Delayed diagnosis of developmental dysplasia of the hip in Northern Ireland

Abstract

Developmental dysplasia of the hip (DDH) should be diagnosed as early as possible to optimise treatment. The current United Kingdom recommendations for the selective screening of DDH include a clinical examination at birth and at six weeks. In Northern Ireland babies continue to have an assessment by a health visitor at four months of age. As we continue to see late presentations of DDH, beyond one year of age, we hypothesised that a proportion had missed an opportunity for earlier diagnosis. We expect those who presented to our service with Tonnis grade III or IV hips and decreased abduction would have had clinical signs at their earlier assessments. We performed a retrospective review of all patients born in Northern Ireland between 2008 and 2010 who were diagnosed with DDH after their first birthday. There were 75 856 live births during the study period of whom 645 children were treated for DDH (8.5 per 1000). The minimum follow-up of our cohort from birth, to detect late presentation, was four years and six months. Of these, 32 children (33 hips) were diagnosed after their first birthday (0.42 per 1000). With optimum application of our selective screening programme 21 (65.6%) of these children had the potential for an earlier diagnosis, which would have reduced the incidence of late diagnosis to 0.14 per 1000. As we saw a peak in diagnosis between three and five months our findings support the continuation of the four month health visitor check. Our study adds further information to the debate regarding selective versus universal screening.

Developmental dysplasia of the hip: why are we still operating on them? A plea for institutional newborn clinical screening

“…active review by a general practitioner or health visitor at specified intervals after birth, such as the system in place in Northern Ireland). (10) Thirdly, this was a single-institution study, so the true rate of open reduction for late DDH diagnosis in Singapore is not known. However, our findings may still be representative of the local patient population, as our institution is the largest of only two public paediatric hospitals in the country; in addition, it has been suggested elsewhere that the rate of late DDH diagnosis is similar between private and public sector hospitals.…”

“…(9) Similarly, 70% of DDH patients were diagnosed only after the age of three months in Northern Ireland. (10) The initial newborn examination is thus paramount to preventing the late diagnosis of DDH. It is known that the examiner′s experience in clinical examination is important for picking up early signs of DDH.…”

Perfil dos pacientes diagnosticados com displasia do desenvolvimento do quadril

“…Other factors described include the presence of oligohydramnios (four times more likely to occur in cases of DDH); in the present study, one case presented oligohydramnios 6 8 and postdatism. 8 22 According to the literature, maternal age is directly associated with DDH occurrence, which is twice as frequent when the mother is older than 35 years of age. 8 In the sample evaluated in the present study, age was not a factor that influenced the presence of DDH.…”

“…14 Undiagnosed cases or cases with delayed diagnosis after gait initiation (at 12 months old) lead to early joint degeneration, with 86% of surgical indication in cases that are undiagnosed until 10 months of age. 7 22 In addition, it is known that 25 to 40% of early cases of hip osteoarthritis are secondary to cases of DDH that were neglected or submitted to delayed treatment. 27 In cases of delayed treatment requiring surgery (pelvic or femoral osteotomy), 44% will have some degree of arthrosis between the ages of 16 and 31 years.…”

“…Outros fatores descritos são a presença de oligodrâmnio (quatro vezes mais chance de ocorrência de DDQ); no presente estudo, um caso apresentou oligodrâmnio 6 8 e pós-datismo. 8 22 De acordo com as referências, a idade materna apresenta associação direta com a ocorrência de DDQ, e é duas vezes mais frequente quando essa for superior a 35 anos. 8 Na amostra avaliada, a idade não foi um fator que influenciou a presença de DDQ.…”