The Earliest Timing Ultrasound can be Performed in the Screening for Developmental Dysplasia of the Hips (DDH)

Si Heng Sharon Tan, Keng Lin Wong, Andrew Kean Seng Lim and James HoiPo Hui Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), Singapore (Full postal address: 1E Kent Ridge Road, NUHS Tower Block, Level 11, Department of Orthopaedic Surgery, Singapore 119074)

 Abstract

  Purpose

 The current study aims to evaluate the results of ultrasound screening done at various weeks of life, to determine the earliest timing ultrasound screening can be performed reliably.

 Methods

 In the 17-year cohort study, all neonates who underwent ultrasound screening prior to the twelfth week of life  with subsequent follow-up radiograph done at one year of life were included. The ultrasound images were  evaluated according to Graf classification, Harcke's dynamic ultrasound screening and Terjesen's femoral head  coverage. The radiographic images were evaluated according to acetabular index and femoral head position. The  accuracy and correlation between the ultrasound findings performed at the various weeks of life with the  radiographic findings performed at one year of life were evaluated.

Results

 A total of 348 neonates were included. When the ultrasound findings were correlated with the radiographic  findings at one year of life, significant differences were identified for ultrasound screening performed prior to the fourth week of life (day 21 and before) (p < 0.05). In contrast, there were no significant differences  identified when the ultrasound was performed between the fourth and twelfth week of life (day 22 and beyond)  (p > 0.05). The accuracy of ultrasound screening was 79.2% and above when performed during or after the  fourth week of life (day 22 and beyond).

Conclusion

The earliest timing that ultrasound screening for DDH can be performed reliably is during the fourth week of life (day 22 and beyond).