Delays in diagnosis are associated with poorer outcomes in adult hip dysplasia

Abstract

Background and Aims Developmental dysplasia of the hip is a common cause of osteoarthritis. Periacetabular osteotomy can restore femoral head coverage; however, it is reserved for patients with minimal articular degeneration. We examined the relationship between delays in diagnosis and outcomes. Methods We identified patients presenting to a hip specialist with a new diagnosis of hip dysplasia. The time taken between patients presenting to their general practitioner and attending the young adult hip clinic was established. Patients were stratified into Early, Moderate and Late Referral groups. Hip and SF-12 questionnaires were completed. Radiographs were graded according to the Tönnis classification system and the outcome following hip specialist review documented. Results Fifty-one patients were identified. Mean time from attending a general practitioner to review at the young adult hip clinic was 40.4 months. Lower hip and SF-12 scores, and higher radiological osteoarthritis grades were found in the Moderate and Late Referral groups. A higher proportion of the Moderate and Late Referral group underwent total hip arthroplasty rather than periacetabular osteotomy. Conclusion Delays in referring a patient to a hip specialist are associated with poorer outcomes. We propose pelvic radiographs are requested early by general practitioners to allow prompt diagnosis and referral to a hip specialist.

A Global Survey of Patient and Caregiver Experiences Throughout Care for Developmental Dysplasia of the Hip

“… 17 Our findings align with existing knowledge that later diagnosis may require more invasive treatments. 4 – 6 Participant-reported age at first surgery suggests a lapse between diagnosis and surgery where other treatment options were employed. 17 …”

The Global Research Trends and Hotspots on Developmental Dysplasia of the Hip: A Bibliometric and Visualized Study

“…(iv, v) Hip osteoarthritis and hip replacement study: Studies demonstrated that even after undergoing osteotomy surgeries, there is still a percentage of patients who progress to osteoarthritis and require arthroplasty ( 47 ). If left untreated, patients with early-stage DDH definitively develop secondary osteoarthritis, with 50% of these patients developing advanced osteoarthritis at the age of 50 years ( 48 ). Developmental dysplasia of the hip was recognized as a significant risk factor in hip osteoarthritis in adults.…”

What the papers say

“…Kennedy et al . [ 5 ] from Glasgow, UK examined the relationship between delay and diagnosis and outcomes of dysplasia surgery. They identified patients presenting to a hip specialist with a new diagnosis of hip dysplasia.…”