Differences in risk factors between early and late diagnosed developmental dysplasia of the hip

Sharpe, Phillipa; Mulpuri, Kishore; Chan, Annabelle; Cundy, Peter

doi:10.1136/adc.2004.070870

Cited by 62 publications

(79 citation statements)

References 14 publications

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“…However, the extent of association of these risk factors is not well understood or well characterized. We have observed that breech presentation is more likely in the younger patients, which is consistent with previous findings [24]. Consequently, the differences between centers in terms of both fetal presentation and …”

Section: Discussionsupporting

confidence: 92%

“…Patients in the younger group most likely presented with a reducible dislocation, whereas patients in the older group most likely presented with an irreducible dislocation. This increased diagnosis of irreducible dislocations in older patients has not previously been reported to our knowledge, because most studies comparing early-versus late-presenting DDH do not report on the reducibility of the dislocation [3,17,24]. Consistent with this finding, however, was that the two centers with predominantly older patients, the Australia and Boston sites, both also had substantially more patients diagnosed with an irreducible dislocation than other centers.…”

Section: Discussionsupporting

confidence: 62%

“…With specific sites such as the Australia and Boston centers tending to have an older patient population, patients 6 to 18 months old at diagnosis comprise 34% (168 of 496) of patients in this study. This is a much higher proportion of late-presenting patients than most studies [3,17,24]. These differences most likely arose as a result of individual center referral patterns with the nature of each center's geography to birthing hospitals potentially influencing the patient demographics.…”

Section: Discussionmentioning

confidence: 92%

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What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip?

Mulpuri

Schaeffer

Kelley

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Little information exists concerning the variability of presentation and differences in treatment methods for developmental dysplasia of the hip (DDH) in children \ 18 months. The inherent advantages of prospective multicenter studies are well documented, but data from different centers may differ in terms of important variables such as patient demographics, diagnoses, and treatment or management decisions. The purpose of this study was to determine whether there is a difference in baseline data among the nine centers in five countries affiliated with the International Hip Dysplasia Institute to establish the need to consider the center as a key variable in multicenter studies. Questions/purposes (1) How do patient demographics differ across participating centers at presentation? (2) How do patient diagnoses (severity and laterality) differ across centers? (3) How do initial treatment approaches differ across participating centers? Methods A multicenter prospective hip dysplasia study database was analyzed from 2010 to April 2015. Patients younger than 6 months of age at diagnosis were included if at least one hip was completely dislocated, whereas patients between 6 and 18 months of age at diagnosis were included with any form of DDH. Participating centers (academic, urban, tertiary care hospitals) span five countries across three continents. Baseline data (patient demographics, diagnosis, swaddling history, baseline International Hip Dysplasia Institute classification, and initial treatment) were compared among all nine centers. A total of 496 patients were enrolled with site enrolment ranging from 10 to 117. The proportion of eligible patients who were enrolled and followed at the nine participating centers was 98%. Patient enrollment rates were similar across all sites, and data collection/completeness for relevant variables at initial presentation was comparable. 123 Clin Orthop Relat Res (2016) 474:1138-1145 DOI 10.1007/s11999-016-4746-y Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons®Results In total, 83% of all patients were female (410 of 496), and the median age at presentation was 2.2 months (range, 0-18 months). Breech presentation occurred more often in younger (\6 months) than in older (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) Conclusions With the lack of strong prognostic indicators for DDH identified to date, the center is an important variable to include as a potential predictor of treatment success or failure.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 92%

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What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip?

Mulpuri

Schaeffer

Kelley

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Traditionally, radiological examination has been used in diagnosis of DDH, but in the last two 2 decades ultrasound has been used as the best method of assessment of DDH in children younger than 6 months of age [7][8][9]. Ultrasound has the potential to identify minor abnormalities that are likely to resolve spontaneously without treatment [10]. Studies have shown that using ultrasound detected more cases, resulting in more children being treated [11].…”

Section: Introductionmentioning

confidence: 99%

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

Hassan

Shannak

2007

Journal of Children's Orthopaedics

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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.

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“…However, in a study of late-presenting DDH, only 2.1% of cases were diagnosed after 3 months [15]. The likelihood of all of the late-presenting cases in the cohort being DDH, which was missed or developed after the early screening program, is therefore minimal.…”

Section: Discussionmentioning

confidence: 99%

Developmental Dysplasia of the Hip and Occult Neurologic Disorders

Luther

Clarke

2008

Clinical Orthopaedics &Amp; Related Research

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Developmental dysplasia of the hip (DDH) is a neonatal condition with various causes. Neuromuscular dysplasia of the hip (NDH) is a sequel of neuromuscular disease, and generally presents later in childhood than DDH. Some evidence, however, supports a concept of a neuromuscular etiology of DDH: (1) a high prevalence of spinal dysraphism in DDH; and (2) abnormal sensory evoked potentials in 31% of DDH patients. To explore this suggestion we ascertained the presence of neuromuscular disease within a cohort of DDH patients, and asked whether the neuromuscular condition is the initial etiology of the dysplasia or a coincidental finding. We retrospectively reviewed patients presenting with DDH. Only those with an initial diagnosis of DDH and a subsequent diagnosis of a neuromuscular condition were assessed. Fifteen of 560 patients fulfilled the criteria, however the presence of true DDH within this group was minimal, as several cases emerged as early presenting NDH. We therefore believe it unlikely DDH has a substantial neurological etiology.

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Differences in risk factors between early and late diagnosed developmental dysplasia of the hip

Cited by 62 publications

References 14 publications

What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip?

What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip?

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

Developmental Dysplasia of the Hip and Occult Neurologic Disorders

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