Related Experiment Video
Updated: May 2, 2026
A Mouse Model of Lumbar Spine Instability
Published on: April 23, 2021
Is there a predilection for breech infants to demonstrate spontaneous stabilization of DDH instability?
Eric J Sarkissian1, Wudbhav N Sankar, Keith Baldwin
1The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Infants with developmental dysplasia of the hip (DDH) in breech position show higher rates of spontaneous hip stabilization. Breech presentation is a key predictor for resolving mild hip instability in newborns.
Area of Science:
- Orthopedics
- Pediatric Medicine
- Radiology
Background:
- Abnormal mechanical forces in breech position can affect fetal hips.
- Developmental dysplasia of the hip (DDH) can arise from various factors, including breech presentation.
- Unlike genetic factors, breech position's influence on hip development is limited to the prenatal period.
Purpose of the Study:
- To compare the rate of spontaneous hip stabilization in breech-presenting infants with mild hip instability.
- To evaluate the rate of spontaneous stabilization in lax hips of breech-presenting infants versus non-breech infants with similar hip laxity.
Main Methods:
- A retrospective study analyzed infants aged 8 weeks or younger with DDH from 2008-2012.
- Infants with ultrasound-detected hip laxity but clinically stable hips were assessed.
- Spontaneous stabilization on follow-up ultrasound was the primary endpoint; logistic regression identified predictors.
Main Results:
- Of 122 unstable hips in 79 infants, 74% stabilized spontaneously by a mean age of 9 weeks.
- Hips of breech-presenting infants demonstrated significantly higher spontaneous stabilization rates (80%) compared to non-breech infants (66%).
- Breech presentation was a strong independent predictor of spontaneous hip stabilization (OR, 3.72; P=0.006).
Conclusions:
- Infants with DDH and a breech presentation history are over 3.7 times more likely to achieve spontaneous resolution of mild hip instability.
- Recognizing breech presentation as a predictor of spontaneous laxity resolution aids in parental counseling and early DDH management.
Background:
Breech position subjects the fetal hip to abnormal mechanical forces. However, unlike genetic or tissue factors linked to developmental dysplasia of the hip (DDH), the causative effect of the breech position ends when the infant is born. The purpose of this study was to evaluate the rate of spontaneous stabilization in mildly unstable hips of breech-presenting infants compared with similarly lax hips in infants with a genetic or tissue-related cause of DDH.
Methods:
We studied a consecutive series of infants presenting to our institution at 8 weeks of age or younger with DDH from January 2008 to January 2012. Infants with increased hip laxity on dynamic ultrasound examination but without frank instability on clinical provocation maneuvers and no history of prior treatment were evaluated. The endpoint was spontaneous stabilization of ultrasound-detected instability, or intervention due to persistent instability on follow-up dynamic ultrasound. A logistic regression model using backward likelihood ratio method was used to analyze predictors of spontaneous stabilization.
Results:
We identified 122 hips in 79 infants with instability on dynamic ultrasound evaluation but with stable clinical examinations. Spontaneous stabilization of sonographic instability occurred in 90 hips (74%) at a mean age of 9 weeks (range, 4 to 18 wk). Breech hips more frequently spontaneously stabilized compared with nonbreech hips (80% vs. 66%). Regression analysis determined that breech presentation was a strong independent predictor for spontaneous hip stabilization (odds ratio, 3.72; 95% confidence interval, 1.45-9.60; P=0.006). Sex, family history, intrauterine positioning syndromes, side involved, bilateralism, and grade of sonographic hip instability were not independently predictive of spontaneous hip stabilization.
Conclusions:
DDH infants with a history of breech presentation are 3.72 times more likely to experience spontaneous resolution of mild hip instability compared with nonbreech infants. Awareness that breech presentation is a strong independent predictor of spontaneous laxity resolution can guide parental counseling and early care of DDH.
Level Of Evidence:
Level II, prognostic retrospective study.
More Related Videos
07:11Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling
Published on: February 5, 2019
07:35Creating Rigidly Stabilized Fractures for Assessing Intramembranous Ossification, Distraction Osteogenesis, or Healing of Critical Sized Defects
Published on: April 11, 2012