Increased Diagnostic Information and Understanding Disease: Uncertainty in the Diagnosis of Developmental Hip Dysplasia

Published Online:Feb 1 2007https://doi.org/10.1148/radiol.2422051937

Abstract

Great advances have been made in developing strategies to improve the quality of medical care in the past decade; these advances include better diagnostic technologies, such as ultrasonography (US), computed tomography, and magnetic resonance imaging. Although these tests provide new information on many conditions, such as developmental dysplasia of the hip (DDH), the differentiation of what is normal, what is abnormal, and what is disease is no longer intuitive. Historically, the diagnosis of DDH was straightforward. The diagnosis was based primarily on clinical findings, which were often confirmed with radiography. Abnormal hips were either subluxated or dislocated and, if left untreated, adverse consequences were certain in either situation. Since the introduction of hip US, however, increased diagnostic sophistication has led to uncertainty as to how to interpret the continuous spectrum of acetabular morphology. There is no consensus on the degree of acetabular dysplasia that does or does not require treatment. Because not every abnormal finding may require treatment, the terms abnormality and disease are not synonymous.

References

1 Perkins G. Signs by which to diagnose congenital dislocation of the hip: 1928. Clin Orthop Relat Res 1992;274:3–5. Medline, Google Scholar
2 Feinstein AR, Sosin DA, Wells CK. The Will Rogers phenomenon: improved technologic diagnosis and stage migration as a source of nontherapeutic improvement in cancer prognosis. Trans Assoc Am Physicians 1984;97:19–24. Medline, Google Scholar
3 Roposch A. Twenty years of hip ultrasonography: are we doing better today? J Pediatr Orthop 2003;23:691–692. Crossref, Medline, Google Scholar
4 Graf R. Classification of hip joint dysplasia by means of sonography. Arch Orthop Trauma Surg 1984;102:248–255. Crossref, Medline, Google Scholar
5 Morin C, Harcke HT, MacEwen GD. The infant hip: real-time US assessment of acetabular development. Radiology 1985;157:673–677. Link, Google Scholar
6 Terjesen T, Bredland T, Berg V. Ultrasound for hip assessment in the newborn. J Bone Joint Surg Br 1989;71:767–773. Medline, Google Scholar
7 Lindner JR. Molecular imaging with contrast ultrasound and targeted microbubbles. J Nucl Cardiol 2004;11:215–221. Crossref, Medline, Google Scholar
8 Tehranzadeh J, Ashikyan O, Dascalos J. Advanced imaging of early rheumatoid arthritis. Radiol Clin North Am 2004;42:89–107. Crossref, Medline, Google Scholar
9 Tonnis D, Storch K, Ulbrich H. Results of newborn screening for CDH with and without sonography and correlation of risk factors. J Pediatr Orthop 1990;10:145–152. Crossref, Medline, Google Scholar
10 Agich GJ. Toward a pragmatic theory of disease. In: Humber JM, Almeder RF, eds. What is disease? Totowa, NJ: Humana, 1997; 221–246. Google Scholar
11 Agich GJ. Evaluative judgement and personality disorder. In: Sadler JZ, Schwartz MA, Wiggens OP, eds. Philosophical perspectives on psychiatric diagnostic classification. Baltimore, Md: Johns Hopkins University Press, 1994; 233–245. Google Scholar
12 Temple LK, McLeod RS, Gallinger S, Wright JG. Essays on science and society: defining disease in the genomics era. Science 2001;293:807–808. Crossref, Medline, Google Scholar
13 Lijmer JG, Mol BW, Heisterkamp S, et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA 1999;282:1061–1066. Crossref, Medline, Google Scholar
14 Buckley G. Revalidation is the answer. BMJ 1999;319:1145–1146. Crossref, Medline, Google Scholar
15 Catterall A. The early diagnosis of congenital dislocation of the hip. J Bone Joint Surg Br 1994;76:515–516. Medline, Google Scholar
16 Davies SJ, Walker G. Problems in the early recognition of hip dysplasia. J Bone Joint Surg Br 1984;66:479–484. Crossref, Medline, Google Scholar
17 Herring JA. Tachdjian's pediatric orthopaedics. 3rd ed. Philadelphia, Pa: Saunders, 2002. Google Scholar
18 Dysplasia. On-line medical dictionary. The CancerWEB Project Web site. http://cancerweb.ncl.ac.uk/omd/index.html. Updated November 18, 1997. Accessed August 8, 2004. Google Scholar
19 Clouser KD, Culver CM, Gert B. Malady. In: Humber JM, Almeder RF, eds. What is disease? Totowa, NJ: Humana, 1997; 175–217. Google Scholar
20 Weinstein SL, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation. I. Instr Course Lect 2004;53:523–530. Google Scholar
21 Wedge JH, Wasylenko MJ. The natural history of congenital disease of the hip. J Bone Joint Surg Br 1979;61-B:334–338. Crossref, Medline, Google Scholar
22 Weinstein SL. Natural history of congenital hip dislocation (CDH) and hip dysplasia. Clin Orthop Relat Res 1987;225:62–76. Medline, Google Scholar
23 Lievense AM, Bierma-Zeinstra SM, Verhagen AP, Verhaar JA, Koes BW. Influence of hip dysplasia on the development of osteoarthritis of the hip. Ann Rheum Dis 2004;63:621–626. Crossref, Medline, Google Scholar
24 Lane NE, Lin P, Christiansen L, et al. Association of mild acetabular dysplasia with an increased risk of incident hip osteoarthritis in elderly white women: the study of osteoporotic fractures. Arthritis Rheum 2000;43:400–404. Crossref, Medline, Google Scholar
25 Reijman M, Hazes JM, Pols HA, Koes BW, Bierma-Zeinstra SM. Acetabular dysplasia predicts incident osteoarthritis of the hip: the Rotterdam study. Arthritis Rheum 2005;52:787–793. Crossref, Medline, Google Scholar
26 Inoue K, Wicart P, Kawasaki T, et al. Prevalence of hip osteoarthritis and acetabular dysplasia in French and Japanese adults. Rheumatology (Oxford) 2000;39:745–748. Crossref, Medline, Google Scholar
27 Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip: a study of radiographic factors that predict the outcome. J Bone Joint Surg Am 1995;77:985–989. Crossref, Medline, Google Scholar
28 Graf R, Scott S, Farkas P, Lercher K, Tschauner C, Benaroya A. Manual for hip sonography. Stolzalpe, Austria: Stolzalpe, 1999. Google Scholar
29 Fletcher RH, Fletcher SW, Wagner EH. Clinical epidemiology: the essentials. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 1996. Google Scholar
30 Tschauner C, Klapsch W, Baumgartner A, Graf R. Maturation curve of the ultrasonographic alpha angle according to Graf's untreated hip joint in the first year of life [in German]. Z Orthop Ihre Grenzgeb 1994;132:502–504. Crossref, Medline, Google Scholar
31 Harcke HT, Clarke NM, Lee MS, Borns PF, MacEwen GD. Examination of the infant hip with real-time ultrasonography. J Ultrasound Med 1984;3:131–137. Crossref, Medline, Google Scholar
32 Roposch A, Moreau N, Uleryk E, Doria AS. Developmental dysplasia of the hip: quality of reporting of diagnostic accuracy for US. Radiology 2006;241:854–860. Link, Google Scholar
33 Woolacott NF, Puhan MA, Steurer J, Kleijnen J. Ultrasonography in screening for developmental dysplasia of the hip in newborns: systematic review. BMJ 2005;330:1413–1418. Crossref, Medline, Google Scholar
34 Grol R, Baker R, Moss F. Quality improvement research: understanding the science of change in health care. Qual Saf Health Care 2002;11:110–111. Crossref, Medline, Google Scholar

Article History

Published in print: 2007

Vol. 242, No. 2

Metrics

Altmetric Score

PDF download