The significance of at-risk factors in ultrasound surveillance of developmental dysplasia of the hip. A ten-year prospective study.
Of the 34,723 infants born between 1 June 1992 and 31 May 2002, the hips of 2578 with clinical instability or at-risk factors for developmental dysplasia of the hip were imaged by ultrasound. Instability of the hip was present in 77 patients, of whom only 24 (31.2%) had an associated risk factor. From the 'at-risk' groups, the overall risk of type-III dysplasia, instability and irreducibility was 1:15 when family history, 1:27 when breech delivery and 1:33 when foot deformity were considered as risk factors. Of those hips which were ultrasonographically stable, 88 had type-III dysplasia. A national programme of selective ultrasound screening of at-risk factors for the diagnosis of hip dislocation or instability alone cannot be recommended because of its low predictive value (1:88). However, the incidence of type-III dysplasia and hip dislocation or dislocatability in the groups with clinical instability, family history, breech position and possibly postural foot deformity as risk factors could justify a programme of selective ultrasound imaging.
Paton
R W
RW
Orthopaedic Department, Blackburn Royal Infirmary, Bolton Road, Blackburn BB2 3LR, Lancashire, England, UK. robin@coppybarn-freeserve.co.uk
Hinduja
K
K
Thomas
C D
CD
D001946:Breech Presentation; D004739:England; D005260:Female; D005532:Foot Deformities, Congenital / Q000209:etiology; D020022:Genetic Predisposition to Disease; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging* / Q000209:etiology / Q000235:genetics; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000379:methods*; D018579:Patient Selection; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography