High incidence of congenital dislocation of the hip in Northern Ireland

Abstract

To determine the incidence of congenital hip dislocation (CDH) a retrospective study was carried out of cases occurring in a defined population using multiple information sources. Of 138,600 children born in the period 1983-1987, a total of 243 were diagnosed with CDH, defined as those requiring splintage or surgery whose treatment extended beyond 6 months of age. Incidence and estimates of relative risks for pre-disposing factors were determined. The rate was 1.75 cases per 1000 livebirths. Major risk factors were female gender and breech presentation. The proportions of cases identified before 1, 3 and 6 months of age were 8, 14 and 35%, respectively. Despite using a restrictive definition, we have obtained an incidence rate among the highest reported in any United Kingdom population. Early detection is widely accepted as desirable, but neonatal screening has proved ineffective.

Quality improvement report: Clinical screening for developmental dysplasia of the hip in Northern Ireland

“…The figure decreased to 102 children (110 hips) with a 6 month threshold, giving a late incidence of 0.59 per 1000 population. This incidence is lower than the 1.14 per 1000 reported for 1983-7 16 table 2. gives the prevalence of risk factors for developmental dysplasia of the hip among affected children and table 3 shows the reasons for referral.…”

“…A study of the outcome of screening of children born in the province during 1983-7 reported a high incidence of developmental dysplasia of the hip (1.75 per 1000) and a late incidence (diagnosis after 6 months) of 1.14 per 1000 16. As this was a relatively poor outcome it was felt that the service needed to be improved.…”

The Epidemiology and Demographics of Hip Dysplasia

“…In the United Kingdom, three studies give a low incidence (0.91 in Birmingham, England [111], 1.55 in Manchester, England [33], and 1.7 in Northern Ireland [118]); most range from 3–6 [107, 109, 112–115, 161, 162], with the highest incidence of 30.3 in Aberdeen, Scotland [108]. In Spain, the incidence was 9.78 in Córdoba [121] and 43.4 in Madrid [122] (5.09 for complete dislocation).…”

“…Breech position/presentation increases the incidence of DDH [32, 34, 44, 54, 56, 63, 65, 67, 100–102, 105, 106, 114, 118, 135, 139, 162, 168–171, 191, 225, 226, 229–231, 234–243]. Breech position/presentation in children with DDH ranges from 7.1% [32] to 40% [65].…”

Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force

“…[21][22][23] Ascertainment of cases was often flawed, and the studies span several decades, which make it difficult to assess whether the varied results represent artifacts of data quality, secular trends, or differences in local practice styles. 24 These studies are also limited because they typically do not follow the screen-negative population with the same vigilance as the screen-positive population and experience significant loss to follow-up in the screen-positive population that can bias the outcomes.…”