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Treat, follow-up, or discharge? An aid in sonographic decisions for the borderline centered neonatal/infantile hips

Konstantinos Chlapoutakis
Konstantinos Chlapoutakis
, 
Maria Raissaki
Maria Raissaki
, 
Styliani Markatzinou
Styliani Markatzinou
, 
Nikolaos Skoulikaris
Nikolaos Skoulikaris
, 
Antonios Galanos
Antonios Galanos
, 
Adam Hatzidakis
Adam Hatzidakis
 e 
Panagiotis Prassopoulos
Panagiotis Prassopoulos
   | 27 feb 2024
Journal of Ultrasonography's Cover Image
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Article Category: Research paper
Pubblicato online: 27 feb 2024
Pagine: -
Ricevuto: 28 apr 2023
Accettato: 21 lug 2023
DOI: https://doi.org/10.15557/jou.2024.0003
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© 2024 Konstantinos Chlapoutakis et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

A. Demonstration of the lines and measurements which were evaluated. B. Schematic representation of major anatomical landmarks. FH – femoral head, L – labrum, IFL – ischiofemoral ligament, BR – bony rim; LLOI – lower limb of the os ilium
A. Demonstration of the lines and measurements which were evaluated. B. Schematic representation of major anatomical landmarks. FH – femoral head, L – labrum, IFL – ischiofemoral ligament, BR – bony rim; LLOI – lower limb of the os ilium

Fig. 2.

Measurement of the pubofemoral distance (PFD)
Measurement of the pubofemoral distance (PFD)

Fig. 3.

ROC analysis of the statistically important measurements (A, F, E) as discriminators between type I and type II hips
ROC analysis of the statistically important measurements (A, F, E) as discriminators between type I and type II hips

Fig. 4.

ROC analysis of the calculated ratios (indices) A/B, C/D, F/D, E/D as discriminators between type I and type II hips
ROC analysis of the calculated ratios (indices) A/B, C/D, F/D, E/D as discriminators between type I and type II hips

Fig. 5.

ROC analysis of (C–F)/D index and PFD as discriminators between type I and type II hips
ROC analysis of (C–F)/D index and PFD as discriminators between type I and type II hips

Intra-observer and Inter-observer reliability analysis of the absolute values and the ratios of the measurements

ICC 95% CI p-value
A Intra-observer 0.983 0.96–0.99 <0.0005
Inter-observer 0.902 0.78–0.95 <0.0005
B Intra-observer 0.964 0.92–0.98 <0.0005
Inter-observer 0.860 0.71–0.93 <0.0005
C Intra-observer 0.992 0.98–1.00 <0.0005
Inter-observer 0.914 0.82–0.96 <0.0005
D Intra-observer 0.989 0.98–1.00 <0.0005
Inter-observer 0.944 0.88–0.97 <0.0005
E Intra-observer 0.992 0.98–1.00 <0.0005
Inter-observer 0.900 0.79–0.95 <0.0005
F Intra-observer 0.991 0.98–1.00 <0.0005
Inter-observer 0.929 0.83–0.97 <0.0005
F/D Intra-observer 0.988 0.98–1.00 <0.0005
Inter-observer 0.922 0.82–0.97 <0.0005
E/D Intra-observer 0.983 0.97–0.99 <0.0005
Inter-observer 0.869 0.73–0.94 <0.0005
(C–F)/D Intra-observer 0.980 0.96–0.99 <0.0005
Inter-observer 0.801 0.59–0.91 <0.0005

ROC analysis of the statistically important measurements, the calculated ratios and PFD, as discriminators between type I and type II hips

AUC SE 95% CI p-value Cut-off point Sensitivity Specificity PPV NPV
A* 0.662 0.042 0.58 0.74 <0.005 7.010 75% 50% – –
F* 0.792 0.033 0.73 0.86 <0.005 5.905 75% 70% 55% 85%
E* 0.691 0.039 0.61 0.77 <0.005 8.47 72% 60% – –
A/B** 0.606 0.044 0.52 0.69 0.020 1.61 68% 48% – –
C/D** 0.502 0.043 0.42 0.59 0.965 0.86 58% 45% – –
F/D** 0.863 0.028 0.81 0.92 <0.005 0.400 83% 71% 60% 88%
E/D** 0.747 0.038 0.67 0.82 <0.005 0.555 70% 71% 53% 83%
(C–F)/D*** 0.790 0.033 0.73 0.86 <0.005 0.450 82% 67% 54% 88%
PFD*** 0.658 0.043 0.57 0.74 <0.005 2.88 52% 68% – –

Comparison of the demographic and clinical characteristics of the study groups

Variables* n % Hip type p-value
Gender Male 86 46.7 Type I (n = 124) Type II (n = 60)
Female 98 53.3
Mode of delivery Vaginal birth 71 38.6 48 (38.7%) 23 (38.3%) 1,000
Caesarean section 113 61.4 76 (61.3%) 37 (61.7%)
Positive family history for DDH** No 168 91.3 114 (91.9%) 54 (90%) 0.781
Yes 16 8.7 10 (8.1%) 6 (10%)
Breech presentation No 172 93.5 113 (91.1%) 59 (98.3%) 0.107
Yes 12 6.5 11 (8.9%) 1 (1.7%)
Reduced amniotic fluid at delivery*** No 157 85.3 103 (83.1%) 54 (90%) 0,269
Yes 27 14.7 21 (16.9%) 6 (10%)
Clinical examination at birth**** Negative 178 96.7 120 (96.8%) 58 (96.7%) 1,000
Positive 6 3.3 4 (3.2%) 2 (3.3%)
Gestational age at delivery (weeks) Mean ± SD (min–max) 38.4 ± 1.5 (33–41) 7.83 ± 1.93 7.40 ± 1.78 0.378a
Birth weight (g) 3,129.2 ± 415.4 (1,880–4,250) 3,146.94 ± 439.66 3,092.52 ± 360.66 0.406
Age at examination (weeks) 7.61 ± 1.91 (5.57–14.57) 7.83 ± 1.93 7.40 ± 1.78 0.148a

Multiple logistic regression analysis

OR1 95% CI p-value
F
  >5.91 1.00 – – <0.0005
  <5.91 7.78 3.57 17.00
F/D
  >0.40 1.00 – – <0.0005
  <0.40 10.64 4.84 23.43
(C–F)/D
  <0.450 1.00 – – <0.0005
  >0.450 10.15 4.53 22.74

Comparison of measurements and calculated ratios between the two hip types

Variables (mm)* Hip type p-value
I (n = 124) II (n = 60)
A** 7.13 ± 0.78 6.67 ± 0.73 <0.005
B** 4.36 ± 0.51 4.39 ± 0.45 0.693
C** 12.69 ± 1.03 12.78 ± 1.02 0.554
D** 15.02 ± 1.04 15.08 ± 1.05 0.714
F** 6.43 ± 0.88 5.51 ± 0.68 <0.005
E** 8.70 ± 0.91 8.08 ± 0.78 <0.005
PFD*** 2.60 ± 0.50 2.90 ± 0.47 <0.005
A/B 1.66 ± 0.30 1.54 ± 0.24 0.020a
C/D 0.85 ± 0.05 0.85 ± 0.03 0.731
F/D 0.43 ± 0.04 0.37 ± 0.04 <0.005
E/D 0.58 ± 0.05 0.54 ± 0.05 <0.005
(C–F) / D 0.42 ± 0.07 0.48 ± 0.04 <0.005
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