Introduction. There is little evidence surrounding the clinical implications of a diagnosis of IIa hip dysplasia with no consensus as to its efficacy as a predictor pathological dysplasia or treatment. Therefore, we evaluated the importance of categorising 2a hip dysplasia in to 2a- and 2a+ to better understand the clinical outcomes of each. Methods. A 9-year retrospective cohort study of patients with a diagnosis of type IIa hip dysplasia between 2011 – 2020 (n=341) in our centre. Ultrasound scans were graded using Graf's classification, assessment of management and DDH progression was completed through prospective data collection by the authors. Results. The prevalence of IIa hip dysplasia within our population was 6.7/1000 live births. There was significantly higher incidence of treatment in the IIa- (31.4%, n=17/54) group when compared to the 2a+ group (10%, n=28/287), (p<0.01). In those that had an abnormality (torticollis and/or foot abnormality) treatment rates (24% n=7/29) were significantly (p<0.05) higher than those without anatomical abnormality (15%, n=48/312). Conclusion. This study has demonstrated the significant clinical impact of a IIa- diagnosis on progression to pathological dysplasia and therefore higher rates of treatment in IIa- hips. Furthermore, we have demonstrated the importance of detection of IIa hips through a national screening program, to allow for timely intervention to prevent missing the acetabular maturation window. Therefore, it is our recommendation that all patients with additional anatomical abnormalities and those with a diagnosis of type IIa- hip dysplasia be considered for immediate treatment or urgent follow up following their diagnosis to prevent late conservative intervention

Ultrasound (US) is the standard imaging modality used to screen for developmental dysplasia of the hip in infants. Currently, radiologists or orthopaedic surgeons review scan images and judge them to be adequate or inadequate for interpretation. If considered adequate, diagnostic dysplasia metrics are determined; however, there is no standardised method for this process. There is significant inter-observer variability in this manual process which can affect misdiagnosis rates. To eliminate this subjectivity, we developed an automatic method to identify adequate US images and extract dysplasia metrics. The purpose of this study was to validate the efficacy of this automatic method by comparing results with observer-determined dysplasia metrics on a set of US images. A total of 693 US images from scans of 35 infants were analysed. Trained clinicians at a single institution labeled each image as adequate or inadequate, and subsequently measured alpha and beta angles on adequate images to diagnose dysplasia. We trained our image classifier on random sets of 415 images and used it to assess the remaining 278 images. Alpha and beta angles were automatically estimated on all adequate images. We compared the manual and automatic methods for discrepancies in adequacy determination, metric variability and incidences of missed early diagnosis or over-treatment. There was excellent agreement between the automatic and manual methods in image adequacy classification (Kappa coefficient = 0.912). On each adequate US image, alpha and beta angle measurements were compared, producing mixed levels of agreement between methods. Mean discrepancies of 1.78°±4.72° and 8.91°±6.437° were seen for alpha and beta angles, respectively. Standard deviations of the angle measures across multiple images from a single patient scan were significantly reduced by the automatic method for both alpha (p<0.05) and beta (p<0.01) angles. Additionally, the automatic method classified three hips (two patients) as Graf type II and two hips (two patients) as type III, while the manual method classified them as type I and II, respectively. Both cases flagged as type III patients by the automatic system subsequently failed Pavlik harness treatment and were booked for surgery. The automatic method produced excellent agreement with radiologists in scan adequacy classification and significantly reduced measurement variability. Good agreement between methods was found in Graf classification. In instances of disagreement, subsequent clinical findings seemed to support the classification of the automatic method. This proposed method presents an alternative automatic, near-real-time analysis for US images that may potentially significantly improve dysplasia metric reliability and reduce missed early diagnoses without increasing over-treatment

Aim. The aim of this study is to assess the effectiveness of clinic based ultrasound screening by Orthopaedic surgeon for early diagnosis and treatment of developmental dysplasia of hip (DDH) in one stop clinic. Methods. This prospective study included 395 infants (185 male and 210 female) (5.2% of study population) who were referred for screening on the basis of abnormal findings or the presence of risk factors for DDH. Average age was 12.5 weeks (1 day to 15 months). All infants were assessed for risk factors of DDH. Clinical examinations were performed by the senior author followed by ultrasonography of both of the infant's hips, using the Graf's technique. Alpha and beta angles were calculated and hips were classified according to Graf's classification system. Results. Out of 790 hips examined 670 (84.8%) were labelled as normal. 120 (15.1%) hips in 84 patients were diagnosed as dysplastic or dislocated. Clinical examination only detected 39 patients out of 84, sensitivity of 46%. Average age of diagnosis was 12 weeks (3days-11 months). 79 patients were successfully treated with pavlic harness, 2 required traction and 3 were referred for surgical treatment. There were 14 cases of late diagnosis during one year period (> 4 months of age) (1.8/1000). Conclusion. Selective ultrasound screening is effective in early diagnosis of DDH and significantly reduces the duration of non operative treatment as well as the need for surgical intervention but does not completely eliminate late diagnosis of DDH. We find the concept of one stop DDH clinic highly effective and recommend that ultrasound training should be a part of orthopaedic curriculum