Birthweight correlates to pubo-femoral distances and α angles in hip ultrasound of newborns at 6 weeks of age: a retrospective cohort study

Authors

  • Maria Tirta Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg
  • Michel Bach Hellfritzsch Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus; Department of Radiology, Aarhus University Hospital, Aarhus
  • Rikke Damkjær Maimburg Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus; Department of Midwifery, University College of Northern Denmark, Aalborg; Department of Clinical Medicine, Aarhus University, Aarhus; Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus
  • Mads Henriksen Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus; Department of Radiology, Aarhus University Hospital, Aarhus
  • Natallia Lapitskaya Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus; Department of Radiology, Aarhus University Hospital, Aarhus
  • Søren Kold Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg; Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus https://orcid.org/0000-0002-3387-1473
  • Bjarne Møller-Madsen Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus; Department of Children’s Orthopaedics, Aarhus University Hospital, Aarhus, Denmark https://orcid.org/0000-0003-2913-3707
  • Ole Rahbek Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg; Danish Paediatric Orthopaedic Research, Aarhus University Hospital, Aarhus
  • Hans-Christen Husum Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg; Danish Paediatric Orthopaedic Research, Aarhus University Hospital https://orcid.org/0000-0001-6953-042X

DOI:

https://doi.org/10.2340/17453674.2023.26188

Keywords:

Birthweight, DDH, Hip ultrasound, Paediatric orthopaedics, Risk factors

Abstract

Background and purpose: There is inconsistency in the literature regarding the relationship between increased birthweight and risk of developmental dysplasia of the hip (DDH). We aimed to investigate the correlation between birthweight and pubo-femoral distance (PFD), as well as Graf’s α angle in newborns undergoing hip ultrasound examination at 6 weeks of age.
Patients and methods: Basic newborn characteristics and ultrasound measurements were retrospectively collected during a 1-year study period. We excluded multiple births, newborns born at less than 37 gestational weeks, and incomplete information. Simple and multiple linear regression analyses were performed to evaluate the correlation of birthweight and PFD, and, second, birthweight and α angles including a stratified regression analysis investigating the potential effect modification of sex.
Results: 707 newborns (1,414 hips) were included. Mean birthweight was significantly higher for male newborns (P < 0.001). Increased birthweight was positively correlated to PFD values (crude coefficient 0.21, 95% confidence interval [CI] 0.10–0.32) and the correlation was still present after adjusting for sex, family history, and breech presentation (adjusted coefficient 0.18, CI 0.07–0.29). The stratified α angle model for the males was significant for both the crude coefficient (–0.73, CI –1.28 to –0.19) and the adjusted (–0.59, CI –1.15 to –0.03), and also for the females (crude coefficient –1.14, CI –1.98 to –0.31 and adjusted coefficient –1.15, CI –1.99 to –0.31).
Conclusion: We found that increased birthweight positively correlated to PFD, and negatively correlated to α angle, but this was not of clinical significance.

Downloads

Download data is not yet available.

References

Pollet V, Percy V, Prior H J. Relative risk and incidence for developmental dysplasia of the hip. J Pediatr 2017; 181: 202-7. doi: 10.1016/j.jpeds.2016.10.017. DOI: https://doi.org/10.1016/j.jpeds.2016.10.017

De Hundt M, Vlemmix F, Bais J M, Hutton E K, de Groot C J, Mol B W, et al. Risk factors for developmental dysplasia of the hip: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2012; 165(1): 8-17. doi: 10.1016/j.ejogrb.2012.06.030. DOI: https://doi.org/10.1016/j.ejogrb.2012.06.030

Manoukian D, Rehm A. Oligohydramnios: should it be considered a risk factor for developmental dysplasia of the hip? J Pediatr Orthop B 2019; 28(5): 442-5. doi: 10.1097/BPB.0000000000000624. DOI: https://doi.org/10.1097/BPB.0000000000000624

Barr L V, Rehm A. Should all twins and multiple births undergo ultrasound examination for developmental dysplasia of the hip?: a retrospective study of 990 multiple births. Bone Joint J 2013; 95-B(1): 132-4. doi: 10.1302/0301-620X.95B1.29927. DOI: https://doi.org/10.1302/0301-620X.95B1.29927

Vaquero-Picado A, González-Morán G, Garay E G, Moraleda L. Developmental dysplasia of the hip: update of management. EFORT Open Rev 2019; 4(9): 548-56. doi: 10.1302/2058-5241.4.180019. DOI: https://doi.org/10.1302/2058-5241.4.180019

Graf R. The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg 1980; 97 (2): 117-33. doi: 10.1007/BF00450934. DOI: https://doi.org/10.1007/BF00450934

Quader N, Schaeffer E K, Hodgson A J, Abugharbieh R, Mulpuri K. A systematic review and meta-analysis on the reproducibility of ultrasound-based metrics for assessing developmental dysplasia of the hip. J Pediatr Orthop 2018; 38(6): 305-11. doi: 10.1097/BPO.0000000000001179. DOI: https://doi.org/10.1097/BPO.0000000000001179

Tréguier C, Chapuis M, Branger B, Bruneau B, Grellier A, Chouklati K, et al. Pubo-femoral distance: an easy sonographic screening test to avoid late diagnosis of developmental dysplasia of the hip. Eur Radiol 2013; 23(3): 836-44. doi: 10.1007/s00330-012-2635-7 DOI: https://doi.org/10.1007/s00330-012-2635-7

Husum H C, Hellfritzsch M B, Hardgrib N, Møller-Madsen B, Rahbek O. Suggestion for new 4.4 mm pubo-femoral distance cut-off value for hip instability in lateral position during DDH screening. Acta Orthop 2019; 90(1): 88-93. doi: 10.1080/17453674.2018.1554404 DOI: https://doi.org/10.1080/17453674.2018.1554404

Husum H C, Bach Hellfritzsch M, Maimburg R D, Henriksen M, Lapitskaya N, Møller-Madsen B, et al. Pubo-femoral distances measured reliably by midwives in hip dysplasia ultrasound. Children (Basel) 2022; 9(9): 1345. doi: 10.3390/children9091345. DOI: https://doi.org/10.3390/children9091345

Chan A, McCaul K A, Cundy P J, Haan E A, Byron-Scott R. Perinatal risk factors for developmental dysplasia of the hip. Arch Dis Child Fetal Neonatal Ed 1997; 76(2): F94-100. doi: 10.1136/fn.76.2.f94. DOI: https://doi.org/10.1136/fn.76.2.F94

Hanratty C, Thyagarajan B, Clarke N M, Aarvold A. There is no link between birth weight and developmental dysplasia of the hip. Indian J Orthop 2021; 55(6): 1515-22. doi: 10.1007/s43465-021-00465-8. DOI: https://doi.org/10.1007/s43465-021-00465-8

Orak M M, Karaman O, Gursoy T, Cagirmaz T, Oltulu I, Muratli H H. Effect of increase in birth weight in a newborn on hip ultrasonography. J Pediatr Orthop B 2015; 24(6): 507-10. doi: 10.1097/BPB.0000000000000206. DOI: https://doi.org/10.1097/BPB.0000000000000206

Cuschieri S. The STROBE guidelines. Saudi J Anaesth 2019; 13(Suppl. 1): S31-4. doi: 10.4103/sja.SJA_543_18. DOI: https://doi.org/10.4103/sja.SJA_543_18

Azzopardi T, Van Essen P, Cundy P J, Tucker G, Chan A. Late diagnosis of developmental dysplasia of the hip: an analysis of risk factors. J Pediatr Orthop B 2011; 20(1): 1-7. doi: 10.1097/BPB.0b013e3283415927. DOI: https://doi.org/10.1097/BPB.0b013e3283415927

Dogruel H, Atalar H, Yavuz O Y, Sayli U. Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. Int Orthop 2008; 32(3): 415-19. doi: 10.1007/s00264-007-0333-x. DOI: https://doi.org/10.1007/s00264-007-0333-x

Hinderaker T, Daltveit A K, Irgens L M, Uden A, Reikeras O. The impact of intrauterine factors on neonatal hip instability: an analysis of 1,059,479 children in Norway. Acta Orthop Scand 1994; 65(3): 239-42. doi: 10.3109/17453679408995446. DOI: https://doi.org/10.3109/17453679408995446

Yiv B C, Saidin R, Cundy P J, Tgetgel J D, Aguilar J, McCaul K A, et al. Developmental dysplasia of the hip in South Australia in 1991: prevalence and risk factors. J Paediatr Child Health 1997; 33(2): 151-6. doi: 10.1111/j.1440-1754.1997.tb01019.x. DOI: https://doi.org/10.1111/j.1440-1754.1997.tb01019.x

Bache C E, Clegg J, Herron M. Risk factors for developmental dysplasia of the hip: ultrasonographic findings in the neonatal period. J Pediatr Orthop B 2002; 11(3): 212-18. doi: 10.1097/00009957-200207000-00004. DOI: https://doi.org/10.1097/01202412-200207000-00004

Schams M, Labruyère R, Zuse A, Walensi M. Diagnosing developmental dysplasia of the hip using the Graf ultrasound method: risk and protective factor analysis in 11,820 universally screened newborns. Eur J Pediatr 2017; 176(9): 1193-200. doi: 10.1007/s00431-017-2959-z. DOI: https://doi.org/10.1007/s00431-017-2959-z

Falliner A, Hahne H J, Hassenpflug J. Sonographic hip screening and early management of developmental dysplasia of the hip. J Pediatr Orthop B 1999; 8(2): 112-17. PMID: 10218172 DOI: https://doi.org/10.1097/01202412-199904000-00010

Ban Y, Luan Q, Shi M, Sun B, Li T, Wang Y, et al. Establishing reference values for the pubofemoral distance in normal infant medial hips by ultrasound. Acta Radiol 2021; 62(4): 551-6. doi: 10.1177/0284185120933240. DOI: https://doi.org/10.1177/0284185120933240

Kolb A, Schweiger N, Mailath-Pokorny M, Kaider A, Hobusch G, Chiari C, et al. Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. Int Orthop 2016; 40(1): 123-7. doi: 10.1007/s00264-015-2799-2. DOI: https://doi.org/10.1007/s00264-015-2799-2

Roposch A, Protopapa E, Malaga-Shaw O, Gelfer Y, Humphries P, Ridout D, et al. Predicting developmental dysplasia of the hip in at-risk newborns. BMC Musculoskelet Disord 2020; 21(1): 442. doi: 10.1186/s12891-020-03454-4. DOI: https://doi.org/10.1186/s12891-020-03454-4

Howson C P, Kinney M V, Lawn J. March of Dimes, PMNCH, Save the Children, Born Too Soon: the global action report on preterm birth. WHO 2012.

Falliner A, Hahne H J, Hassenpflug J. Sonographic investigation of anatomical specimens of infant hip joints. J Pediatr Orthop B 2002; 11(3): 192-203. doi: 10.1097/00009957-200207000-00002. DOI: https://doi.org/10.1097/01202412-200207000-00002

Published

2023-12-13

How to Cite

Tirta, M., Hellfritzsch, M. B., Maimburg, R. D., Henriksen, M., Lapitskaya, N., Kold, S., … Husum, H.-C. (2023). Birthweight correlates to pubo-femoral distances and α angles in hip ultrasound of newborns at 6 weeks of age: a retrospective cohort study. Acta Orthopaedica, 94, 594–599. https://doi.org/10.2340/17453674.2023.26188

Issue

Section

Articles

Categories