of the studies using both exams revealed a sensitivity of 57% (95% CI:0.30-0.82) and a specificity of 95% (95% CI:0.68-0.99). Conclusion Based on the results, the investigated clinical examinations have high specificity but low sensitivity to detect the DDH; therefore, they have limited application as a screening test. If obliged to rely on clinical examinations for screening, the combination of Ortolani-Barlow and LHA tests can provide more sensitivity than either of these tests performed independently.
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Affiliation(s)
- Mohammadreza Chavoshi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazaleh Soltani
- Translational Ocular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Cody Clayton Wyles
- Department of Clinical Anatomy, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Hilal Maradit Kremers
- Departments of Health Science Research and rthopedics Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Pouria Rouzrokh
- Department of Radiology, Radiology Informatics Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Xu N, Xia B, Tao H, Sun K, Liu Q, Chen W, Wang D, Gao H, Guo Y, Liu Y, Gao J, Teng J, Li T, He Q, Wu Z. Epidemiological investigation and ultrasonic diagnosis of developmental dysplasia of the hip in Chinese infants: A large multi-center cohort study. Medicine (Baltimore) 2022; 101:e28320. [PMID: 35029175 PMCID: PMC8758026 DOI: 10.1097/md.0000000000028320] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/26/2021] [Indexed: 01/05/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) is common among Chinese infants, but a lack of large-scale, multi-center epidemiological studies has made it difficult to characterize the risk factors associated with this disease.This multi-center cohort study included 19,833 Chinese infants aged 14 days to 6 months. A multi-center ultrasound protocol was used to diagnose hip abnormalities, and epidemiological data of the infants were collected through questionnaires. Categorical variables were expressed as percentages and compared using χ2 test. Multivariate analysis was performed through logistic regression.Of 19,833 infants, 345 had DDH (1.7%). DDH incidence was higher in female infants (n = 279) than in male infants (n = 66) (χ2 = 95.89, P < .05), and there were more left hip cases (n = 149) than right hip cases (n = 79) (χ2 = 12.49, P < .05). DDH incidence was statistically different amongst different age groups in months (χ2 = 451.71, P < .05), and it gradually decreased with age (P < .05). The prevalence of a positive DDH family history, breech presentation, oligohydramnios, swaddling style, and other musculoskeletal deformities was higher in the positive group than in the negative group (all P < .05). No significant differences were found in terms of delivery by cesarean section, multiple births, or premature birth between both groups.Family history, breech presentation, oligohydramnios, musculoskeletal deformities, and female sex are high-risk factors for DDH in Chinese infants. The incidence of DDH gradually decreases with age. The results of this study provide evidence for the epidemiology of infant DDH in China.
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Affiliation(s)
- Na Xu
- Department of Ultrasound, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Bei Xia
- Department of Ultrasound, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Hongwei Tao
- Department of Ultrasound, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Ke Sun
- Department of Orthopedics, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Qinghua Liu
- Department of Ultrasound, The Qilu Children's Hospital of Shandong University, Jinan, Shandong, China
| | - Wenjuan Chen
- Department of Ultrasound, The Hunan Children's Hospital, Changsha, Hunan, China
| | - Dan Wang
- Department of Ultrasound, The Zhengzhou Children's Hospital, Zhengzhou, Henan, China
| | - Hong Gao
- Department of Ultrasound, The Kunming Children's Hospital, Kunming, Yunnan, China
| | - Yan Guo
- Department of Ultrasound, The Shanxi Children's Hospital, Taiyuan, Shanxi, China
| | - Yan Liu
- Department of Ultrasound, The Guizhou Women and Children's Hospital, Guiyang, Guizhou, China
| | - Jun Gao
- Department of Ultrasound, The Wuhan Women's and Children's Health Care Center (Wuhan Children's Hospital), Wuhan, Hubei, China
| | - Jianbo Teng
- Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Tianzi Li
- Department of Ultrasound, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Qiancheng He
- Department of Ultrasound, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Zhixia Wu
- Department of Ultrasound, The Shenzhen Children's Hospital, Shenzhen, Guangdong, China
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Fludder CJ, Keil BG, Neave MJ. Case report: Morphological changes evident after manual therapy in two cases of late-diagnosed developmental dysplasia of the hip. Front Pediatr 2022; 10:1045812. [PMID: 36776679 PMCID: PMC9909744 DOI: 10.3389/fped.2022.1045812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/28/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Late diagnosed Developmental Dysplasia of the Hip (DDH) is the detection of DDH after 3 months of age and is associated with significantly poorer outcomes than when diagnosed and managed early. Late diagnosed DDH has lower rates of success with bracing, higher rates of surgery and higher rates of complications, including avascular necrosis of the femoral head and early osteoarthritis of the hip. We describe two cases of late-diagnosed DDH which demonstrated changes in femoroacetabular joint morphology on radiographic interpretation after a 6-month trial period of manual therapy. CASE PRESENTATION Two cases (13 and 30 months of age) with late-diagnosed DDH presented to a private chiropractic clinic for conservative, non-bracing management. One case had unilateral DDH and the other bilateral DDH. A trial of manual therapy was utilized over a 6-month period. Both cases demonstrated changes to femoroacetabular morphology as well as improvements in gross motor activity and lower extremity muscle tone. CONCLUSION Manual therapy, as an adjunct or alternative to static bracing, may be of benefit in individuals with late-diagnosed DDH not responding to bracing, and prior to more invasive interventions. Additional cases of manual therapy-based management of this condition are required to inform the design of future trials to investigate this hypothesis.
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Wu H, Wang Y, Tong L, Yan H, Sun Z. The Global Research Trends and Hotspots on Developmental Dysplasia of the Hip: A Bibliometric and Visualized Study. Front Surg 2021; 8:671403. [PMID: 34760913 PMCID: PMC8572967 DOI: 10.3389/fsurg.2021.671403] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Developmental dysplasia of the hip (DDH) is a common musculoskeletal disorder in newborns and also one of the most common causes of hip arthritis in women. Many topics concerning DDH still remain controversial, and the global research trend in this field has not been well-studied yet. The aim of the present study was to illustrate the overall knowledge structure, development trends, and research hotspots of DDH. Methods: The publications related to DDH from 1998 to 2020 were identified from the Web of Science Core Collection (WOSCC). Three bibliometric tools were used to conduct visualization and knowledge maps. Annual trends of publications, contributions of countries, institutions, authors, funding agencies and journals, and clustering of keywords were analyzed. Results: A total of 2,691 publications were included. The annual number of DDH publications showed an increasing trend worldwide. The United States has made the greatest contribution, with the largest number of publications and the highest H-index. The most prolific institutions were Shanghai Jiao Tong University, Children's Hospital of Philadelphia, and Shriners Hospital for Children. Professors Tönnis D, Harris WH, Crowe JF, Graf R, and Salter RB have made great achievements in this field. However, the collaboration between international institutions or researchers was relatively low and mainly conducted in European and American countries. All the keywords could be divided into five clusters: hip osteoarthritis study, hip replacement study, hip ultrasound study, osteotomy surgery study, and etiology study. A trend of balanced and diversified development existed in these clusters. Keywords with the ongoing bursts, including clinical outcome, risk factor, femoroacetabular impingement, predictor, arthroscopy, morphology, and anteversion may continue to be the research hotspots in the near future. Conclusions: There will be an increasing number of publications on DDH research, and the United States stay ahead in this field. International collaboration needs to be further strengthened. The information can provide helpful references for researchers to explore hot issues or target a specific field of DDH.
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Affiliation(s)
- Haiyang Wu
- Graduate School of Tianjin Medical University, Tianjin, China.,Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Yulin Wang
- Graduate School of Tianjin Medical University, Tianjin, China.,Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Linjian Tong
- Graduate School of Tianjin Medical University, Tianjin, China.,Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Hua Yan
- Graduate School of Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhiming Sun
- Graduate School of Tianjin Medical University, Tianjin, China.,Department of Orthopaedic Surgery, Tianjin Huanhu Hospital, Tianjin, China
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The Association of Asymmetric Skinfolds and the Diagnosis of Developmental Dysplasia of the Hip in Infants. Adv Neonatal Care 2021; 22:352-356. [PMID: 34387217 DOI: 10.1097/anc.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The clinical finding of asymmetric skinfolds (ASF) in infants is used to indicate the possibility of developmental dysplasia of the hip (DDH). The association of ASF and a diagnosis of DDH remains unknown. PURPOSE To determine the association of ASF in the gluteal and femoral regions with a diagnosis of DDH. METHODS The correlation of ASF and other physical examination findings with DDH was compared retrospectively. The medical records of infants who underwent DDH screening in the clinic were analyzed. The physical examination findings were reviewed and categorized as ASF, clunk of the hip, limb-length discrepancy, hip abduction limitation, combined conditions of musculoskeletal disorders, and regular screening for DDH. The hip conditions were classified by Graf's ultrasound method. Type IIb and higher classifications were defined as DDH. The diagnosed rate and severity of DDH based on physical examination findings were calculated and compared. RESULTS Clinical data of 3266 infants aged up to 6 months were reviewed, and 194 infants were diagnosed with DDH by ultrasound examination. ASF was the most common indication for DDH screening (64.5%; 2107/3266). However, this was poorly correlated with a diagnosis of DDH (4.79%; P < .0001). No difference was found between the Graf classification severity and various indications (P = .079). IMPLICATIONS FOR PRACTICE Clinicians should recognize that, although ASF is the most common reason for DDH screening in infants, ASF does not correlate with a diagnosis of DDH. IMPLICATIONS FOR RESEARCH Additional research should examine the relationship between DDH and ASF in other populations.
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Young JR, Anderson MJ, O'Connor CM, Kazley JM, Mantica AL, Dutt V. Team Approach: Developmental Dysplasia of the Hip. JBJS Rev 2021; 8:e20.00030. [PMID: 32890048 DOI: 10.2106/jbjs.rvw.20.00030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Developmental dysplasia of the hip (DDH) encompasses a wide spectrum of hip disorders, including neonatal instability, acetabular dysplasia, hip subluxation, and frank dislocation of the hip. It is a common disorder, with a reported incidence of between 0.1% and >10% of live births.
Coordinated, interdisciplinary care is important to achieving successful outcomes. This starts with accurate assessment of risk factors in the prenatal period, thorough clinical examination by the primary care provider at all well-child visits, and early referral to a pediatric orthopaedic surgeon for prompt diagnosis and treatment. Early diagnosis and prompt treatment is critical for an excellent outcome. Ongoing, open communication between clinicians is essential for the effective coordination of care. Treatment options vary depending on the age of presentation. A Pavlik harness (dynamic hip abduction orthosis) is used for children up to 6 months of age. A more rigid abduction orthosis may be used if treatment with a Pavlik harness is unsuccessful, with a closed reduction and spica cast being the next step if needed for children up to 18 months of age. Finally, open reduction with possible concomitant femoral and/or pelvic osteotomies is the surgical option in an older child, when necessary. In general, the later the child is diagnosed with and treated for DDH, the greater the risk of a nonoptimal outcome. Depending on the severity of the condition, children with DDH may need to be followed closely until skeletal maturity so as not to miss the diagnosis of asymptomatic residual hip dysplasia, which can predispose patients to early hip arthritis.
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Affiliation(s)
- Joseph R Young
- Division of Orthopedic Surgery, Albany Medical Center, Albany, New York
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Na XMD, Bei XMD, Hongwei TMD, Ke SMD, Qinghua LMD, Wenjuan CMD, Dan WMD, Hong GMD, Yan GMD, Yan LMD, Jun GMD, Jianbo TMD. Chinese Expert Consensus on Ultrasonographic Acquisition, Measurement, and Reporting System for Developmental Dysplasia of the Hip. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.190041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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