To investigate the risk factors affecting hip joint development in infants and to compare abnormalities in hip joint development between preterm and term infants.

This retrospective cohort study reviewed the medical records of newborns admitted to the neonatology department of our hospital between January 2019 and January 2020. Hip joint ultrasound screening and follow-up data were collected for each newborn. The enrolled newborns were categorized into two groups: preterm (<37 weeks) and term (≥37 weeks). Hip joint ultrasounds were assessed using the Graf classification criteria.

A total of 955 newborns were included in the study, comprising 393 preterm and 562 term infants. All preterm infants were born at a gestational age over 28 weeks. Among term infants, the proportion of abnormal hip joints during the first and second screenings was significantly higher in singletons than twins (p < 0.05), in non-small for gestational age (non-SGA) infants than SGA infants (p < 0.05), and in females than males (p < 0.0001). By the third screening, the proportion of abnormal hip joints remained significantly higher in females than in males (p < 0.01). In newborns with birth weight percentiles above the 50th percentile (P50), term infants showed a significantly higher proportion of abnormal hip joints than preterm infants during the first screening (P50-P75: 32.1 vs. 15.8%, P75-P90: 36.0 vs. 16.7%, p < 0.01; >P90: 32.1 vs. 15.8%, p < 0.05). During the second screening, term infants in the P50-P75 and P75-P90 percentiles exhibited abnormal hip joint proportions of 27.6 and 34.8%, respectively, which were significantly higher than those in preterm infants (13.9%, p < 0.05; 12.1%, p < 0.01). By the third screening, the proportion of abnormal hip joints in term infants within the P75-P90 percentile was 11.2%, which was significantly higher than that of preterm infants (1.5%, p < 0.05). Overall, preterm infants demonstrated a significantly lower proportion of abnormal hip joints compared to term infants across all four screening time points. By the fourth screening, all abnormal hips in preterm infants had evolved into normal ones according to Graf classification criteria. In contrast, although most abnormal hips in term infants had also resolved, with only 6 of them persisted.

Term singletons, female, and non-SGA infants demonstrated a higher proportion of abnormal hip joints during the early postnatal period. Among neonates born after 28 weeks of gestation, there is no difference in hip development between preterm infants with a birth weight percentile Collapse

Developmental dysplasia of the hip (DDH) is one of the most prevalent skeletal deformities, primarily due to the incompatibility between the acetabulum and femoral head. It includes complete dislocation, partial dislocation, instability with femoral head subluxation, and a range of imaging abnormalities that reflect inadequate acetabular formation. Known risk factors for DDH include positive family history, sex, premature birth, non-cephalic delivery, oligohydramnios, gestational diabetes mellitus, maternal hypertension, associated anomalies, swaddling clothes, intrauterine space restriction, and post-term pregnancy. Various research designs have been employed in DDH studies to identify relevant genes, including candidate gene association studies (CGAS), genome-wide association studies (GWAS), restriction fragment length polymorphism (RFLP), and whole exome sequencing (WES). To date, multiple DDH-associated genes have been identified in various populations. Despite extensive research into the epidemiology, risk factors, and genes associated with DDH, its pathogenesis remains unclear. This study provides a comprehensive summary of DDH research designs and evidence for relevant gene mutations through a PubMed search.

Previous studies have shown that minimizing the length of hospital stay (LOS) following surgical procedures reduces costs and can improve the patients' quality of life and satisfaction. However, this relationship has not been defined following operative treatment for developmental dysplasia of the hip (DDH). Therefore, the purpose of this study was to determine the most important nonmodifiable and modifiable factors that can predispose patients to require a prolonged LOS following hip dysplasia surgery. From 2012 to 2019, a national pediatric database was used to identify pediatric patients who underwent surgery for hip dysplasia. Demographic, clinical, and comorbidity variables were analyzed in a patient cohort who had a normal LOS versus one with an extended LOS using chi-square tests and analysis of variance. Statistically significant variables ( P value <0.05) were inputted into an artificial neural network model to determine the level of importance. Out of 10,816 patients, 594 (5.5%) had a prolonged LOS following DDH surgery. The five most important variables to predict extended LOS following hip dysplasia surgery were increased operative time (importance = 0.223), decreased BMI (importance = 0.158), older age (importance = 0.101), increased preoperative international normalized ratio (importance = 0.096), and presence of cardiac comorbidities (importance = 0.077). Operative time, BMI, age, preoperative international normalized ratio, and cardiac comorbidities had the greatest effect on predicting prolonged LOS postoperatively. Evaluating factors that impact patients' LOS can help optimize costs and patient outcomes.

Alleviating postoperative pain from developmental dysplasia of the hip (DDH) surgery is beneficial for paediatric patients. The most commonly used anaesthetic approach currently is general anaesthesia combined with regional nerve blocks. Existing research primarily focuses on studies comparing regional nerve blocks with placebo controls, or studies comparing two different regional nerve blocking techniques. However, the conclusions from these studies offer limited assistance to clinicians in selecting the safest and most effective nerve block. Therefore, we plan to conduct a systematic review and network meta-analysis to compare the efficacy and safety of different regional nerve blocks in managing postoperative pain in children undergoing surgery for DDH.

We will systematically search the following databases: MEDLINE, Embase, Cochrane Central Register of Controlled Trials via Ovid, as well as the Chinese databases CNKI and Wanfang. We will comprehensively search from the inception of each database to April 2024 and will include randomised controlled trials without restrictions on language or publication status. The primary outcome are postoperative pain scores at 4 hours following surgery. The quality of all included trials will be assessed using version 2 of the Cochrane Randomised Trial Risk of Bias Tool. We will employ the GeMTC package in R software for both direct and indirect comparisons within a Bayesian framework using a random effects model. Additionally, the Confidence in Network Meta-Analysis method will be employed to assess the quality of evidence.

Ethical approval is not required for this study, as it exclusively involves the compilation of published data. We plan to submit our review to academic conferences and peer-reviewed scholarly journals.

CRD42024527459.

Background: Graf ultrasound screening is considered an established method for early detection of developmental dysplasia of the hip (DDH). Although characterized by a high degree of standardization to allow for good reproducibility of results, examination-related factors may still affect sonographic measurements. The relative tilt angle between the hip and the probe is a potential pitfall as it significantly influences sonographic measurements and consequently classification of DDH according to Graf. Objectives: Evaluation of an electronic guidance system developed to reduce relative tilt angles and increase reliability and comparability in ultrasound screening of DDH. Materials and Methods: Twenty-five newborns were examined using a prototype guidance system, which tracks the position of the transducer and the pelvis to calculate the relative tilt angles. Two ultrasound images were obtained, one conventionally and the other one using the guidance system. Subsequently, relative roll and pitch angles and sonographic measurements were determined and analyzed. Results: The relative inclination angles in the conventional group ranged from -12.6° to 14.3° (frontal plane) and -23.8° to 32.5° (axial plane). vs. -3.7° to 3.0° and -3.2° to 4.5° in the guidance system group. The variances were significantly lower in the guidance system-assisted group for both planes (p < 0.001 and p < 0.001, respectively). The optimized transducer position showed significant effects and consequently significantly reduced alpha angles were observed (p = 0.001, and p = 0.003). Conclusions: The guidance system allowed a significant reduction in the relative tilt angles, supporting optimal positioning of the transducer, resulting in significant effects on Graf sonographic measurements. This technique shows great potential for enhancing the reproducibility and reliability of ultrasound screening for DDH.

Background: Developmental hip dysplasia is a common condition with preventable causes, and its etiology is still not fully elucidated. In our study, we aimed to examine the use of synthetic oxytocin during childbirth as a potential risk factor for developmental hip dysplasia. Methods: This study involved comprehensive hip examinations on postnatal days 0, 14, 30, and 60, as well as hip ultrasonography results at 6-8 weeks. We specifically focused on healthy girls born with vaginal deliveries, comparing those who were applied with a low-dose oxytocin induction protocol (Group 2) and those who had vaginal deliveries without induction (Group 1). Results: When the examination findings were compared with the hip ultrasonography findings (Type 2a was detected in the left hip of one patient (6.3%) in Group 1 and in the right hip of two patients (11.8%) in Group 2), it was seen that oxytocin induction did not cause a risk for developmental hip dysplasia. The oxytocin induction rate was higher in newborns weighing more than 3400 g (p = 0.04). Conclusions: A low-dose oxytocin protocol applied at birth has not been shown to harm the hip joint in the neonatal period and on ultrasonographic α and β angle measurements applied at 6-8 weeks. However, our study also highlights the need for new studies investigating oxytocin peripheral receptors and their effects, underscoring the importance of our findings in guiding future research in this area.

To clarify the efficacy of artificial intelligence (AI)-assisted imaging in the diagnosis of developmental dysplasia of the hip (DDH) through a meta-analysis.

Relevant literature on AI for early DDH diagnosis was searched in PubMed, Web of Science, Embase, and The Cochrane Library databases until April 4, 2024. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess the quality of included studies. Revman5.4 and StataSE-64 software were used to calculate the combined sensitivity, specificity, AUC value, and DOC value of AI-assisted imaging for DDH diagnosis.

The meta-analysis included 13 studies (6 prospective and 7 retrospective) with 28 AI models and a total of 10,673 samples. The summary sensitivity, specificity, AUC value, and DOC value were 99.0% (95% CI: 97.0-100.0%), 94.0% (95% CI: 89.0-96.0%), 99.0% (95% CI: 98.0-100.0%), and 1342 (95% CI: 469-3842), respectively.

AI-assisted imaging demonstrates high diagnostic efficacy for DDH detection, improving the accuracy of early DDH imaging examination. More prospective studies are needed to further confirm the value of AI-assisted imaging for early DDH diagnosis.

Background Timely diagnosis of developmental dysplasia of the hip (DDH) is crucial for implementing less invasive treatment. However, socioeconomic barriers may lead to late diagnoses. The Area Deprivation Index (ADI) is an indicator of the socioeconomic challenges experienced by patients and their families. The primary objective is to investigate if the age at which DDH is diagnosed and the treatment protocol are influenced by the ADI or the insurance type. Materials and methods Using International Classification of Diseases-Tenth Edition (ICD-10) codes, newly diagnosed DDH patients (age under 10 years) from 2020 to 2023 were retrospectively identified at our pediatric tertiary center. Patients were categorized into four groups based on ADI percentile: (1) 1-10th percentile, (2) 11-20th percentile, (3) 21-40th percentile, and (4) 41-100th percentile. They were also stratified by insurance type. Age at diagnosis and treatment protocol (non-operative vs. operative) were collected and compared between the different ADI groups and insurance groups. Operative treatment was defined as open reduction with or without femoral/pelvic osteotomy. Results A total of 327 patients satisfied the inclusion criteria and had available ADI scores for analysis. The average age at diagnosis was notably lower in ADI group 1 compared to all other ADI groups (p < 0.05) and considerably lower for patients with commercial insurance compared to those with public (p = 0.0002). The rate of surgical treatment was markedly lower in ADI group 1 compared to ADI groups 2 and 3 (both p < 0.05) and notably lower for those with commercial insurance compared to public (p = 0.0005). ADI groups 2-4 showed no significant differences in average age at diagnosis or surgical treatment rate. Conclusion The study demonstrates that socioeconomic factors affect the diagnosis and, consequently, the treatment course of DDH. Specifically, patients residing in areas with lower levels of deprivation tend to be diagnosed at a younger age and undergo surgical treatment less frequently.

Objectives Developmental dysplasia of the hip (DDH) encompasses a spectrum of abnormalities in the immature hip. Surgical intervention is indicated if conservative management fails. Despite the increased supply of pediatric orthopedic surgeons (POSs) over the last few decades, there continues to be a maldistribution of surgeons. The purpose of this study is to determine outcomes following surgical management of hip dysplasia by POSs compared to non-pediatric orthopedic surgeons. Methods Pediatric patients who underwent surgical treatment for hip dysplasia from 2012 to 2019 were identified using a large national database. Patient demographics, comorbidities, and postoperative complications were compared by pediatric versus nonpediatric-trained orthopedic surgeons. Bivariate and multivariable regression analyses were performed. Results Of the 10,780 pediatric patients who underwent hip dysplasia surgery, 10,206 patients (94.7%) were operated on by a POS, whereas 574 (5.3%) were operated on by a non-pediatric orthopedic surgeon. POSs were more likely to operate on patients with a higher American Society of Anesthesiologists class (p<0.001) and those with a greater number of medical comorbidities, including cardiac (p=0.001), gastrointestinal (p=0.017), and neurological (p<0.001). Following analysis using multivariable regression models to control for patient baseline characteristics, there were no differences in any postoperative complications between patients treated by pediatric-trained and nonpediatric-trained orthopedic surgeons. Conclusions Compared to non-pediatric orthopedic surgeons, POSs were more likely to operate on younger patients with increased medical comorbidities. However, there were no differences in postoperative complications following surgical management for DDH in patients treated by nonpediatric and pediatric orthopedic surgeons.

Ultrasound hip screening is suitable for the early identification of developmental dysplasia of the hip (DDH). Newborn and infant home visits are good opportunities for hip screening in the community, but studies focusing on nurse-led screenings are lacking. Based on a pre-post design, this study aims to develop and evaluate an ultrasound training program to improve nurses' assessment skills in detecting DDH cases during newborn and infant home visits. Said educational program will include e-learning, hands-on seminars, and clinical training. The primary outcome will be the success rate of imaging standard planes (standardized images for hip assessment) in clinical training. The secondary outcomes will include knowledge test results, objective structured clinical examination scores, time required for imaging, and inter-rater reliability between nurses and physicians. The educational program will address the issue of missed and late detection of DDH cases in resource-limited communities. This study will demonstrate the feasibility of procedures and the effectiveness of the educational program in 2024. The protocol was registered in the University Hospital Medical Information Network Clinical Trial Registry before starting the study (no. UMIN000051929, 16 August 2023).