Family history in developmental dysplasia of the hip: should we follow-up?

Abstract

Objectives: Developmental dysplasia of the hip (DDH) is an important problem. Ultrasonography (US) is aproper method before 6 months of age. For older children, plain radiographs can be useful. Six risk factors areemphasized: breech presentation, female sex, a positive family history, being first-born, left hip affected, andmode of delivery. In some centers, clinicians prefer to perform a control US examination or pelvic radiographsafter 6 months of age for the children having a positive family history. We aimed to evaluate the necessity ofcontrol US/direct radiography examinations.Methods: A total of 205 children with a positive family history for DDH are included. US examinations areperformed according to Graf’s method. We have evaluated direct radiographs by using Hilgenreiner, Perkin,and Shenton lines, acetabular angle.Results: Initial US examinations are performed at a median age of 8.3 weeks. Seventy-four patients (36%)had a repeat ultrasound scan at a median age of 7 months; none of them demonstrated abnormal findings. Onehundred and thirty-one patients (63.9%) had control radiographs at a median age of 8.2 months. Shenton lineis considered as normal, and the upper femoral epiphysis is located in inferomedial quadrant according toHilgenreiner and Perkin lines.Conclusions: A positive family history for DDH may be a less important reason for performing control US orradiographic examination. Patients with a normal screening US result and having risk factors can be dischargedfrom follow up safely, so that unnecessary examinations and family anxiety will be reduced.