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

Abstract

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.

Developmental Dysplasia of the Hip (DDH) in Saudi Arabia: Time to Wake up. A Systematic Review (1980-2018)

“…The pattern of the DDH in this review did not differ from the rest of the world in 3 parameters: gender, side of the affected hip, and family history. In a multicenter study involving 4 countries (Australia, Canada, United States and United Kingdom), Mulpuri et al found similar results [23]. One parameter that did not correspond to this study was breech delivery as a risk factor.…”

Introductory Chapter: Five-Dimensional Approach to the Developmental Dysplasia of the Hip

“…There is considerable diversity in opinions worldwide regarding both diagnostic and therapeutic approach to DDH. Besides orthopaedic, many other factors could contribute to it: demographic, socioeconomic and differences regarding healthcare organisation [5]. Reflecting this diversity, in this book authors will present their experience and opinion on several important issues regarding DDH: screening for DDH, biomechanical considerations, diagnostic procedures in all age groups, treatment modalities of hip dysplasia and dislocation in childhood, and dealing with the consequences in adulthood.…”

“…The incidence of many faces of DDH is fortunately distributed: it is reported to be as much as 8% for dysplasia, 1-3% for neonatal hip instability and <0.2% for frank dislocation [2][3][4]. These epidemiological data are greatly influenced by both diagnostic criteria and diagnostic methods used [5,6]. They evolve not only due to demographic changes of population, predominantly through migrations and genetic mixing, but also due to changes in nutrition [7][8][9].…”

Developmental dysplasia of the hip: addressing evidence gaps with a multicentre prospective international study

“…Results of bracing studies may be obfuscated by including patients with reducible and irreducible dislocated hips, unstable or subluxable hips and dysplastic hips together, 11,13,14,25,62 and studies comparing operative management also often fail to clearly define the included patient population. 63 To attempt to identify best practice evidence in DDH management, the International Hip Dysplasia Institute (IHDI) initiated in 2010 an international, multicentre prospective study 64 of infants with the most severe form of DDHdislocated hips at rest. Infants diagnosed under 18 months of age with a dislocated hip at rest were enrolled at nine centres across North America, Europe and Australia.…”

“…Initial findings have shown distinct differences across contributing centres in patient demographics, DDH severity and laterality at presentation, confirming the importance of locality variation in any predictive analysis of treatment success or failure in multicentre studies. 64 Additionally, infants presenting late (> 3 months of age) tend to have fewer traditional risk factors typically associated with DDH (ie, breech presentation), and late presentation may be 51,52 found no impact on reduction success and on development of avascular necrosis in the presence or absence of the ossific nucleus…”