Ultrasound technique predicts hip dysplasia in infants

Date:
January 25, 2022
Source:
Radiological Society of North America
Summary:
A technique that uses ultrasound images to determine the depth and
shape of the hip socket can accurately predict which infants with
hip dysplasia will develop normal hip structure and which remain
dysplastic, according to a new study. Researchers said statistical
shape modeling improves on existing techniques and could spare
many infants from unnecessary treatment.



FULL STORY ==========================================================================
A technique that uses ultrasound images to determine the depth and
shape of the hip socket can accurately predict which infants with hip
dysplasia will develop normal hip structure and which remain dysplastic, according to a study in Radiology. Researchers said statistical shape
modeling improves on existing techniques and could spare many infants
from unnecessary treatment.


========================================================================== Developmental dysplasia of the hip occurs when the baby's hip socket
is too shallow to cover the head of the thigh bone. In severe cases,
the thigh bone can become dislocated from the hip entirely. According to
the International Hip Dysplasia Institute, 1 in 10 infants are born with
hip instability, meaning the hips can be wiggled in the socket because
of loose ligaments. After birth, most will tighten up naturally. One in
100 infants will need treatment for hip dysplasia.

There is no consensus on how and when to treat stable hip dysplasia
(Graf type 2, as determined by the Graf classification system). It is
estimated that about 80% of stable Graf 2 hips will develop to normal
without treatment. But since there is currently no way to differentiate
those that will develop to normal in the future compared to those that
will not, a large percentage of stable cases are likely to be overtreated, according to study senior author Ralph J. B.

Sakkers, M.D., Ph.D., from the Department of Orthopedic Surgery
at the University Medical Center Utrecht in Utrecht, the
Netherlands. Overtreatment has significant drawbacks.

"The most important negative consequences of overtreatment are the
financial and logistical burdens for parents and society," Dr. Sakkers
said. "Medical consequences of overtreatment are relatively rare, but
the risk is not zero. If there is a rare medical consequence this would probably be avascular necrosis of the hip due to non-proper use of the treatment device." Avascular necrosis is a disease that results from
the temporary or permanent loss of blood supply to the bone.

The Graf classification system is commonly used to evaluate hip
dysplasia, but it has limitations. Patients are classified into groups
based on acetabular angle appearance on ultrasound images. This angle
is derived from the depth and shape of the socket of the hip bone where
the head of the femur fits. The Graf system is reported to have a high variability and low agreement in all reported hip dysplasia metrics,
and the ultrasound image quality and anatomic appearance of the hip can
be affected by probe positioning.



========================================================================== Statistical shape modeling with ultrasound is an alternative method that quantifies the shape of the image of the hip with multiple reference
points that each have an X and an Y coordinate in the 2D ultrasound
image. It offers potential advantages over existing predictive models.

"By quantifying the shape of the image of the hip with statistical shape modeling, significantly more data are extracted from the ultrasound
images as compared to the current methods used," Dr. Sakkers said.

For the study, Dr. Sakkers and colleagues analyzed the predictive power
of the technique in 97 infants with stable developmental dysplasia of
the hip.

They developed statistical shape modeling on baseline ultrasound images
and then correlated the model with persistent hip dysplasia on ultrasound
after 12 weeks follow-up and residual hip dysplasia on pelvic X-rays
around the age of one year.

The results showed that statistical shape modeling accurately predicted
which hips developed to normal or remained dysplastic. It also identified
hips that benefitted from treatment with the Pavlik harness, a soft
splint that encourages normal development of the hip socket.

Although more research is needed to validate the proof of concept, the
study findings support a future role for statistical shape modeling in
the clinic.

"The method could be automated after validation, similarly to the current automated determination of the skeletal age on X-rays of the hand,"
Dr. Sakkers said.

The researchers hope to prove the robustness of the method with additional research in other patient populations with stable hip dysplasia according
to the Graf classification.

========================================================================== Story Source: Materials provided by
Radiological_Society_of_North_America. Note: Content may be edited for
style and length.


========================================================================== Journal Reference:
1. Joshua M. Bonsel, Willem Paul Gielis, Virginie Pollet, Harrie
H. Weinans,
Ralph J.B. Sakkers. Statistical Shape Modeling of US Images to
Predict Hip Dysplasia Development in Infants. Radiology, 2022;
DOI: 10.1148/ radiol.211057 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/01/220125112527.htm

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