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Developmental dysplasia of the hip. Prevention and real incidence
1University Department of Paediatric Orthopaedics, Comenius University, Childrens Hospital, Bratislava, Slovakia. kokavecm@hotmail.com
Insights
True developmental dysplasia of the hip (DDH) is rare, affecting 4.8 per 1000 newborns. Many neonatal hip abnormalities resolve naturally, distinguishing true DDH from transient sonographic findings and improving incidence calculations.
Area of Science:
- Orthopedics
- Pediatric Radiology
- Developmental Biology
Background:
- Developmental dysplasia of the hip (DDH) diagnosis is complicated by unclear criteria for neonatal hip pathology.
- Accurate incidence determination requires distinguishing between transient and persistent hip abnormalities.
Purpose of the Study:
- To identify neonatal hips that progress to dysplasia if untreated.
- To establish criteria for true DDH incidence calculation.
Main Methods:
- Clinical and ultrasonographic screening of 4356 neonatal hips.
- Exclusion of newborns with congenital deformities or neurological disorders.
- Follow-up of hips with initial sonographic abnormalities to assess resolution or deterioration.
Main Results:
- Sonographic screening identified 69.5/1000 hips with deviations.
- Only 4.8/1000 hips demonstrated persistent abnormality requiring treatment (true DDH).
- The majority of initially abnormal hips resolved spontaneously without intervention.
Conclusions:
- Neonatal hip pathology can be categorized into transient (resolving) and progressive (true DDH) types.
- This distinction refines DDH definition, incidence, and treatment decisions.
- Improved diagnostic criteria enhance cost-effectiveness of early DDH detection programs.
Objective:
The controversy over the incidence of developmental dysplasia of the hip (DDH) stems mainly from an ambiguity of criteria for defining a genuinely pathologic neonatal hip. The aim of this study was to identify those neonatal hips which, if left untreated, would develop any kind of dysplasia and, therefore, are to be included in the determination of DDH incidence.
Methods:
Clinical and ultrasonographic examinations for DDH were performed on 4356 neonatal hips. Newborns with skeletal deformities, neurologic/muscular disorders, and neural tube defects were excluded. Hips that featured any type of sonographic pathology were reexamined at 2 or 6 weeks, depending on the severity of the findings. Only hips in which the initial pathology was not improved or had deteriorated were treated; all others were examined periodically until the age of 12 months.
Results:
Sonographic screening of 4356 hips detected 301 instances of deviation from normal, indicating a sonographic DDH incidence of 69.5 per 1000. However, only 21 hips remained abnormal and required treatment, indicating a true DDH incidence of 4.8 per 1000 hips. All the others evolved into normal hips, and no additional instances of DDH were found on follow-up throughout the 12 months.
Conclusions:
These findings enables us to distinguish two categories of neonatal hip pathology: one that eventually develops into a normal hip (essentially sonographic DDH); and another that will deteriorate into a hip with some kind of dysplasia, including full dislocation (true DDH). This approach seems to allow for a better-founded definition of DDH, for an appropriate determination of its incidence, for decision-making regarding treatment, and for assessment of the cost-effectiveness of screening programs for the early detection of DDH (Tab. 2, Ref. 15).
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