25 Jahre sonografisches Screening der Säuglingshüfte am Universitätsklinikum Marburg - Eine kritische Analyse

The orthopedic clinic at Marburg University Hospital began to perform ultrasound screening of the newborn´s hip in 1985. This dissertation is a compilation and analysis of all the epidemiological data on hip type distribution and the risk factors for developmental dysplasia of the hip, gathered from the screenings of 18,247 infants at Marburg University hospital from 1985 to 2009. In the evaluation of the postnatal sonographic screenings of the infants’ hips, anamnestic data such as the family history and special characteristics at birth (breech presentation, Cesarean section, premature delivery), as well as the findings from the clinical examinations of the hips and other orthopedic abnormalities, were analyzed. Additionally, the morphological criteria, α- and β-angles according to Graf (which determine the hip type), and the corresponding therapy recommendations for each child were also included in the analysis. Moreover, the entire diagnostic procedure was scrutinized, taking into consideration how each examiner`s individual experience played into the diagnoses they made, as well as the courses of treatment they recommended. Finally, inferential statistics were calculated based on comprehensive comparisons of the aforementioned data. During the entire period, hip dysplasia (Type IIc-IV according to Graf) was detected in 0.8% of cases. 15.7% of the hips were physiological immature (Type IIa), and 83.4% mature. Significant changes in hip types can be clearly seen over the course of time. For example, between the years of 1985-1989, over 40% of the hips were described as "physiological immature" or worse. From 1990-1994, the number of IIa hips decreased to 16%, and for the most recent period from 2005-2009, the percentage dropped even further to 9%. The number of infants diagnosed with pathological hip dysplasia (Type IIc-IV according to Graf) amounted to 3% in the years from 1985-1988, then dropped to less than 1% of cases per year since 1989. A small but statistically not significant lateral difference can be observed to the detriment of the left side. The family history gives no clear indications. Another more statistically important observation include: The female sex and the breech presentation correlated significantly with the occurrence of developmental dysplasia of the hip. A total of 55 employees at the orthopedic clinic in Marburg each performed an average of 350 examinations. Accuracy of documentation improved over time. It can be assumed that in the early days of the screening the hip type was determined by "visual diagnosis" or by morphological criteria. The angle measurement began to be documented in 1993. Physicians with more limited experience in administering sonographic screenings tended to recommend more drastic therapeutic interventions than their more experienced colleagues. The treatment strategy was rather inconsistent over the entire period. The epidemiological data on hip type distribution can be confirmed by this study, especially during the first years large fluctuations were noticed. Overall, a reduction in the incidence of the developmental dysplasia of the hip is observed. Clinical examination or risk screening alone is not sufficient. The necessity for a standardized sonographic examination of the infant's hip becomes clear. The not constructive "bedside teaching" has to be replaced by a structured training of the medical staff. Clear and uniform therapy and treatment algorithms, as already available in public medical journals, should be established in the hospitals.