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Neonatal screening for congenital hip dysplasia

Congenital hip dysplasia (CHD) is the most common congenital musculoskeletal disorder in newborns. The term “congenital” indicates the presence of the condition at birth, with cases of late-onset development being extremely rare.

The disease includes scenarios ranging from minor alterations of the acetabulum to complete dislocation of the femoral head. In other words, due to acetabular instability, it tends to “slide upward,” leading to subluxation (partial displacement) and even dislocation (complete displacement). If left untreated, CHD can lead to limping, severe functional limitations starting from the onset of walking, and early hip arthritis in young adults.

For this reason, in Anglo-Saxon countries, the term “evolutionary” is associated with this condition, referring to the case history of a worsening condition after birth, especially in the event of delayed intervention.

WHAT ARE THE CAUSES OF HIP DYSPLASIA?

Considered a multifactorial condition, dysplasia has several risk factors: female gender (girls, due to the laxity characterizing their ligaments, have a higher incidence), family history (parents, grandparents, or first-degree cousins), pregnancy or delivery type (neonates with: breech presentation, prolonged oligohydramnios, twin pregnancy, first-born, premature rupture of membranes, excessive weight), other skeletal abnormalities.

Note: Over 30% of hip dysplasias can occur without any risk factors.

WHAT CAN BE DETECTED THROUGH AN ULTRASOUND?

Ultrasound can detect even minimal alterations of the acetabulum and accurately visualize the bony and cartilaginous components of the infant hip, as well as recognize all possible abnormalities from the early days of life.

The Graf technique is currently the most widely used technique worldwide, as well as the most standardized and reliable. This technique, initially used mainly in Italy and Germany, has spread worldwide over the years. Executable rapidly, the Graf technique allows detailed visualization of the morphology of all joint components through careful angular measurement of the bony and cartilaginous components of the acetabulum. This technique enables the distinction between normal and pathological conditions according to an increasing severity index.

Therapy is most effective when treatments begin early, within the first month.

In the presence of hip dislocation at birth, anatomical alterations secondary to femoral head dislocation are not yet consolidated, whereas they can be when therapy begins late, after the 2nd-3rd month of the child’s life.

The 6th week of life has been identified as the ideal limit by which to reach the diagnosis and start treatment; beyond this age, the certainty of complete normalization in response to therapy decreases.

RECOMMENDATIONS TO FOLLOW

Here is a summary of the “evidence-based” recommendations regarding the clinical and ultrasound screening of CHD.

Clinical screening for all newborns (to check for signs of hip instability, such as the Ortolani and Barlow signs)
Ultrasound examination within the first 15 days of life in the presence of positive clinical signs (Ortolani, Barlow) or doubts, or in the presence of universally recognized risk factors (family history and breech presentation regardless of gender)
Ultrasound examination for all newborns within the 6th week of life and in any case not later than 8 weeks (because in the absence of clinical signs and risk factors, dysplasia may still be present, and even in the case of severe dysplasia, early treatment is still possible at an age where the potential for hip healing is still very high).

MiniHospital “Sandro Pertini” is a center of excellence for performing ultrasound screening and total treatment of congenital hip dysplasia. For more information, fill out the form and submit your request; you will receive all the information you need.

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