Hip dysplasia in the African Bantu

Abstract

Dysplasia of the hip is almost unknown in the Bantu peoples of Africa, except in cases of arthrogryposis and in those with partly European ancestry. Evidence is produced to show that the importance of intrinsic genetic factors in hip dysplasia far outweighs that of the extrinsic factors. These are of great importance only if allowed to act on a hip in which genetic factors have already determined dysplasia. Evidence is also produced to contradict the theory that the "piggyback" carrying method used by Bantu mothers is the reason for the immunity from dysplasia of the hip. The absence of "primary" osteoarthritis of the hip is noted, and the range of hip disorders leading to "secondary" osteoarthritis in the adult African is compared with that in the adult European. Three patients are described, one in each of the groups mentioned above, the third having an isolated "typical" congenital dislocation of one hip. The methods of study used were enquiry into obstetric history and into carrying methods, and arthrography to confirm clinical findings. The experience of other surgeons working in Africa is recorded.

Retracted: Joined at the hip? A paleoepidemiological study of developmental dysplasia of the hip and its relation to swaddling practices among indigenous peoples of North America

“…Infants born in colder winter months demonstrate poorer acetabular development compared to those born in the warmer months (Andr en and Palm en, 1963;Siffel et al, 2005) as measured by acetabular depth and acetabular angles; this may explain the increase in DDH in children born in the winter or may represent an effect of increased swaddling or tight clothing to protect the baby from the colder weather (Walker, 1977). In cultures where infant transport involves abduction of the legs around the mother (as in Hong Kong) or where swaddling is absent, DDH is virtually unheard of (e.g., Southern Chinese, African Bantu, Thai, North Korean, Sri Lankan; Hoaglund et al, 1981;Roper, 1976). For instance, Inuit mothers who carried their young inside their parkas in a hood, abducting the hips around their backs, have a low incidence of DDH similar to that of Europeans (Loder and Skopelja, 2011).…”

Developmental dysplasia of the hip: Controversies and current concepts

“…In populations where neonatal screening with hip US is not routinely performed a prevalence of 0.8 to 1.6 per 1000 live births has been reported. 6 The prevalence in the USA is quoted as 1.5-15 per 1000 live births, with the African American subgroup as 0.46 per 1000 live births. 3,4 This 40-fold variation in prevalence is due in part to variable definitions of DDH used in different reports, with the higher prevalence in many cases due to inclusion of all cases of sonographically abnormal hips, the so-called sonographic DDH.…”

“…Most notably it is rarely seen in the African population, with Bantu Africans having a prevalence of almost zero. 6 The prevalence in the USA is quoted as 1.5-15 per 1000 live births, with the African American subgroup as 0.46 per 1000 live births. The higher prevalence among African Americans compared with native Africans is possibly secondary to the effects of environmental factors in the USA and/or genetic heterogeneity.…”

To swaddle, or not to swaddle? paleoepidemiology of developmental dysplasia of the hip and the swaddling dilemma among the indigenous populations of North America

“…In cultures where infant transport involves abduction of the legs around the mother (as in Hong Kong) or where swaddling is absent, DDH is virtually unheard of (e.g. Southern Chinese, African Bantu, Thai, North Korean, Sri Lankan) (Hoaglund et al, ; Roper, ). For instance, Inuit mothers who carried their young inside their parkas in a hood, abducting the hips around their backs, have a low incidence of DDH similar to that of Europeans (Lodder and Skopelja, ).…”