Engesaeter IØ, Lie SA, Lehmann TG, Furnes O, Vollset SE, Engesaeter LB.
The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Unifob, Bergen. firstname.lastname@example.org
BACKGROUND AND PURPOSE: Dysplasia is probably the most common underlying condition in osteoarthritis of the hip, leading to total hip replacement (THR) in young adulthood. We investigated whether hip instability at birth predisposes to THR in young adulthood.
METHODS: Since 1967, all newborns in Norway have been screened for neonatal hip instability (NHI) and the results have been reported to the Medical Birth Registry of Norway (MBRN). In the period 1967-2004, 2,218,596 newborns were registered. From 1987 to 2004, 442 of these individuals had been reported to the Norwegian Arthroplasty Register (NAR) after undergoing total hip replacement (mean age 25 (12-36) years).
RESULTS: Neonatal hip instability was reported in 19,432 newborns (0.88%) in the MBRN; according to the NAR, they had a 2.6 (CI 1.4-4.8) times increased risk of THR in young adulthood compared to those without NHI. The absolute risk was low, however; only 57 (95% CI: 30-105) in 10(5) for patients with NHI compared to 20 (95% CI: 18-22) in 10(5) for those without registered hip pathology. Of the 442 patients with THR, 95 were operated because of osteoarthritis of the hip secondary to dysplasia, according to the surgeon's report. However, only 8 of these 95 patients had been reported to have hip instability at birth.
INTERPRETATION: Neonatal hip instability increases the risk of THR in young adulthood. Unexpectedly, only 8% of those who underwent THR due to dysplasia were reported to have unstable hips at birth. Our results indicate that clinical testing for NHI is insufficient as a screening method for dysplastic hips that require THR in young adulthood.
No parece que el cribado neonatal de la displasia evolutiva de cadera sea muy sensible :-(
O quizás es que lo de displasia evolutiva de cadera (DEC) sea muy cierto y muchas de ellas se desarrollen después del nacimiento. O quizás que los casos detectados por nosotros no llegan a THR precisamente por el cribado correcto al nacimiento y durante el primer año y el consiguiente tratamiento precoz. (Me quedo con esta última, que es la más favorable ;-)