Diagnostic Imaging Pathways - Paediatric, Hip Developmental Dysplasia
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Population Covered By The Guidance
This pathway provides guidance on the screening imaging of paediatric patients to exclude developmental dysplasia of the hips.
Date reviewed: July 2014
Date of next review: July 2016
Published: July 2014
Quick User Guide
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The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
 | None | 0 |
 | Minimal | < 1 millisieverts |
 | Low | 1-5 mSv |
 | Medium | 5-10 mSv |
 | High | >10 mSv |
Teaching Points
Teaching Points
- Risk factors that predispose to DDH include
- Family history
- Associated congenital orthopaedic conditions
- Oligohydramnios
- Breech presentation
- High birth weight
- If risk factors present, and screening is indicated ultrasonography is the initial investigation of choice
- Ultrasonography should be performed before 6mnths of age. After this time, plain films of the hip are indicated
radio
Plain Radiography
- Plain radiography is less reliable in the first few months of life when the femoral head is composed mainly of cartilage
- It becomes a more useful method of investigating for DDH in children aged between 4 and 6 months
- The relationships of the femoral head and proximal femoral metaphysis to the acetabulum are an important part of evaluating for DDH
- The use of the acetabular index and other objective means are used to evaluate for DDH, although the sensitivity and specificity of some of these are uncertain. However, these measurements are only one part of the radiographical assessment used to gauge hip dysplasia 12,13
us
Ultrasound
- Uses and features
- Effective non-invasive way to image the cartilaginous hip joint that involves no exposure to radiation 3
- Indications for its use vary but in general it is used in children under 4-6 months of age who have signs of hip instability on examination
- If clinical examination is normal and hip ultrasound is performed as a screening test due to the presence of risk factors it is best delayed until at least 3 weeks post term because of physiological immaturity evident on early US which may lead to false positive results
- Whilst it is ideal to delay ultrasound until at least 3 weeks post term, if the hip is clinically dislocatates or is frankly unstable then earlier orthopaedic referral and hip ultrasound should be sought
- Consists of an anatomical and dynamic assessment of the hip joint 1,2,3
- Graf's standardised morphology criteria are commonly used 2
- Different variations of the anatomical and dynamic methods are used in clinical practice 4,5
- The screening of children for developmental dysplasia of the hip is a controversial topic. Clinical methods of screening when performed by experienced clinicians have a reasonably high sensitivity and specificity for detecting DDH 6-9
- Ultrasonography is used as a screening tool in some centres and it has reduced the number of infants who require surgical treatment at the expense of more infants being treated with abduction splinting 10,11
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Graf R. The diagnosis of congenital hip-joint dislocation by the ultrasonic combound treatment. Arch Orthop Trauma Surg. 1980;97:117-33. (Review article)
- Graf R. Fundamentals of sonographic diagnosis of infant hip dysplasia. J Pediatr Orthop. 1984;4:735-40. (Level III evidence)
- Clarke NMP, Harcke HT, McHugh P, et al. Real-time ultrasound in the diagnosis of congenital dislocation and dysplasia of the hip. J Bone Joint Surg. 1985;67:406-12. (Level III evidence)
- Terjeson T, Bredland T, Berg V. Ultrasound for hip assessment in the newborn. J Bone Joint Surg. 1998;71:767-73. (Level III evidence)
- Andersson JE. Neonatal hip instability: normal values for physiological movement of the femoral head determined by an anterior dynamic ultrasound method. J Pediatr Orthop. 1995;15:736-40. (Level III evidence)
- Düppe H, Danielsson LG. Screening of neonatal instability and of developmental dislocation of the hip: a survey of 132,601 living newborn infants between 1956-1999. J Bone Joint Surg. 2002;84:878-85. (Level III evidence)
- Krikler SJ, Dwyer NS. Comparison of results of two approaches to hip screening in infants. J Bone Joint Surg. 1992;74:701-3. (Level III evidence)
- Macnicol MF. Results of a 25 year screening programme for neonatal instability. J Bone Joint Surg. 1990;72:1057-60. (Level III evidence)
- Bialik V, Fishman J, Katzir J, Zeltzer M. Clinical assessment of hip instability in the newborn by an orthopaedic surgeon and a paediatrician. J Pediatr Orthop. 1986;6:703-6. (Level IV evidence)
- Patel H. Preventive health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns. CMAJ. 2001;164:1669-77. (Evidence based recommendations)
- Rosendahl K, Markestad T, Lie RT. Ultrasound screening for developmental dysplasia of the hip in the neonate: the effect on treatment rate and prevalence of late cases. Pediatrics. 1994;94:47-52. (Level II evidence). View the reference
- Kay RM, Watts HG, Dorey FJ. Variability in the assessment of acetabular index. J Pediatr Orthop. 1997;17:170-3. (Level III evidence)
- Spatz DK, Reiger M, Klaumann M, et al. Measurement of acetabular index intraobserver and interobserver variation. J Pediatr Orthop. 1997;17:174-5. (Level III evidence)
Information for Consumers
Information for Consumers
Information from this website |
Information from the Royal Australian and New Zealand College of Radiologists’ website |
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Consent to Procedure or Treatment Radiation Risks of X-rays and Scans |
Radiation Risk of Medical Imaging for Adults and Children Children's (Paediatric) Hip Ultrasound for DHH Children's (Paediatric) X-ray Examination Making Your Child's Test or Procedure Less Stressful |
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