Related Experiment Video
Updated: Jan 23, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
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.
Insights
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.
Background:
Identifying patients at the highest risk of developmental dysplasia of the hip (DDH) is critical to the success of an efficient selective screening program. Defining and evaluating risk factors is, therefore, vital. This study was designed to analyze the relationship between classic risk factors and rates of DDH in a contemporary United States-based population.
Methods:
All patients presenting before 12 months of age to a single tertiary care pediatric hospital's orthopaedic department for DDH screening, with explicit medical record documentation of DDH risk factors from 2018 to 2022 were included. Classic risk factors were defined as breech presentation, female sex, firstborn status, and family history of hip dysplasia. Ultrasounds and radiographs obtained at initial presentation were reviewed to determine Graf and IHDI classifications. Reasons for referral for DDH screening were obtained from the chart review.
Results:
One thousand two hundred twenty-six patients were eligible for the study. The probability of having DDH increased as the number of risk factors present for DDH increased ( P <0.001). Female sex and firstborn status were found to be independent risk factors for DDH. Females were 2.5 times more likely to have DDH than males ( P <0.001). Firstborn children were 1.3 times more likely to have DDH than subsequent birth-order children ( P =0.048). There was no difference in the proportion of DDH in breech presenting patients compared with non-breech ( P =0.511) or in subjects with a family history of DDH ( P =0.16).
Conclusions:
The primary risk factor for DDH in this contemporary cohort was female sex. Female patients without any other risk factors for DDH had a 25.2% rate of DDH, significantly higher than the estimated population incidence. Fifteen percent of these patients had no notable physical exam findings consistent with DDH. Given the high rate of DDH in female patients in the absence of notable physical exam findings, universal ultrasound screening for females at the age of 6 weeks should be considered.
Level Of Evidence:
Level IV.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:12Relative Risk
01:17Design Example: Analyzing Capacity Contours for Flood Risk Assessment
01:27Introduction to Developmental Psychology
01:29Three Developmental Domains
Physical Development
Physical processes, also known as maturation, encompass the biological changes that occur across an individual's life. These changes begin with genetic inheritance and continue through various stages, including growth in height and weight,...
01:14Decision Making: Traditional Method
First, a specific claim about the population parameter is decided based on the research question and is stated in a simple form. Further, an opposing statement to this claim is also stated. These statements can act as null and alternative hypotheses, out of which a null hypothesis would be a...