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The early diagnosis of developmental Dysplasia of Hip (DDH) remains elusive. In the absence of symptoms, early signs need heightened awareness and an astute clinical examination.

Every newborn child must be examined for hip instability by the Barlow and Ortolani tests. Periodic examination of the lower limbs for limb length discrepancy, restricted hip abduction, thigh or gluteal crease asymmetry must alert the examiner to rule out hip dysplasia. In a walking child with unilateral DDH the limp is obvious, and the Trendelenburg sign is positive. In bilateral DDH, limitation of hip abduction and waddling gait with increased lumbar lordosis are the only early discernible signs. Often the care-giver or parents notice the subtle changes of limb asymmetry and bring to the notice of the primary care doctors. These early signs must not be ignored to prevent late presenting DDH.

This article highlights the signs of DDH that every clinician dealing with children must be well-versed.

The online version contains supplementary material available at 10.1007/s43465-021-00528-w.

The online version contains supplementary material available at 10.1007/s43465-021-00528-w.

The growth and development of the acetabulum in children with developmental dysplasia of hip (DDH) depends upon the extent of concentric reduction. Children in walking age often need open reduction with or without additional osteotomies to obtain congruous, stable reduction. The purpose of this study was to evaluate acetabular development in late diagnosed DDH treated by open reduction with or without femoral osteotomy.

This is a retrospective study of 29 children (40 hips) with idiopathic DDH, previously untreated managed by open reduction with or without femoral osteotomy. We analyzed preoperative and yearly postoperative radiographs up to 6years of age for acetabular development by measuring acetabular index. Acetabular remodeling was assessed with a graphical plot of serial mean acetabular index. Those with AI < 30° at outcome measure point of 6years of patient age were considered to have satisfactory acetabular remodeling.

Mean age of surgery was 26.8months. Open reduction alone was done in 14 hble acetabular development. Femoral osteotomy when required along with open reduction may suffice to address acetabular dysplasia found in the initial years of management of DDH.

Leg-length difference (LLD) is common in patients with developmental dysplasia of the hip (DDH). LLD of > 1cm at skeletal maturity is reported in > 40% of patients, with the majority related to ipsilateral overgrowth. A longer DDH leg might lead to excessive mechanical loading at the acetabular margin, resulting in compromised acetabular development. We hypothesised that the LLD would negatively influence acetabular development. If so, it would be advantageous to identify such patients early in the course of follow-up, and address this if necessary.

A retrospective study was conducted on a consecutive series of DDH patients managed surgically at the Royal National Orthopaedic Hospital, Stanmore, United Kingdom. We included patients with adequate long-leg radiographs at the age of 4-8years (early-FU) and skeletal maturity (final-FU). Bilateral cases and those who underwent surgical procedures for hip dysplasia during the follow-up period were excluded. Measurements including leg length and centre-edge online version contains supplementary material available at 10.1007/s43465-021-00492-5.

The online version contains supplementary material available at 10.1007/s43465-021-00492-5.

Since 2017, five Indian centres have enrolled into the International Hip Dysplasia Registry for prospective collection of data on Developmental Dysplasia of Hip (DDH).

To assess how baseline patient characteristics and initial treatment modalities differ across these five centres.

Registry data collected over 3 years were analyzed. Children with DDH that had radiograph-based diagnoses were included.

Collectively, there were 234 hips (181 patients), of which 218 had undergone surgery. Overall, median age at presentation was 25.3months (IQR 16.8-46.0); female/male ratio was 2.61 (range 1.46-4.751); with 42%, 29%, and 29% unilateral left, bilateral and unilateral right hip dislocations respectively. Most were IHDI grade III and IV dislocations (94%). Closed reduction was performed at all but one centre, at median 15.3months (IQR 9.6-21.1). Open reduction (OR) as a stand-alone procedure was performed at all centres, at median 20.8months (IQR 15.4-24.9). Combination of OR with a single osteotomy, femoral (FO) or acetabular (AO), was performed at all centres at median 29.7months (IQR 22.1-43.5). However, for the same age group, three centres exclusively performed FO, whereas the other two exclusively performed AO. The combination of OR with both FO and AO was used at all centres, at median 53.4months (IQR 42.1-70.8).

The preliminary findings of this multi-centre study indicate similar patient demographics and diagnoses, but important differences in treatment regimens across the five Indian centres. Comparison of treatment regimens, using the 'centre' as a predictive variable, should allow us to identify protocols that give superior outcomes.

The preliminary findings of this multi-centre study indicate similar patient demographics and diagnoses, but important differences in treatment regimens across the five Indian centres. Lapatinib price Comparison of treatment regimens, using the 'centre' as a predictive variable, should allow us to identify protocols that give superior outcomes.

Since it is fast, inexpensive and increasingly portable, ultrasound can be used for early detection of Developmental Dysplasia of the Hip (DDH) in infants at point-of-care. However, accurate interpretation\is highly dependent on scan quality. Poor-quality images lead to misdiagnosis, but inexperienced users may not even recognize the deficiencies in the images. Currently, users assess scan quality subjectively, based on image landmarks which are prone to human errors. Instead, we propose using Artificial Intelligence (AI) to automatically assess scan quality.

We trained separate Convolutional Neural Network (CNN) models to detect presence of each of four commonly used ultrasound landmarks in each hip image straight horizontal iliac wing, labrum, os ischium and midportion of the femoral head. We used 100 3D ultrasound (3DUS) images for training and validated the technique on a set of 107 3DUS images also scored for landmarks by three non-expert readers and one expert radiologist.

We got AI ≥ 85% accuracy for all four landmarks (ilium = 0.89, labrum = 0.94, os ischium = 0.85, femoral head = 0.98) as a binary classifier between adequate and inadequate scan quality. Our technique also showed excellent agreement with manual assessment in terms of Intraclass Correlation Coefficient (ICC) and Cohen's kappa coefficient (

) for ilium (ICC = 0.81,

 = 0.56), os ischium (ICC = 0.89,

 = 0.63) and femoral head (ICC = 0.83,

 = 0.66), and moderate to good agreement for labrum (ICC = 0.65,

 = 0.33).

This new technique could ensure high scan quality and facilitate more widespread use of ultrasound in population screening of DDH.

The purpose of this retrospective diagnostic study was to investigate whether or not assessment variabilities occurred in hip ultrasonography (US) by the Graf method between the examiners having (CC) and not having (NoCC) additional special hands-on course trainings by the authorized trainers.

Randomly selected 270 hip sonograms of 135 babies were independently assessed by CC and NoCC according to the Graf method.

An inconsistency between CC and NoCC regarding the US diagnosis was seen in 128 hips (47%). This was mainly due to the fact that CC considered 120 of 128 sonograms unusable according to the checklist of the Graf's examination technique. Probe tilting errors followed by non-visualization of lower limb of os ilium as well as of chondroosseous junction were the most noticed technical problems by CC. There was a significant difference between CC and NoCC concerning the measurement of beta angle. This was mainly due to discordance between the groups about identifying the "bony rim" point.

Significant hip US image assessment variabilities exist between the examiners having further trainings by the authorized trainers in special hands-on courses and the examiners having no further trainings in special hands-on courses in the Graf method. The findings of this study may emphasize the importance of training the hip US practitioners in the special hands-on courses for providing a standard clinical practice as well as for avoiding the assessment variabilities between the examiners in the Graf method.

Significant hip US image assessment variabilities exist between the examiners having further trainings by the authorized trainers in special hands-on courses and the examiners having no further trainings in special hands-on courses in the Graf method. The findings of this study may emphasize the importance of training the hip US practitioners in the special hands-on courses for providing a standard clinical practice as well as for avoiding the assessment variabilities between the examiners in the Graf method.

The best treatment option in children with late detected DDH is still a subject of much controversy and only few studies have investigated the long-term outcome of treatment in such patients. We performed a systematic review to assess long-term outcome of late detected DDH hips treated after walking age.

Studies met inclusion criteria if they (1) reported at least 30 hips treated; (2) included children aged between 9months and 12years; (3) treatment indication was late detected DDH after walking age; (4) presented a minimum follow-up of 10years; (5) reported a clinical or radiological outcome. The Kaplan-Meier method was used to evaluate long-term survival according to clinical and radiological outcomes. The rate of total hip replacement (THR) was retrieved.

From a total of 6561 articles, 13 articles with grade IV level of evidence were included in our review. A total of 988 hips in 800 patients with a mean follow-up of 27.9years (range 10-67) were included. The mean age at surgery was 3.3years (range, 9months-12years). The rate of THR increased according to the length of final follow-up. In particular, all studies reported no case of THR at 23.5years of follow-up, a rate of 10.2% of THR between 30 and 40years of follow-up and a rate of 35.6% of THR in patients with follow-up more than 40years.

In patients with late detected DDH, most THR became necessary more than 30years after the index procedure and their number increased further after 40years and more of follow-up. Late detected DDH diagnosed after walking age is a life-long disease.

In patients with late detected DDH, most THR became necessary more than 30 years after the index procedure and their number increased further after 40 years and more of follow-up. Late detected DDH diagnosed after walking age is a life-long disease.

Residual acetabular dysplasia occurs in up to a third of patients treated successfully for developmental dysplasia of the hip (DDH) and has been found to be a significant risk factor for early hip osteoarthritis (OA).

Age at the time of initial reduction and the initial severity of DDH have been linked to residual acetabular dysplasia. An anteroposterior pelvic radiograph is the main diagnostic modality, but MRI also provides valuable information, particularly in equivocal cases. The literature supports intervening when significant residual acetabular dysplasia persists at 4-5 years of age, and common surgical indications include acetabular index (AI) > 25°-30°, lateral center-edge angle (LCEA) < 8°-10°, and a broken Shenton's line on radiographs; and a cartilaginous acetabular angle (CAI) > 18°, cartilaginous center-edge angle (CCE) < 13°, and/or the presence of high-signal intensity areas on MRI. Surgical options include redirectional pelvic osteotomies and reshaping acetabuloplasties, which provide comparable radiographic and clinical results.