The Risk of Developmental Dysplasia of the Hip (DDH) in High Birth Weight babies: A Major Risk Factor Detected in the Analyses of Sonograms based on the Graf Technique

Document Type : original article

Author

Division of Neonatology, Hirslanden Clinic Witellikerstrasse 40 CH-8032 Zürich, Switzerland

Abstract

Background: The purpose of this retrospective study was to check sonographic hip types according to the Graf technique and to compare the results related to large newborns with those related to the normal and small ones based on their Gestational Age (GA); and to investigate the influence of birth weight on the incidence of Developmental Dysplasia of the Hip (DDH).
Methods: Between 1993 and 2003 Ultrasonography (US) of the hips was performed in 7417 consecutive newborns at 34-42 gestational weeks using the Graf method during the first week of life.
Results: The US showed pathological findings in 168 hips (2.3%). 139 of these cases were girls (82.7%) and 29 were boys (17.3%). According to Graf types, there were 63 type IIc, 56 type D, 46 type III, and 3 type IV hips. Except for one boy (type III) all were successfully treated by conservative orthopedic methods. Being overweight (large for GA) in association with breech presentation showed the highest risk for pathological hips requiring treatment (15.6%), followed by normal weight and breech presentation (7.6%), and then came the term newborns large for GA (5%). The lowest percentage need of subsequent orthopedic treatment was in 66 in small newborns for GA with breech presentation (1.5%). There were no associations with DDH in 230 small GA newborns at term, and in 174 twins.
Conclusion: The results, according to the sonographic types, suggest that high birth weight is a major risk factor of DDH, especially when combined with breech presentation; and an almost 5:1 female preponderance was observed.

Keywords

References

  1. Ortolani M. Congenital hip dysplasia in the light of early diagnosis. Clin.orthop. 1976; 119; 6-10.
  2. Barlow TG. Early diagnosis and treatment of congenital dislocation of the hip joint J Bone joint Surg. 162; 44; 292-301.
  3. Falliner A, Hahne HJ, Hassenpflug J. Sonographic hip screening and early management of developmental dysplasia of the hip pediatr Orthop B. 1999 Apr;8(2): 112-7.
  4. Tönnis D, Storch K, Ulbrich H. Results of newborn screening for CDH with and without sonography and correlation of risk factors pediatr Orthp. 1990 Mar-Apr; 10(2): 145.52.
  5. Bache CE, Clegg J, Herron M. Risk factors for development dysplasia of the hip: Ultrasonographic findings in the neonatal period. J pediatr Orthop B. 2002 Jul; 11(3):212.
  6. Mohammad Schams, Rob Labruyere, Anne Zuse, Mikolaj Walensi.

Diagnosing developmental dysplasia of the hip using the Graf ultrasound method: Risk and protective factor analysis in 11,820 universally screened newborns Eur J pediatr 17. July 2017 Springer.

  1. Von Kries R, Ihme N, Oberle D, Lorani A, Stark R, Altenhofen L, Niethard FU Effect of ultrasound screening on the rate of first operative procedures for development hip Dysplasia in Germany. Lancet. 2003 Dec 6, Vol 362(9399): 1883-7.
  2. Dorn U, Neumann D. Ultrasound for screening developmental dysplasia of the hip: a European perspective Curr Opin pediatr.2005 Feb: 17(1): 30.3.
  3. Synder M, Harcke HT, Domzalski M Role of ultrasound in the diagnosis and management of developmental dysplasia of the hip: an international perspective Orth Clin North Am. 2006 Apr; 37(2): 141-7, v.
  4. Graf R, Tschauner Chr, Klapsch W. Progress in Prevention of Late Developmental Dislocation of the Hip by Sonographic Newborn. Hip “Screening”: Results of a Comparative Follow up Study pediatr Orthop B: 1993; 2: 115-121.
  5. Christoph Thallinger, Renata Pospischill, Rudolf Ganger, Christoph Radler, Christof Krall. Franz Grill Long-term results of a nationwide general ultrasound screening system for developmental Disorders of the hip: the Austrian hip screening program Child Orth0p (2014) 8:3-10.
  6. Thaler, R. Biedermann, J. Lair, M.Krismer, F.Landauer Cost-effectiveness of universal ultrasound screening compared with clinical examination alone in The diagnosis and treatment of neonatal hip dysplasia in Austria Bone Joint Surg(Br) 2011; 93.B: 1126-30.
  7. Terjesen T, Bredland T, Berg V. Ultrasound for hip assessment in the newborn. J Bone Joint Surg (Br) 1989; 71-B: 767-73.
  8. Roovers EA, Boere-ness of ultrasound screening for MM, Castelein RM, Zielhuis GA, Kerkhoff TH Effectiveness of ultrasound screening for developmental dysplasia of the hip Arch Dis Child Fetal Neonatal ED. 2005 Jan; 90(1): F25-3.
  9. Graf R. The diagnosis of congenital hip-Joint dislocation by compound treatment. Arch Orthop Trauma Surg. 1980, 117-33.
  10. Harcke HT, Clarke NM, Lee MS, Borns PF, MacEwen GD Examination of the infant hip with real-time ultrasonography J Ultrasound Med. 1984 Mar; 3(3): 131-7.
  11. Clegg J, Bache CE, Raut VV, Financial Justification for routine ultrasound screening of the neonatal Hip. Bone Joint Surg Br. 1999 Sep, 81(5): 852-7.
  12. Tschauner C, Klapsch W, Baumgartner A, Graf R. Maturation curve of the sonographic alpha angle according to Graf of untreated hip joints in the first year of life. Orthop. 1994; 132(6): 502-4.
  13. Graf R. Hip sonography Diagnosis and management of infant hip dysplasia Springer Verlag 2006.
  14. Graf R, Hammer N, Mathiesen D. An integrated Concept Explaining for Risk Factors Related to the Onset of Developmental Dysplasia of the Hip Joint Ann Orthop Musculoskelet Disord. 2021; 4(1): 1029.
  15. Reinhard Graf, Tamara Seidl Sonographie der Säuglingshüfte Georg Thieme Verlag AG 2022.
  16. Chan A, Mc Caul KA, Cundy PJ, Haan EA, Byron-Scott R Perinatal risk factors for developmental dysplasia of the hip Arch Dis Child Fetal Neonatal Ed 1997: 76: F 94 -F 100 (March).
  17. Holen KJ, Teg nander A, Terjesen T, Johansen OJ, Eik-Nes SH Ultrasonographic evaluation of breech presentation as a risk factor for hip dysplasia Acta Paediatr. 1996 Feb; 85(2):225-9.
  18. Von Deimling U, Brähler JM, Niesen M, Wagner UA, Walpert Effect of birth weight on hip maturation in the newborn infants Klin Paediatr. 1998; 210(3): 115-9.
  19. Ruhmann O, Lazovic D, Bouklas p, Schmolke S, Flamme CH. Ultrasound examination of neonatal hip: correlation of twin pregnancy and congenital dysplasia. Twin Res. 2000 Mar; 3(1): 7-11.
  20. De Pellegrin M, Moharamzadeh D. Development Dysplasia of the hip in twin: The importance of mechanical Factors in the Etiology of DDH J pediatr. Orthop. 2010 30; 774/778.
  21. Graf R. Ultrasound examination of the hip. An Update Orthopade. 2002 Feb; 31(2):181-9.
  22. Gardiner HM, Clarke NM, Dunn PM A sonographic study of the morphology of the preterm Neonatal hip. J Pediatr Orthop B. 1990 Sep-Oct; 10(5): 633-7.
  23. Lubchenco LO, Hansmann C, Dressler M, Boyd E. Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation. Pediatrics 32(1963) 793-800.
  24. Shipman SA, Helfand M, Moyer VA, Yawn BP. Screening for developmental dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force. Pediatrics 2006; 117.557-576.
Journal of Pediatric Perspectives
Volume 11, Issue 12
December 2023
Pages 18398-18405

Files

Share

How to cite

Statistics