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Developmental dysplasia of the hip: risk markers, clinical screening and outcome
Chen Stein-Zamir1, Irina Volovik, Shmuel Rishpon
1Jerusalem District Health Office, Ministry of Health and Braun School of Public Health and Community Medicine, Hebrew University, Hadassah, Jerusalem, Israel. chen@lbjer.health.gov.il
Insights
Early detection of developmental dysplasia of the hip (DDH) is crucial. Targeted clinical screening identifies at-risk infants, potentially reducing surgery and long-term disability.
Area of Science:
- Pediatrics
- Orthopedic Surgery
- Developmental Pediatrics
Background:
- Early detection, diagnosis, and treatment of developmental dysplasia/dislocation of hip (DDH) are essential for preventing childhood disability.
- Identifying DDH risk markers and understanding the impact of screening age on outcomes are critical.
Purpose of the Study:
- To evaluate demographic and perinatal risk markers for DDH.
- To assess the association between the age of clinical screening and patient outcomes.
Main Methods:
- Clinical screening for DDH was conducted on 8145 infants at birth, 6, and 13 weeks.
- Infants with suspected DDH underwent clinical evaluation, imaging, and follow-up.
- Demographic and perinatal characteristics of DDH cases were compared to matched controls.
Main Results:
- The rates of suspected and diagnosed DDH were 0.95% and 0.63%, respectively.
- Female gender, firstborn status, and breech presentation were significant risk factors (OR: 4.3, 2.7, 6).
- Diagnosis after 6 weeks of age increased the likelihood of surgery and motor disability.
Conclusions:
- Specific demographic and perinatal factors are associated with DDH.
- Targeted clinical screening for early DDH diagnosis can minimize surgical intervention and motor handicaps.
Background:
Early detection, diagnosis and treatment of developmental dysplasia/dislocation of hip (DDH) are essential in preventing further disability and quality of life impairment in children. DDH risk markers and association between the age of clinical screening and outcome, were evaluated.
Methods:
Clinical screening at ages birth, 6 and 13 weeks was performed in 8145 infants by pediatricians. Infants suspected for DDH were referred to the community hospital clinic for clinical evaluation by a pediatric orthopedic surgeon, imaging procedures and follow up. Demographic and perinatal characteristics of the children with suspected (n= 77) and diagnosed DDH (n= 51) were compared to matched controls (n= 154).
Results:
The rate of suspected DDH was 0.95% and that of diagnosed DDH was 0.63%. Female gender, firstborn child and breech presentation were significantly more frequent among cases versus controls (odds ratio [OR]: 4.3, 2.7, and 6 respectively; P < 0.05). The highest positive predictive value (95.5%) in physical evaluation was any evidence of a dislocatable hip. The proportion of DDH among infants referred from the newborn department was significantly higher (OR, 4.4). DDH diagnosis after 6 weeks of age was associated with a higher likelihood of subsequent surgery and motor disability. Untoward outcome was significantly associated with increasing age of referral both at ages of 6 and 13 weeks (P < 0.05).
Conclusions:
Children with DDH have certain specific demographic and perinatal risk markers. Clinical screening targeted towards early diagnosis may lessen the need for surgical intervention and the risk of disability or motor handicap.
