Developmental Dysplasia of the Hip

Auriemma, Jeanna; Potisek, Nicholas M.

doi:10.1542/pir.2017-0239

Cited by 6 publications

(7 citation statements)

References 1 publication

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“…3 Risk factors for DDH in full-term infants include oligohydramnios, first born, female, a family history of DDH, and talipes equinovarus deformity. 1,[5][6][7] Improper swaddling of newborns has also been linked to DDH. 1,5 In full-term infants, breech presentation is associated with a five-fold increase in the risk for DDH.…”

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confidence: 99%

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Developmental Dysplasia of the Hip Is Not Associated with Breech Presentation in Preterm Infants

Leonard

Kresch

2022

Am J Perinatol

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Objectives The aim of the study is to (1) determine the incidence of developmental dysplasia of the hip (DDH) in preterm infants born prior to 35 completed weeks' gestation in a breech presentation, and (2) evaluate if the association between breech presentation and DDH in full-term infants holds for premature infants. Study Design This study design comprises retrospective review of infants born between January 1, 2008, and December 31, 2017, at <35 weeks' gestation and admitted to the NICU. Infants had hip ultrasounds at 4 to 6 weeks' corrected age if they were born in a breech presentation with a stable hip examination. We excluded infants born in a presentation other than breech or vertex, had no documentation of presentation at birth, or if they died within the first year. Results We included 1,533 infants. Preterm infants <35 weeks' gestation born in the breech versus vertex position had an incidence of DDH of 0.47% (2/428) and 0.36% (4/1,105), respectively. There was no significant difference in the incidence of DDH between infants born in the breech versus vertex position (Chi-square and Fisher's exact tests). The sensitivity, specificity, and positive and negative predictive values of breech presentation in detecting DDH were 33, 72, 0.47, and 99.6%, respectively. Conclusion There is no association between breech presentation and DDH in preterm infants <35 weeks' gestation. Obtaining hip ultrasounds on preterm infants <35 weeks' gestation born in the breech presentation with a normal hip examination is not recommended. Key Points

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“…1,[5][6][7] Improper swaddling of newborns has also been linked to DDH. 1,5 In full-term infants, breech presentation is associated with a five-fold increase in the risk for DDH. 7 There are few studies of the incidence of DDH in preterm infants.…”

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confidence: 99%

Developmental Dysplasia of the Hip Is Not Associated with Breech Presentation in Preterm Infants

Leonard

Kresch

2022

Am J Perinatol

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“…Breech presentation is one of the well-known causes for the hip's developmental dysplasia, as the fetal breech position can limit the fetal movements in the womb, particularly when the fetus's knees are extended (frank breech). 16,17 In this case, breech presentation is most likely the cause of a congenital anomaly and not a symptom. Fortunately, this association is recognized, and children born in breech presentations are in many countries routinely screened during the neonatal period for developmental dysplasia of the hip, and therefore early detected and treated.…”

Section: Discussionmentioning

confidence: 81%

Congenital anomalies in breech presentation: A nationwide record linkage study

Macharey

Gissler

Toijonen

et al. 2021

Congenital Anomalies

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Our study aimed to determine if congenital anomalies are associated with breech presentation at delivery. We conducted a nationwide, retrospective population-based record linkage study and analyzed all singleton births in Finland from 1996 to 2016 using the mandatory health register data collected by the Finnish Institute for Health and Welfare. We compared all major congenital anomalies detected during pregnancy, birth, or the first year of life according to the fetus's presentation at the time of delivery using X 2 -square statistic and Student's t test. We adjusted the results for known risk factors for congenital anomalies to estimate adjusted odds ratios and 95% confidence intervals. Fetuses in breech presentation at delivery had an increased risk for congenital anomalies (6.5%) compared with fetuses in cephalic presentation (3.6%), P < .001. Breech presentation was associated with nearly all types of examined congenital anomalies. The strongest associations were observed with congenital deformities of the hip, the central nervous system, the respiratory system, and the musculoskeletal system. Our study supports the theory that breech presentation is, in many cases, a symptom of a fundamental problem in fetal morphogenesis or function. Neonates born in the breech presentation have a higher risk of congenital anomalies and should undergo a postnatal screening.

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“…The following comprised our inclusion criteria: a dislocated hip as demonstrated on the anteroposterior radiograph of the pelvis with the proximal femoral metaphysis lateral to Perkin’s line and superior to a line bisecting the inferolateral quadrant of Putti at 45º in between Hilgenreiner’s and Perkin’s lines, as well as an acetabular index ≥2 SD from the mean for age and discontinuation of the Shenton’s line, all correlating with clinical and physical examination findings [15,17,18]. The following comprised our exclusion criteria: diagnosing an underlying neurologic or syndromic condition such as amyoplasia and any prior ipsilateral open hip procedure.…”

Section: Methodsmentioning

confidence: 99%

The tension of the iliopsoas tendon more than doubles during extension of the dysplastic hip in open reduction

Mojica

García

Huebschmann

et al. 2022

Journal of Pediatric Orthopaedics B

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The role of the iliopsoas as an obstructing and re-dislocating factor in developmentally dislocated hips is unclear. The purpose of this article is to determine the change in the iliopsoas' tension during flexion and extension when performing an open reduction. We evaluated 34 hips undergoing an anterior open reduction for a developmental dislocation. At the time of surgery, we identified the iliopsoas, and before sectioning it as part of the open reduction, we measured the tension while cycling the reduced hip through flexion and extension. We performed statistical analysis using Pearson and Spearman correlation tests. We created an initial tension artificially at 20 N with the hip held in 90º of flexion, which then doubled to a mean of 42 N when placed in extension. We found a significant increase in tension when the hip went below 20º of flexion. We also found the correlation between the angle of the hip and the force of tension to be statistically significant (P = 0.003). This study provides quantitative support that the tension of the iliopsoas tendon increases significantly in extension when performing an open reduction of a developmentally dislocated hip.

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Developmental Dysplasia of the Hip

Cited by 6 publications

References 1 publication

Developmental Dysplasia of the Hip Is Not Associated with Breech Presentation in Preterm Infants

Developmental Dysplasia of the Hip Is Not Associated with Breech Presentation in Preterm Infants

Congenital anomalies in breech presentation: A nationwide record linkage study

The tension of the iliopsoas tendon more than doubles during extension of the dysplastic hip in open reduction

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