Grant: Op. Grant: NWHRI: Innovation Fund - Translational Research

Developmental hip dysplasia (DDH) is a condition where the ball-and-socket hip joint has a shallow socket. It is generally curable by wearing a harness if detected while the patient is a baby, but if missed, leads to multiple surgeries in childhood, early osteoarthritis, a lifetime of pain and hip replacement. DDH affects 1.5% of female babies vs. only 0.7% of male babies, and the risk of having DDH is 3.6 times higher for females than males. Worse, 85% of severe DDH requiring surgery occurs in females. Rates of DDH are also much higher in some Indigenous populations. DDH screening by hip ultrasound currently requires scans performed by expert sonographers and interpreted by radiologists, which may require patients to travel to large centers. The universal DDH ultrasound screening performed in parts of Europe is not currently offered in Canada/USA, due to factors such as inconclusive scans requiring costly follow-up. Instead, only babies with risk factors such as having breech presentation or family history are screened. Unfortunately, selective screening has not reduced the rate of late DDH detection, as many infants with DDH lack risk factors and are missed. Our pilot work shows that new technology combining inexpensive portable ultrasound with automated artificial intelligence (AI) image analysis may make DDH screening more practical and reliable. We propose an implementation study to focus on how to most equitably screen babies using this innovation, especially female babies, and those in rural, remote and/or Indigenous communities where health care is hard to access. We will work closely with patient and community partners, to help us understand the complex interplay between gender, sex, screening, and innovation implementation. Our goal is to provide evidence and tools to support universal screening of DDH, especially for those at highest risk and who have the most difficulty obtaining healthcare.