Developmental Dysplasia of the Hip.

Combined Clinical Screening and Ultrasound of the Hips at risk.

Experience of 14 years.
Nuno Craveiro Lopes, Carolina Escalda, Carlo Villacreses
Orthopaedic Department, Garcia de Orta Hospital, Almada, Portugal

The effectiveness of the ultrasound screening in reducing the cases of late diagnosis of DDH is well
documented.
The protocols of systematic ultrasound screening of all newborns have diminished the rate of false negatives,
but substantially increased the number of children treated without necessity (false positives). By the other side
this kind of protocol has a low cost/effectiveness level, because it is very costly and difficult to implement.
For this reason, as other Authors, we advise the use of ultrasound diagnosis only in newborns where factors of
risk or signals of suspicion had been detected in a systematic clinical screening of all newborns.
The screening protocol that we have implemented in our department has the particularity of including a
double clinical screening: One in the newborn and the second on the developmental consultation.
We present the result of 14 years of experience with the present protocol with a comparative study of 2
periods, one between 1992 and 1994 (3 years) in the beginning of the implementation of the protocol where
318 children in a total of 8761 newborns had been screened and the second period, between 2005 and 2006 (2
years), including 537 screened children in 7828 newborns.
Our screening protocol showed to have a sensitivity (false negatives) equivalent to protocols of the same type
(0,26/1000) but the existence of a second stage of screening made in the developmental consultation, an
authentic "net of security" have detected the cases that had escaped to the initial screening. This fact came to
improve the sensitivity of our protocol to the same values of systematic ultrasound screening (0/1000).
What concerns the specificity (false positives), our screening protocol showed initially a value of about half of
the systematic ultrasound screening (3,4/1000) and the experience earned in the execution and interpretation
of ultrasound examination along the years, came to lower this value for levels of about ¼ of the systematic
ultrasound screening (1,8/1000).
The result of the implementation of this screening protocol in our department, led, along these 14 years, to the
gradual disappearance of the cases of delayed diagnosis that needed surgery, including open reductions,
femoral and pelvic osteotomies, as well as of treatment sequels, namely the aseptic necrosis of the femoral
head.

RC-F-2 weeks Diag.- DDH RC-F-8 weeks Trat.- Fredjka P. RC-F-16 weeks
Ultrasound – Unstable hips Ultrasound – Stable Hips Ultrasound – Normal
α- R- 50,2º ; L- 46,8º α- R- 57,6º ; L- 50,6º α- R- 68,4º ; L- 62,7º
β- R- 60,7º ; L- 74,9º β- R- 42,2º ; L- 28,6º β- R- 32,4º ; L- 33,8º