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Radiographic follow-up of dysplastic hips indicated in some children at 5 months old
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Initial ultrasounds of infants’ pelvises performed at an average 2 weeks of age detected dysplastic hips in about one-third of this population. Investigators said early detection by ultrasound led to 96% of those with dysplastic hips being treated effectively.
Curtis Robb, MRCS(Ed), of Birmingham, England, presented results of ultrasonic scans performed over a 24-month period between 2005 and 2007 at the 9th European Federation of National Associations of Orthopaedics and Traumatology Congress in Nice.
“We have found that, despite normal follow-up with ultrasound scan, four patients of 96 were significantly dysplastic on follow-up,” Robb said. During the presentation he discussed the four cases where dysplasia recurred despite early treatment with a Pavlik harness.
Harnesses used
Investigators performed screening ultrasounds at a British hip ultrasound clinic on 370 patients at an average age of 2 weeks. They found that a majority of the patients had normal hips, but 77 patients presented with 96 dysplastic hips.
“Initial treatment was indicated in a majority of patients with a Pavlik harness,” Robb explained. The rest were treated with open reduction, double or triple “nappies” or diapers to prevent adduction, or by a wait-and-see approach.
The investigators used the Morin classification system to describe how much femoral head coverage was present in the dysplastic hip cases, wherein 58% is considered normal coverage.
“More importantly, each hip was also dynamically examined under ultrasound to ensure stability,” he said.
Continued scans
Patients diagnosed with dysplasia continued to be followed up with ultrasound scans until their hips were normal, which usually took about 6 months.
“We found that, despite normal follow-up by ultrasound scan, a further dysplasia existed in four patients of the 96 [hips], representing approximately 4%,” Robb noted.
According to the study abstract, several issues are raised by these findings, including the fact that hips made “normal” through treatment can develop recurrent dysplasia, and that weaning patients from a Pavlik harness may be appropriate. The study also clarifies the importance of longer follow-up in these cases.
“Therefore, we recommend for all patients with dysplastic hip, we follow all of them with a check X-ray at 5 months, and this also raises the controversial issue of whether we should do an X-ray,” Robb noted.
For more information:
- Curtis E. Robb, MRCS(Ed), can be reached at the Department of Orthopaedic Surgery, Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, England; +44-121-685-4156; e-mail: edsarahbache@aol.com. Orthopaedics Today Europe was unable to determine if he has any financial disclosures related to this study.
Reference:
- Robb C, Bache CE, Bradish C, Jawanda S. How sound is hip ultrasound? Paper F144. Presented at the 9th European Federation of National Associations of Orthopaedics and Traumatology Congress. May 29-June 1, 2008. Nice.