The Epidemiology and Demographics of Hip Dysplasia

Abstract

The etiology of developmental dysplasia of the hip (DDH) is unknown. There are many insights, however, from epidemiologic/demographic information. A systematic medical literature review regarding DDH was performed. There is a predominance of left-sided (64.0%) and unilateral disease (63.4%). The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans. There is significant variability in incidence within each racial group by geographic location. The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. Predictors of DDH are breech presentation, positive family history, and gender (female). Children born premature, with low birth weights, or to multifetal pregnancies are somewhat protected from DDH. Certain HLA A, B, and D types demonstrate an increase in DDH. Chromosome 17q21 is strongly associated with DDH. Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. Swaddling is strongly associated with DDH. Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. Associated conditions are congenital muscular torticollis and congenital foot deformities. The opposite hip is frequently abnormal when using rigorous radiographic assessments. The role of acetabular dysplasia and adult hip osteoarthritis is complex. Archeological studies demonstrate that the epidemiology of DDH may be changing.

Serum prolidase activity and oxidative–antioxidative status in patients with developmental dysplasia of the hip and its relationship with radiographic severity

“…21 There are several studies on the pathological differences in collagen content, and distribution and metabolism of the joint capsule and ligaments in patients with DDH. [22][23][24][25] Pathological changes were documented in an anatomical study of six infants with DDH that included a loss of proteoglycans and an increase in collagen deposition in the lateral acetabular roof, manifesting as a ridge of degenerating acetabular cartilage. 2 Significant changes in the type of collagen, the fibril diameter, and the nature of the crosslinks in the joint capsules of subjects with DDH were reported, but these changes were probably tissue specific since no detectable change could be observed in the skin of Figure 3 The correlation of TOS with prolidase activity Figure 4 The correlation of OSI with prolidase activity these subjects compared to the controls.…”

Epidemiology of Primary Hip Arthroplasty: Report From Register of Vreden Russian Research Institute of Traumatology and Orthopedics

“…Средний возраст в этой группе пациентов (54,4 года) свидетель-ствует о том, что диагноз в большинстве случаев совершенно обоснованный. Вероятно, это повод задуматься о качестве скрининга новорожден-ных и своевременности диагностики не только врожденного вывиха бедра, но и нестабильно-сти ТБС, которая встречается в 10-20 раз чаще и создает основную массу пациентов с диспла-зией ТБС [9]. Возможно, ранняя диагностика патоморфологических изменений ТБС, таких как фемороацетабулярный импинджмент и дру-гие незначительные деформации суставных по-верхностей, при своевременном хирургическом лечении позволит довести возраст пациентов с идиопатическим коксартрозом до уровня ев-ропейских государств.…”

A new sign in the standard hip ultrasound image of the Graf method.

“…The final difference between the 2 groups consisted only of that for group I, the classic Graf method was applied and for group II the Graf method with the additional accuracy criterion was used. In evaluating the results, it was assumed nonvariable DDH incidence in the constant ethnic population over a few years as stated by Randall et al [1].…”

“…Although numerous studies have focused on the issue of diagnosis, there is still no widespread consensus on the approach [1,2]. The literature presents many concepts ranging from purely clinical diagnosis to complex screening programs [2,3].…”