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Revisiting Traditional Risk Factors: Implications for Risk Stratification in Developmental Dysplasia of the Hip
Ena Nielsen1, Rajvarun S Grewal2, James D Bomar1
1Rady Children's Hospital, San Diego.
Journal of Pediatric Orthopedics
|January 21, 2026
Summary
Female sex is the primary risk factor for developmental dysplasia of the hip (DDH). Even without other risk factors, females have a high DDH rate, suggesting universal screening for infant females.
Area of Science:
- Pediatric Orthopaedics
- Developmental Pediatrics
- Medical Screening
Background:
- Identifying high-risk infants for developmental dysplasia of the hip (DDH) is crucial for effective screening programs.
- Evaluating established risk factors is vital for accurate DDH risk stratification.
- This study examines classic risk factors and their association with DDH rates in a current US population.
Purpose of the Study:
- To analyze the relationship between classic risk factors and the incidence of developmental dysplasia of the hip (DDH).
- To evaluate the predictive value of specific risk factors in a contemporary pediatric population.
- To inform targeted screening strategies for DDH.
Main Methods:
- Retrospective review of patients under 12 months old screened for DDH between 2018-2022.
- Inclusion criteria: documented classic DDH risk factors (breech, female sex, firstborn, family history).
- Analysis of ultrasound and radiographic data (Graf, IHDI classifications) and referral reasons.
Main Results:
- Female sex (OR 2.5) and firstborn status (OR 1.3) were significant independent risk factors for DDH.
- Increased number of risk factors correlated with higher DDH probability (P<0.001).
- Breech presentation and family history did not show a significant association with DDH in this cohort.
Conclusions:
- Female sex emerged as the predominant risk factor for DDH in this contemporary cohort.
- Female infants without other risk factors exhibited a 25.2% DDH rate, exceeding population estimates.
- Universal 6-week ultrasound screening for all female infants is recommended due to high rates and asymptomatic presentations.
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