The Impact of Focused Hip Ultrasound Training on Imaging Quality in Infants With Hip Dysplasia

Abstract

Background: The orthopedic department at Al Jalila Children's Specialty Hospital (AJCH) was opened in April 2018. A focused hip ultrasound training course was conducted in April 2019 to improve hip ultrasound imaging quality.

Objectives: This study aims to evaluate the impact of focused training courses on predefined image quality criteria of infant hip ultrasound in the context of developmental hip dysplasia. It also seeks to measure the inter- and intra-rater agreement among various disciplines.

Methods: A retrospective review of 120 hip ultrasound images (60 infants) was performed between April 2018 and April 2020. Based on internationally agreed criteria, 60 hip images obtained before the course were compared to another 60 hip images obtained after the course. Inter-rater and intra-rater agreements were also evaluated using intraclass correlation (ICC).

Results: The study evaluated the impact of a focused training course on the quality of infant hip ultrasound images for developmental dysplasia of the hip. Image quality significantly improved after the training, with optimal images increasing from 48% to 82% (P<0.001). Logistic regression confirmed the training's positive effect, highlighting its clinical and statistical significance. The study has also demonstrated excellent agreement among raters for alpha and beta angles, as reflected by ICC statistics. The agreement for alpha angles was notably higher than for beta angles (ICC 0.970 vs. 0.904; P<0.0001). However, inter-rater agreement for hip types, assessed using kappa statistics, was moderate (κ = 0.512) and targeted to address a limited shortfall or gaps in services.

Conclusion: The study confirms the value of focused training in improving the quality of care. This training should be carefully planned and targeted to address limited shortfalls or gaps in services in other areas of service delivery.

Level of evidence: The study is a retrospective cohort with evidence level II.

Keywords: developmental dysplasia of the hip ( ddh ); graf method; hips; neonatal screening; pavlik harness; pediatric orthopedics; pediatric ultrasound; ultrasound.

Figure 1. Hip ultrasound image.

The image shows the correct measurement of alpha and beta angles. Ensuring the accuracy of an image involves two crucial steps. The first step is identifying eight anatomical landmarks on the image: the chondro-osseous border, femoral head, synovial fold, joint capsule, labrum, the cartilage portion of the roof, the bony portion of the roof, the bony rim (also known as the turning point between the bony roof's concavity and convexity), and the ilium. The second step is completing the usability checklist, which ensures the identification of three key elements: the lower limb of the acetabular roof (typically the brightest and most prominent lower end of the bony roof), the midportion of the ilium, and the labrum. If any of these elements are missing or not clearly visible, the sonogram is considered invalid and should not be used.

Figure 2. The improvement in the quality of infant hip ultrasound images after the focused training course.

After the course, 82% of the images were considered optimal, compared to 48% before the course. Images are created by the authors.

Figure 3. A child wearing a Pavlik harness.

Early diagnosis of developmental dysplasia of the hip can lead to simple treatment, such as a Pavlik harness or similar devices, and avoiding major surgery.

Figure 4. A compound image of open reduction of a dislocated hip in a child who presented late.

Late presentation of hip dysplasia often involves major surgery of open reduction of the hip, pelvic, and femoral osteotomy. After surgery, the child is put in a hip spica (inset) for eight weeks. These could be prevented by early, high-quality hip ultrasound.