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Demographic and Practice Variability Amongst Indian Centres in a Multicentre Prospective Observational Study on
Deepika Pinto1, Alaric Aroojis2, Hitesh Shah3
1Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India.
Insights
This study found similar patient demographics for Developmental Dysplasia of Hip (DDH) across five Indian centers, but significant variations in surgical treatment approaches were observed. Further analysis will compare treatment protocols to identify superior outcomes for DDH management.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Public Health
Background:
- Five Indian centers joined the International Hip Dysplasia Registry since 2017.
- Prospective data collection focuses on Developmental Dysplasia of Hip (DDH).
Purpose of the Study:
- To compare baseline patient characteristics in DDH across five Indian centers.
- To assess variations in initial treatment modalities for DDH among these centers.
Main Methods:
- Analysis of registry data collected over three years.
- Inclusion of children with radiograph-confirmed DDH diagnoses.
Main Results:
- 234 hips (181 patients) analyzed, with 218 undergoing surgery.
- Median age at presentation: 25.3 months; female/male ratio: 2.6:1.
- IHDI grades III and IV dislocations comprised 94% of cases.
- Variations noted in surgical techniques, including open reduction (OR) with femoral (FO) or acetabular (AO) osteotomy, with some centers exclusively using FO or AO.
Conclusions:
- Preliminary findings show consistent patient demographics and diagnoses for DDH.
- Significant differences in treatment regimens were identified across the five participating Indian centers.
- Future research will use center as a variable to identify optimal DDH treatment protocols.
Background:
Since 2017, five Indian centres have enrolled into the International Hip Dysplasia Registry for prospective collection of data on Developmental Dysplasia of Hip (DDH).
Aims:
To assess how baseline patient characteristics and initial treatment modalities differ across these five centres.
Methods:
Registry data collected over 3 years were analyzed. Children with DDH that had radiograph-based diagnoses were included.
Results:
Collectively, there were 234 hips (181 patients), of which 218 had undergone surgery. Overall, median age at presentation was 25.3 months (IQR 16.8-46.0); female/male ratio was 2.6:1 (range 1.46-4.75:1); with 42%, 29%, and 29% unilateral left, bilateral and unilateral right hip dislocations respectively. Most were IHDI grade III and IV dislocations (94%). Closed reduction was performed at all but one centre, at median 15.3 months (IQR 9.6-21.1). Open reduction (OR) as a stand-alone procedure was performed at all centres, at median 20.8 months (IQR 15.4-24.9). Combination of OR with a single osteotomy, femoral (FO) or acetabular (AO), was performed at all centres at median 29.7 months (IQR 22.1-43.5). However, for the same age group, three centres exclusively performed FO, whereas the other two exclusively performed AO. The combination of OR with both FO and AO was used at all centres, at median 53.4 months (IQR 42.1-70.8).
Conclusions:
The preliminary findings of this multi-centre study indicate similar patient demographics and diagnoses, but important differences in treatment regimens across the five Indian centres. Comparison of treatment regimens, using the 'centre' as a predictive variable, should allow us to identify protocols that give superior outcomes.
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