Epidemiology of developmental dysplasia of the hip within the UK: Refining the risk factors

Abstract

PurposeThe epidemiology and risk factors for developmental dysplasia of the hip (DDH) are still being refined. We investigated the local epidemiology of DDH in order to define incidence, identify risk factors, and refine our policy on selective ultrasound screening.MethodsWith a cohort study design, data were prospectively recorded on all live births in our region from January 1998 to December 2008. We compared data on babies treated for DDH with data for all other children. Crude odds ratios (ORs) were calculated to identify potential risk factors. Logistic regression was then used to control for interactions between variables.ResultsThere were 182 children born with DDH (with a total of 245 dysplastic hips) and 37,051 without. The incidence was 4.9 per 1000 live births. Female sex (adjusted OR 7.2, 95% confidence interval [CI] 4.6–11.2), breech presentation (adjusted OR 24.3, 95% CI 13.1–44.9), positive family history (adjusted OR 15.9, 95% CI 11.0–22.9) and first or second pregnancy (adjusted OR 1.8, 95% CI 1.5–2.3) were confirmed as risk factors (p < 0.001). In addition, there was an increased risk with vaginal delivery (adjusted OR 2.7, 1.6–4.5, p < 0.001) and post-maturity (OR 1.7, 1.2–2.4, p < 0.002).ConclusionsOne in 200 children born within our region requires treatment for DDH. Using both established and novel risk factors, we can potentially calculate an individual child’s risk. Our findings may contribute to the debate regarding selective versus universal ultrasound screening.Level of EvidencePrognostic Study: Level 1.

Developmental Dysplasia of the Hip: A Review of Etiopathogenesis, Risk Factors, and Genetic Aspects

“…According to literature, DDH incidence in newborns considerably varies with geographical location from lowest in Africans, to highest in Native Americans and Caucasian population. The global incidence can roughly be estimated to 0.1-6.6 cases per 1000 live births and is responsible for up to 30% of primary THAs in people up to 60 years of age [15][16][17][18][19]. Variations in incidence considering geographical location can be caused by epigenetic factors, consanguinity rates or study limitations, e.g., group size and diagnostic methods used.…”

“…Factors such as oligohydramnios [30], high birth weight (HBW) or primiparity [18], present an increased risk for DDH.…”

Ultrasound screening for developmental dysplasia of the hip after 4 weeks increases exam accuracy and decreases follow-up visits

“…9 Conversely, cases identified early often resolve spontaneously a few weeks later. 10 There is evidence that screening after 3 months can increase the rate of surgery, 11 although others have found that delayed screening improves the results. 12,13 Conversely, Roovers et al 6 found evidence that earlier screenings led to better detection of abnormal hips.…”

Hüftdysplasie – Teil 1: Im Kindes- und Jugendalter

“…1) diagnostizieren [3]. Die Analyse der Geschlechterverteilung bestätigte die bisher bekannte Verteilung zugunsten des weiblichen Geschlechts [3,4].…”