Participants were eligible for inclusion when they presented with first-onset pain of the hip or knee were aged between 45 and 65 years and had not yet consulted their general practitioner for these symptoms or the first consultation was within 6 months before entry of the cohort. CHECK is a Dutch nationwide multicenter prospective cohort study containing 1002 participants, aiming to study the course and risk factors of early hip and knee OA. We used data of the Cohort Hip and Cohort Knee (CHECK). The secondary aim was to investigate the correlation between the W-LCEA and W-ACEA as a surrogate of lateral and anterior dysplasia, respectively. The primary aim of this study was therefore to evaluate the additional value of an FP view in the diagnosis of DDH as compared with an AP view only. Several studies mention the possibility of adding the FP view, but the additional value and correlation with the AP view alone has not yet been established. To the best of our knowledge, the additional value of an FP view as opposed to a sole AP view in the diagnosis of DDH is unclear. As DDH is a condition that can be both present laterally and anteriorly, an additional value of the FP view radiograph is to be expected. An additional lateral view, the false-profile (FP) view, can be used to determine the anterior acetabular coverage of the femoral head, which can be quantified by the Wiberg-anterior center-edge angle (W-ACEA). However, the W-LCEA only quantifies lateral acetabular coverage and might therefore lead to an underestimation of DDH prevalence, potentially resulting in delayed diagnosis. DDH is generally diagnosed with a W-LCEA 25° were normal and hips with an LCEA between 20 and 25° were considered uncertain. The most frequently used parameter to quantify acetabular coverage on an AP pelvic radiograph is the Wiberg-lateral center-edge angle (W-LCEA). In order to make the diagnosis of DDH complete, anteroposterior (AP) pelvic radiographs are usually obtained. Clinical findings include pain provoked with the hip instability tests (hyperextension-external rotation (HEER), Abduction-hyperextension-external rotation (AB-HEER) and the PRONE instability test), abductor fatigue with a positive Trendelenburg sign and increased range of motion of the hip. Symptoms may include hip and groin pain and instability of the hip joint. ĭDH in adulthood is diagnosed based on a combination of symptoms, signs and imaging findings. DDH has been associated with hip pain and loss of function in young adults, and may lead to an up to six times increased risk of developing hip osteoarthritis (OA) later in life. Despite early screening at birth and during infancy, DDH can remain undetected until adulthood, with an estimated prevalence of 0.1% in the United States. In hips with DDH a moderate correlation between W-LCEA and W-ACEA was calculated indicating that joints with normal acetabular coverage on the AP view can still be undercovered on the FP view.ĭevelopmental dysplasia of the hip (DDH) is a commonly seen developmental disorder of the acetabulum, leading to undercoverage of the femoral head and increase in contact pressure on the joint cartilage. Over 4 out of 10 (43.2%) individuals’ DDH will be missed when only using the AP radiograph. There is a strong additional value of the FP radiograph in the diagnosis of DDH. A mean difference of 9.4° (SD 8.09) was present between the W-LCEA and the W-ACEA in the hips with DDH. The Pearson correlation coefficient between W-LCEA and W-ACEA of all included hips was 0.547 (95% confidence interval: 0.503–0.591) and 0.441 (95% confidence interval: 0.231–0.652) in hips with DDH. DDH was present in 74 hips (5.3%), of which 32 were only present on the FP view radiograph (43.2%). In total 720 participants (1391 hips) were included. The correlation between the W-LCEA and W-ACEA was determined. The proportion of DDH only present on the FP view determined the FP view additional value. A threshold of <20° was used to determine DDH for both the W-LCEA and the W-ACEA. DDH was quantified on AP pelvic and FP hip radiographs using semi-automatic measurements of the W-LCEA and W-ACEA. We used baseline data from a nationwide prospective cohort study (Cohort Hip and Cohort Knee). The aim of this study was to determine the additional value of the false-profile (FP) view radiograph in the diagnosis of developmental dysplasia of the hip (DDH), as compared with an anteroposterior (AP) pelvic radiograph only, and evaluate the correlation between the Wiberg-lateral center edge angle (W-LCEA) and Wiberg-anterior center edge angle (W-ACEA).
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