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| |  Hip Dysplasia Check at 6 Months Recommended for Infants Born Breech: Presented at AAOS By Sophie Bainbridge NEW ORLEANS -- March 16, 2010 -- Breech babies, who are at high risk for hip dysplasia, may appear normal on ultrasound screening at 6 weeks, but should be brought back to the clinic for radiographic follow-up at 6 months to rule out subsequent developmental dysplasia of the hip (DDH), according to a retrospective study presented here on March 11 at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). “Ultrasound is currently commonly used to evaluate infants’ hips for developmental dysplasia of the hip, especially in patients with recognised risk factors, such as family history, positive clinical examination, and breech presentation,” said Meghan N. Imrie, MD, Pediatric Orthopedic Surgery at Stanford University Medical Center Lucile Packard Children’s Hospital, Palo Alto, California. “However, the necessity and details of subsequent follow-up in patients with normal ultrasound examinations is not entirely clear.” While there have been several recent studies recommending no further follow-up for these high-risk patients that have had a normal screening ultrasound, none have been done specifically in patients that are born breech, she said. Dr. Imrie and colleagues retrospectively reviewed the clinical data and imaging studies of all breech infants who were referred to Rady Children’s Hospital in San Diego, California, for orthopaedic evaluation over a 5-year period. Ultrasounds, using both dynamic and static methods, were done at age 6 weeks, and all patients with normal screening ultrasounds were brought back for a final clinical examination and radiographic check at 4 to 6 months. Acetabular dysplasia was indicated by clinical and radiographic parameters. The researchers found that, of the 300 breech babies in their review, 27% had abnormal screening ultrasounds at 6 weeks. These babies received immediate treatment with a Pavlik harness. The remaining 73% of infants with normal 6-week ultrasounds were brought back for another clinical and radiographic check at 4 to 6 months. Of these infants, 29% were found to have dysplasia that required treatment, and were treated with a Pavlik harness. “These data support breech as the most important risk factor for hip dysplasia,” Dr. Imrie said. “We therefore recommend careful and longitudinal evaluation of these patients with a careful newborn physical examination, an ultrasound at age 6 weeks, and an anteroposterior pelvis and frog lateral radiograph at 6 months, as the risk of subsequent dysplasia is too high to discharge patients after a normal ultrasound.” The development of a baby’s hip is a very dynamic process and changes over time, Dr. Imrie said. “Some of the hips with subtle dysplasia that we see on x-ray may normalise on their own, but some do not. The trouble is we don’t know which kids will normalise and which kids won’t.” A hip dysplasia that does not normalise and goes untreated can lead to big problems when the child is older. These include the development of arthritis and a need for surgery in the adolescent and young adult years. “We think that it’s much easier to treat a baby with a harness for a few months when they are little, instead of not treating them, and then having to have a major surgical procedure when they are older,” concluded Dr. Imrie. “So, based on our findings, we feel that the risk of subsequent dysplasia is too high to discharge patients after a normal ultrasound and recommend radiographic follow-up at age 6 months.” [Presentation title: Is Ultrasound Screening for DDH in Breech Babies Enough? Abstract 396]
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