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[Developmental dysplasia of the hip - epidemiological determinants and age assessment regarding time of surgical
S Milasinović1, R Brdar, I Petronić
1Institute for childrens disease, Clinical center of Montenegro, Podgorica, Montenegro.
Insights
Delayed diagnosis of developmental dysplasia of the hip (DDH) is suggested by most patients presenting between 24-48 months. Female infants are more frequently affected, with vaginal delivery and head presentation being common in DDH cases.
Area of Science:
- Orthopedics
- Pediatrics
- Epidemiology
Context:
- Developmental dysplasia of the hip (DDH) is a common pediatric condition.
- Early diagnosis and treatment are crucial for optimal outcomes.
- Understanding epidemiological determinants aids in early detection strategies.
Purpose:
- To analyze the age structure of patients undergoing surgery for DDH.
- To investigate epidemiological factors including gender, affected hip laterality, delivery type, and presentation mode.
- To correlate radiographic and clinical findings with patient demographics and birth factors.
Summary:
- A study of 78 children with DDH revealed a majority (46.2%) were diagnosed between 24 and 48 months, indicating potential diagnostic delays.
- Female gender (82.1%) was significantly more affected than males (17.9%).
- Vaginal delivery (87.2%) and cephalic presentation (71.8%) were predominant in affected infants. Radiographic parameters correlated with age at diagnosis, while male gender was associated with more clinical findings.
Impact:
- Findings suggest female gender as a potential risk factor for DDH.
- Highlights the need for enhanced diagnostic awareness and continuous education for healthcare professionals.
- Emphasizes the importance of early DDH detection and intervention for improved patient outcomes.
Purpose Of The Study:
Aim of the study was to analyze age structure of the patients with developmental dysplasia of the hip (DDH) at the time of the operation and epidemiological determinants: gender distribution, proportion of left or right hip affection, type of delivery and mode of labor presentation.
Material And Methods:
The population of 78 children with DDH was evaluated. Three age groups were analyzed: first group younger than 24 months of life, second group between 24 and 48 months and third group older than 48 months of life. Male and female gender was separately evaluated as well as type of delivery and mode of labor presentation. Separately, 2 groups regarding affected hip were analyzed: group with affected left hip and group with affected right hip. Radiographic findings (Collodiaphyseal angle, Hilgenreiner angle and Wibergs center-edge angle) and clinical findings (positive Trendelenburgs sign, reduced flexion angle (<114°), pain in the hip and incomplete crouch) were evaluated regarding: age of the patients, gender, mode of presentation and type of delivery.
Results:
There was 33.3% of patients in the first age group, 46.2% of patients in second group and 20.5% of patients in third age group, and regarding gender, 17.9% of males and 82.1% of females. Vaginal delivery was predominant mode with distribution of 87.2% as well as head presentation with distribution of 71.8%. Distribution of children with affected left hip was 46.2% and right hip 53.9%.
Discussion:
Majority of patients in the study were in the age group between 24 and 48 months of life, suggesting delay in on-time diagnostics of DDH. Female gender was more frequently affected by DDH and vaginal delivery as well as head presentation of newborn was significantly frequent in patients with DDH. It is shown that Collodiaphyseal, Hilgenreiner and Wibergs center-edge angles values are in correlation with the age structure of the patients with DDH at the time of diagnosis. Male gender tends more frequently to present with clinical findings. Reduced flexion angle of the hip is the frequent clinical finding for children with DDH that were born by breech presentation or delivered by Caesarean section.
Conclusion:
Female gender can be taken as one of possible risk factors during clinical examination of newborn regarding diagnostics of DDH, while breech presentation has been shown not to be one of possible risk factors. Early diagnostics and prompt treatment are beneficial in overall outcome for children with DDH. Therefore, there is great need for countinous education of orthopedic surgeons and pediatricians.
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