Implementing the AAOS Guidelines for Screening of Developmental Dysplasia of the Hip Before the Age of 6 Months in Taiwan
Kuei-Hsiang Hsu1,2, Wen-Chieh Chang1,2, Chi-Kuang Feng1,2
1Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.
Insights
Implementing new guidelines for developmental dysplasia of the hip (DDH) significantly increased diagnosis rates and enabled earlier treatment in East Asian newborns. This approach may reduce the need for surgery, though female infants remain at higher risk for residual DDH.
Area of Science:
- Pediatric Orthopedics
- Neonatal Screening
- Public Health
Background:
- Developmental dysplasia of the hip (DDH) prevalence in East Asia may be underestimated due to inconsistent diagnostic criteria.
- The American Academy of Orthopaedic Surgeons (AAOS) released new guidelines for systematic DDH screening in 2015.
- This study evaluated the impact of implementing AAOS guidelines on DDH incidence and outcomes.
Purpose of the Study:
- To compare DDH incidence and outcomes before and after the implementation of AAOS screening guidelines.
- To assess the effect of guideline implementation on referral rates, age at referral, and surgical intervention.
- To identify risk factors for residual DDH.
Main Methods:
- A historical cohort study compared newborns before (July 2015-May 2017) and after (July 2017-May 2019) guideline implementation.
- Data were retrospectively collected for the pre-guideline group and prospectively for the post-guideline group.
- Key outcomes included DDH incidence, referral rates, age at referral, and surgical rates.
Main Results:
- The post-guideline group showed a significantly higher referral rate (8.4% vs 1.1%) and DDH incidence (1.3%).
- The mean age at referral decreased substantially in the post-guideline group (0.9 months vs 6.7 months), indicating earlier detection.
- Female sex was identified as a risk factor for residual hip dysplasia at 6 months of age.
Conclusions:
- DDH incidence in East Asia appears comparable to Western countries.
- Implementing AAOS guidelines enhances DDH diagnosis and facilitates early treatment, potentially reducing surgical needs.
- Early detection and intervention are crucial, but vigilance for residual DDH in female infants at 6 months is necessary.
Background:
The prevalence of developmental dysplasia of the hip (DDH) has been considered to be low in East Asia, but this may be incorrect because of inconsistent diagnostic definitions and testing criteria. In 2015, the AAOS released guidelines for systematic screening for DDH in newborns. We implemented these guidelines and compared DDH incidence and outcomes before and after their implementation.
Methods:
We used a historic comparison cohort of newborns with DDH between July 2015 and May 2017 before guideline implementation (the preguideline group); their data were retrieved using electronic medical records. In this group, the newborns received general hip screening without systemic follow-up. The postguideline group included newborns who were screened for hip dysplasia and followed up per the AAOS guidelines between July 2017 and May 2019. Their data were prospectively collected. The primary outcome in the postguideline group was DDH incidence. Other outcomes included rates of referral, surgery, and complications, and DDH prognosis.
Results:
The preguideline and postguideline groups included 3534 and 2663 newborns, respectively, of whom 49 (1.1%) and 225 (8.4%), respectively, were referred to the pediatric orthopaedic clinic enrolled. In the postguideline group, 35 patients were diagnosed as having DDH (incidence: 1.3%, 95% CI: 0.8%-1.9%). Both the incidence and referral rates were significantly higher in the postguideline group than in the preguideline group. Furthermore, the mean age at referral was 6.7±10.06 months and 0.9±0.25 months in the preguideline and postguideline groups, respectively, indicating a potential for early treatment in the postguideline group. Finally, the female sex was identified as a risk factor for residual hip dysplasia at 6 months of age.
Conclusion:
DDH incidence in East Asia seems comparable to that in Western countries. Implementing the AAOS guidelines increased the diagnosis rate and opportunity for early treatment initiation, thus potentially avoiding surgical intervention. Nevertheless, residual DDH may be detected in some patients at 6 months of age, particularly in female infants.
Level Of Evidence:
Level IV.
