Ultrasound Screening for DDH Time for a Paradigm Change?

Daniel Weigl 1,2 Elhanan Bar-On 1,2 Yael Gelfer 3 Eyal Mercado 1 Karen Daly 3 Tali Becker 1
1Pediatric Orthopedics, Schneider Children's Medical Center, Israel
2Sackler Medical School, Tel Aviv University, Israel
3Pediatric Orthopedics, St Georges Hospital NHS Trust, UK

Background: The policy for ultrasound screening in Israel and the United Kingdom includes mandatory clinical screening with ultrasound referral in selected cases based on risk factors and clinical findings.

Purpose: The purpose of this study was to evaluate the ability of this policy to detect DDH.

Methods: The study was a binational multicenter retrospective study. Patient cohorts were:

1. Patients treated in a community clinic in Zichron Yaakov (ZY) – Israel ( 2009 -2016)

2. Patients treated for DDH in the operating theatre at Schneider Children’s medical Center in Petah Tikva – Israel (1996 - 2016 )(SCMC)

3. Patients treated for DDH in the operating theatre at St Georges Hospital in London – UK (1997 – 2016) (SGH)

All available medical records were examined and telephone interviews of parents were performed for missing information.

Data collected included patient demographics, age at diagnosis, and means of diagnosis – clinical vs US. Risk factors recorded included breech presentation, multiple fetus pregnancy,

Family history of DDH, torticollis and foot deformity.

Results: 370 patients were included. (150 SCMC, 147 SGH, 73 ZY)Mean age at diagnosis was 25 weeks (0-141) with significant differences between the groups. (ZY=4, SCMC=14, SGH=47). Risk factors for DDH were found in 171 patients (46%). Risk factor frequency was: Breech presentation - 20%, family history -16%, torticollis – 6% multi-fetus pregnancy – 4% and foot deformity – 4%. 33% had 1 risk factor, 11% had 2 and 2% had 3 or more. 199 patients (54%) had no risk factors for DDH.

Conclusions: Selective ultrasound screening based on known risk factors for DDH will fail to detect 54% of patients. A change of paradigm in the approach to US screening for DDH should be considered. The option of universal US screening should be examined in order to avoid late detection and resultant long term morbidity.