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Title: Does selective ultrasound imaging of 'at risk' hips and clinically unstable hips, in developmental dysplasia of the hip (DDH) produce an effective screening programme?
Author: Paton, Robin William
Awarding Body: Lancaster University
Current Institution: Lancaster University
Date of Award: 2011
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Aim: A 10 year prospective, observational, longitudinal cohort study was undertaken. All clinically unstable hip joints and those with 'risk factors' were selectively screened for Developmental Dysplasia of the Hip (DOH) in a specialised Paediatric Orthopaedic clinic. The main 'risk factors' included breech presentation, strong family history, certain foot deformities [Congenital Talipes Equino Varus (CTEV), Congenital Talipes Calcaneo-valgus (CTCY), postural talipes equinovarus (TEV)] and oligohydramnios. Other lesser 'risk factors' (torticoliis, metatarsus adductus) and miscellaneous factors (clicky hip joints, limited hip abduction) were in addition screened. Method: From the 37,510 births there were 130 referred as clinically unstable and 2826 neonates/infants whose hips were sonographically screened. Data recorded included the presence of clinical hip instability or 'risk factors', the gender, the race, the age, the sonographic results (primary and secondary scans), type of referral (GP or Paediatricians) and the side of pathology. Pathological DDH comprised Graf Type Ill, IV sonographic abnormalities and irreducible hip dislocation. Results: Males with 'pure' risk factors (without clinical instability) were not at risk and their hips should not be routinely imaged by ultrasound (Breech 1:594, family history 1:99, CTCV 0). There was an equivocal case to be made for selective hip screening in females with certain risk factors (without clinical instability, Breech 1:32, family history 1:28, CTCV 1:52). Possible 'risk factors' of TEV, CTEV, 'clicky' hips and oligohydramnios were not identified as 'true' risk factors. Oligohydramnios is defined as a lack of amniotic fluid around the foetus Primary neonatal clinical hip screening was more effective at identifying cases of pathological DDH than 'at risk' sonographic screening (clinical screen in g: sensitivity of 66%, the specificity of 99.77% and PPY of 27.97%) The General Practitioner 6-8 week clinical hip check was ineffective as a screening programme and is not recommended (only identified one non- surgically treatable case in 10 years). Conclusion: Selective sonographic screening of conventional 'at risk' factors does not improve the effectiveness of the established 'best practise' clinical hip joint screening programmes (with the outcome measure of irreducible hip dislocation).
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available