Can the increase in the use of perinatal hip sonography really reduce the number of developmental hip dislocations needing closed/open reduction? The experience of a large Italian pediatric hospital.

Abstract

Perinatal hip sonography (PHS) is not mandatory in Italy, but during the last years, it has been performed increasingly more even in babies with negative Ortolani maneuver. We aimed to investigate whether the increased use of PHS decreased the number of Graf's type IV hips needing closed/open reduction (COR) at the Bambino Gesù Hospital of Rome, Palidoro (BGHRP). We consulted the BGHRP database from 2012 to 2022 to determine the number of patients with Graf's type IV hips who had COR; the COR patients who had PHS done inside and outside the hospital; the patients who had brace treatment after PHS with a diagnosis of DDH. The hospital's sonographers were ascertained to be experts in Graf's method because they had attended several instructional courses, while the sonographers operating in other centers had not received this training. Sixty-three patients with Graf's type IV hips had COR from 2012 to 2016 while 31, from 2017 to 2022. The difference was significant ( P  = 0.009). The 67 patients with COR who came to BGHRP for follow-up were divided into two groups. Group 1 included 61 patients who had PHS done outside the hospital. In those patients, several DDH had a wrong diagnosis and none had brace treatment. Group 2 included six patients out of the 277 with DDH who had PHS done at BGHRP and who received brace treatment. The difference between the two groups was significant ( P  < 0.001). To decrease the number of dislocated hips needing COR, an increased use of PHS is not sufficient but it is also necessary that sonographers must be experts in Graf's method and aware of DDH treatment.