Purpose Developmental dysplasia of the hip (DDH) varies from mild instability of the hip to subluxation or total dislocation of the joint. Well-known risk factors of DDH include pre-natal breech position, female sex, positive family history, hip side, primiparity and the mode of delivery. Aim of the present study was to further evaluate known risk-factors of DDH, find associations with more severe dysplasia (characterized with Ortolani positivity) and find risk factors of failure of the Pavlik harness treatment. Material and methods All children with the diagnosis of DDH treated in Tampere University hospital in the years 1998–2018 were retrospectively identified for the study and the data was collected from the medical records. Teratological dislocations (n = 3) were excluded from the analysis. Total of 945 patients were included. Results Breech presentation was strongly associated with Ortolani positivity (p < 0.001). Breech presentation was not associated with ending up for spica casting and/or operative treatment (p = 0.291) despite the association with Ortolani positivity. Ortolani positivity (p = 0.002), positive family history (p = 0.013) and girl sex (p = 0.029) were associated with ending up for spica casting and/or operative treatment. Conclusion Breech presentation seems to increase the risk of Ortolani positive DDH. However, these infants are likely to recover with initially started Pavlik harness treatment, as it was not associated with elevated risk for undergoing more robust treatments. Positive family history and girl sex are associated with the most severe cases of developmental dysplasia of the hip, and it may predispose to the failure of the Pavlik harness treatment.

Background Developmental dysplasia of the hip is a common condition, which varies in severity. Abduction treatment is widely used to correct the development of the hips, but mild forms of DDH can also recover spontaneously. The purpose of this study was to evaluate factors affecting the rate of improvement of developmental dysplasia of the hip, and evaluate any risk factors slowing the process. Material and methods The study population consisted of patients diagnosed with DDH in Tampere University hospital in the years 1998–2018. Data were retrospectively collected, and associations between clinical variables and rate of improvement were analyzed. Alpha angles were assessed monthly, and associations between risk factors and improvement of alpha angles were studied. A total of 948 patients were included in the analysis. Results More severe first status of the hips was associated with faster improvement in dynamic ultrasound compared to milder DDH in univariate design in first 3 months of age; in the multivariable design, Ortolani positivity was conversely associated with lower alpha angles in 1-month follow-up. Immediate abduction treatment was associated with faster recovery rate compared to delayed abduction or watchful waiting. Female sex and positive family history were associated with slower rate of improvement and lower alpha angles. In multivariable design, female sex, positive family history and treatment strategy remained statistically significant as initiation time of the treatment explained the first found association of clinical hip status and the recovery rate after 2 months of age. Conclusion Female sex and positive family history might be independent risk factors for slower recovery in DDH before 6 months of age. These children might need special attention in their follow-up plans and abduction treatment.

Purpose. Developmental dysplasia of the hip (DDH) varies from mild instability of the hip to subluxation or total dislocation of the joint. Well-known risk factors of DDH include pre-natal breech position, female sex, positive family history, hip side, primiparity and the mode of delivery. Aim of the present study was to further evaluate known risk-factors of DDH, find associations with more severe dysplasia (characterized with Ortolani positivity) and find risk factors of failure of the Pavlik harness treatment. Material and methods. All children with the diagnosis of DDH treated in Tampere University hospital in the years 1998-2018 were retrospectively identified for the study and the data was collected from the medical records. Total of 948 patients were included. Results. Breech presentation was strongly associated with Ortolani positivity (p<0.001). Among breech born infants C-section was strongly associated with Ortolani positivity (p<0.001) (OR 1.833, CI95% 1.332-2.524), whereas vaginal delivery was not (p=0.420). Breech presentation was not associated with ending up for spica casting and/or operative treatment (p=0.849) despite the association with Ortolani positivity. Ortolani positivity (p=0.002), positive family history (p=0.013) and primiparity (p=0.048) were associated with ending up for spica casting and/or operative treatment. Conclusion. Breech presentation seems to increase the risk of Ortolani positive DDH. However, these infants are likely to recover with initially started Pavlik harness treatment, as it was not associated with elevated risk for undergoing more robust treatments. Positive family history is associated with the most severe cases of developmental dysplasia of the hip, and it may predispose to the failure of the Pavlik harness treatment.

Background. Known risk factors of DDH include female sex, family history and breech presentation. Abduction treatment fails more often with severe forms of DDH. Risk factors´ effects on abduction treatment failure are not well established. Material and methods. The children with DDH diagnosis treated in Tampere University hospital in the years 1998-2018 were retrospectively identified. Only the children with early evaluation (maximum 2 weeks of age) of pediatric surgeon or pediatric surgery resident were included in the analysis. Total of 761 children were included. Results. Family history of DDH and girl sex were associated with more severe forms of DDH, characterized by alpha angles under 50 degrees and/or major instability in dynamic ultrasound at one month of age. Conclusion. Family history of DDH and female sex increase the risk of more severe forms of DDH and thereby might increase the risk of abduction treatment failure.

Purpose. Developmental dysplasia of the hip (DDH) varies from mild instability of the hip to subluxation or total dislocation of the joint. Well-known risk factors of DDH include pre-natal breech position, female sex, positive family history, hip side, primiparity and the mode of delivery. Aim of the present study was to further evaluate known risk-factors of DDH, find associations with more severe dysplasia (characterized with Ortolani positivity) and find risk factors of failure of the Pavlik harness treatment. Material and methods. All children with the diagnosis of DDH treated in Tampere University hospital in the years 1998-2018 were retrospectively identified for the study and the data was collected from the medical records. Total of 948 patients were included.Results. Breech presentation was strongly associated with Ortolani positivity (p<0.001). Among breech born infants C-section was strongly associated with Ortolani positivity (p<0.001) (OR 1.833, CI95% 1.332-2.524), whereas vaginal delivery was not (p=0.420). Breech presentation was not associated with ending up for spica casting and/or operative treatment (p=0.849) despite the association with Ortolani positivity.Ortolani positivity (p=0.002), positive family history (p=0.013) and primiparity (p=0.048) were associated with ending up for spica casting and/or operative treatment. Conclusion. Breech presentation seems to increase the risk of Ortolani positive DDH. However, these infants are likely to recover with initially started Pavlik harness treatment, as it was not associated with elevated risk for undergoing more robust treatments. Positive family history is associated with the most severe cases of developmental dysplasia of the hip, and it may predispose to the failure of the Pavlik harness treatment.