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Screening of selected risk factors in developmental dysplasia of the hip: an observational study
Christopher L Talbot1, Robin W Paton
1Orthopaedic Department, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK. christalbot@doctors.org.uk
Insights
This study found a significantly higher incidence of developmental dysplasia of the hip (DDH) in females compared to males. Current UK screening policies for DDH in males with risk factors may need re-evaluation.
Area of Science:
- Orthopedics
- Pediatrics
- Public Health
Background:
- Developmental dysplasia of the hip (DDH) is a common neonatal musculoskeletal condition.
- The UK implemented selective screening for 'at risk' infants in 2008.
- Risk factors include breech presentation and family history.
Purpose of the Study:
- To assess the risk factors of breech presentation and family history for DDH.
- To evaluate the effectiveness of current screening protocols.
Main Methods:
- A 15-year prospective, observational, longitudinal cohort study.
- Infants were screened clinically and sonographically.
- Risk factors analyzed: breech presentation and family history of DDH.
Main Results:
- Of 64,670 live births, 2984 infants were screened.
- Incidence of pathological DDH was significantly higher in females (0.028) than males (0.003) (p<0.001).
- Four cases of irreducible hip dislocation occurred, all in females.
Conclusions:
- The study questions the current UK screening policy for DDH in clinically stable males with risk factors.
- Findings may influence future DDH screening program policies.
- Further research into sex-specific risk stratification is warranted.
Background:
Developmental dysplasia of the hip (DDH) is the most common neonatal musculoskeletal condition. In 2008, the NHS Newborn and Infant Physical Examination committee added selective 'at risk' screening to the existing universal neonatal and general practitioner clinical hip screening guidelines.
Objective:
Assessment of breech and family history risk factors in DDH.
Design:
A 15 year prospective, observational, longitudinal cohort study.
Method:
Breech presentation and evidence of a strong family history for DDH were the 'risk factors' studied. All infants referred were clinically and sonographically screened by one consultant paediatric orthopaedic surgeon.
Results:
From a cohort of 64 670 live births, 2984 neonates/infants, 46.1 (95% CI 44.6 to 47.8) per 1000 live births, were referred and sonographically screened with these risk factors alone. 1360 were male, of which four were identified as having 'pathological' DDH (an incidence of 0.003 (95% CI 0.001 to 0.008)). 1624 were female, of which 45 were identified as having 'pathological' DDH (an incidence of 0.028 (95% CI 0.021 to 0.037)). This difference in incidence of 0.025 (95% CI 0.016 to 0.033) was statistically significant (p<0.001). From those who were clinically stable and screened with either or both of the two risk factors, four individuals were diagnosed with irreducible hip dislocation (0.06 (95% CI 0.024 to 0.159) per 1000 live births). All were females.
Conclusions:
This study questions the current UK screening policy for DDH in clinically stable males referred with risk factors, and may influence future DDH screening programme policy.
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