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Late presentation of developmental dysplasia of the hip : a 15-year observational study
1Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.
Insights
Late presenting developmental dysplasia of the hip (DDH) still occurs in infants despite screening. Improvements in screening and follow-up are recommended to ensure timely diagnosis and treatment for affected infants.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip (DDH)
- Neonatal Screening
Background:
- Developmental dysplasia of the hip (DDH) poses significant challenges, with late presentations occurring despite existing screening programs.
- Universal clinical neonatal and selective ultrasound screening are standard but do not prevent all late-presenting cases.
Purpose of the Study:
- To assess the incidence and characteristics of infants with late-presenting hip dislocation despite current screening protocols.
- To identify factors contributing to delayed diagnosis in these cases.
Main Methods:
- A prospective, longitudinal study of 64,670 live births between 1997 and 2011.
- Late presentation defined as diagnosis after three months of age; confirmed by ultrasound and radiography.
- Data collected included demographics, referral details, risk factors, and clinical/radiological findings.
Main Results:
- An incidence of 0.48 per 1000 live births for irreducible hip dislocation was observed.
- 18 infants (58%) presented late, with 72% having no identifiable risk factors.
- Delays were often due to general practitioner referrals or administrative issues, with a mean diagnosis time of 62.4 weeks.
Conclusions:
- Late-presenting irreducible hip dislocation remains a concern despite current screening methods.
- Recommendations include updating the national screening program, enhancing healthcare professional training in infant physical examination, and implementing additional post-natal checks.
Aims:
Despite the presence of screening programmes, infants continue to present with late developmental dysplasia of the hip (DDH), the impact of which is significant. The aim of this study was to assess infants with late presenting dislocation of the hip despite universal clinical neonatal and selective ultrasound screening.
Patients And Methods:
Between 01 January 1997 to 31 December 2011, a prospective, longitudinal study was undertaken of a cohort of 64 670 live births. Late presenting dislocation was defined as presentation after three months of age. Diagnosis was confirmed by ultrasound and plain radiography. Patient demographics, referral type, reason for referral, risk factors (breech presentation/strong family history) and clinical and radiological findings were recorded.
Results:
There were 31 infants with an irreducible dislocation of the hip, an incidence of 0.48 (95% confidence interval (CI) 0.34 to 0.68) per 1000 live births. Of these, 18 (0.28 (95% CI 0.17 to 0.44) per 1000 live births; 58%) presented late. All infants had a documented normal newborn clinical examination and no abnormality reported in the six to eight week check. Of the 18 late presenting cases 72% (n = 13) had no risk factors: 16 were referred by GPs and two were late due to administrative issues (missed appointments). The mean time to diagnosis was 62.4 weeks (19 to 84).
Conclusion:
Despite universal clinical neonatal and selective ultrasound screening, late cases of irreducible hip dislocation still occur. We recommend an update of the national screening programme for DDH, a review of training and education of healthcare professionals involved in the physical examination of neonates and infants, and the addition of a further assessment after the six to eight week check. Cite this article: Bone Joint J 2017;99-B:1250-5.
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