Associated risk factors in children who had late presentation of developmental dysplasia of the hip

Abstract

Purpose The purpose of this study was to assess the role of clinical examination, associated risk factors and plain radiograph of the pelvis in children who had late presentation of DDH. Methods We report on a 7-year prospective study, in children who had late presentation of developmental dysplasia of the hip (DDH). For this purpose, 740 hips in 370 referred children, age range 3-7 months (mean 3.44 months) were clinically and radiologically assessed, and the associated risk factors recorded. Results Female sex, first born, positive family history and breech presentation were confirmed as risk factors for DDH. Significant findings were an increased risk for vaginal delivery over caesarean section for breech presentation (P = 0.002). There was an increased risk for caesarean section in the absence of breech presentation. Multiple births and preterm births had a reduced risk. For breech presentation, the risk of DDH was estimated to be at least 1.6% for girls and 3.4% for boys; a combination of factors increased the risk. Limitation of abduction (43.2%) and asymmetry of the groin skin folds (72.7%) were found to be the two most common clinical findings associated with DDH. Bilateral acetabular dysplasia is more common than unilateral dysplasia. Foot deformities were rarely encountered in children with acetabular dysplasia. Conclusions The percentage of first-born babies who had DDH is lower than reported in the literature (34%), but still shows significant risk. We did find that bilateral acetabular dysplasia is more common than unilateral dysplasia. Torticollis and foot deformities are rarely found to be associated with DDH. All these findings needs further evaluation in children who had surgical treatment for DDH, to see if they are different from dysplastic groups. Limitation of abduction is an important clinical finding, but is not always associated with DDH. Asymmetry of the skin folds in the groin were found to be an important clinical finding associated with DDH for all age groups. As clinical examination depends on many factors, and most DDH cases are of the dysplastic type, it is mandatory to depend on further diagnostic tools for confirmation of DDH.

Developmental dysplasia of the hip: addressing evidence gaps with a multicentre prospective international study

“…Most existing studies on DDH are retrospective, single centre, have small sample sizes, or may include the entire spectrum of DDH severity. [20][21][22][23][24] Compounding these issues, there is confusion in reporting of DDH diagnoses, particularly with laterality (the side affected by the condition). Many studies have examined incidence, prevalence and treatment outcomes of DDH comparing unilateral (only right or left hip involvement) and bilateral (both hip involvement) DDH, 11,14,25,26 and differential success has indeed been reported in some bracing studies.…”

Brief communication: Developmental dysplasia of the hip in medieval London

“…This is why the incidence is higher in babies born with breech presentation (more mechanical force on the hips), being first born (less compliant uterus) or one of a multiple birth (less space in the uterus), premature birth with a low birth weight (immature hips) and being female (Sionek et al, 2008;Stein-Zamir et al, 2008;Czubak et al, 2003). DDH is thought to have an autosomal dominant heritage that can be either polygenic or rarely monogenic, and therefore, the genes possessed by an individual can predispose them to developing DDH when exposed to such mechanical forces in the uterus (Abu Hassan and Shannak, 2007;Mabuchi et al, 2006). The risk of developing DDH is also higher if the mother has the endocrine disorder hyperthyroidism, where too much thyroid hormone is produced (Ishikawa, 2008).…”

How to use… Hip examination and ultrasound in newborns

“…A prospective 7-year study on late-presenting DDH of 740 hips (age range 3–7 months, mean 3.44 months) showed that the most common abnormality was asymmetric skin folds in 83% (72.7% groin folds, 10.3% thigh folds) 1515. These anterior skin folds slightly contrast with the indications for USS set by NIPE 1…”