Clinical and sonographic improvement of developmental dysplasia of the hip: analysis of 948 patients

Abstract

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.

Positive family history and girl sex might increase the risk of failure of abduction treatment in developmental dysplasia of the hip

“…However, our results indicate, that even though breech presentation is a risk factor of DDH, it is not a risk of major instability at one month of age and thus it does not increase a risk of operative treatment. This is in line with our previous study where we found, that breech born infants recover well and fast with correct treatment 24 .…”

“…Same results were found with children with family history compared to children without family history. These ndings support our earlier ndings, where we found girl sex and family history to be risk for late recovery 24 and failure of the abduction treatment 21 . Our results in this study further explain the mechanism through which these risk factors effect on the recovery of DDH.…”

Positive family history and girl sex might increase the risk of failure of abduction treatment in developmental dysplasia of the hip

“…According to our data it seemed, that instability after birth corrects well in one month time. This is in line with our previous study where we found that breech born infants recover well and fast with correct treatment 23 .…”

“…Same results were found with children with family history compared to children without family history of DDH. In our earlier study we have found, that girl sex and positive family history might increase the risk for late recovery 23 . Moreover, they seem to be risk factors for Ortolani positivity and might predispose to abduction treatment failure 21 .…”