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A mini-review of risk factors for developmental dysplasia of the hip: insights from multiple comparative cohort
Thomas Cho1, Ajay Nair1, Phillip Stokey2
1Department of Orthopedic Surgery, University of Toledo Medical Center.
Insights
Developmental dysplasia of the hip (DDH) is more likely in infants with breech presentation, a family history of DDH, oligohydramnios, or female sex. These factors significantly increase the risk, highlighting the need for targeted infant screening.
Area of Science:
- Pediatric Orthopedics
- Epidemiology
- Genetics
Background:
- Developmental dysplasia of the hip (DDH) is a prevalent pediatric orthopedic condition.
- Existing knowledge identifies several risk factors for DDH, but their quantitative association strength is not well-established.
Purpose of the Study:
- To quantitatively evaluate the risk factors associated with developmental dysplasia of the hip (DDH).
- To provide pooled evidence on the strength of association for recognized DDH risk factors.
Main Methods:
- A systematic meta-analysis was conducted, searching PubMed and Embase databases through December 2025.
- Included 22 comparative cohort studies with 133,108 participants and 3,151 DDH cases.
- Random-effects models were used to pool data and calculate relative risks (RRs) with 95% confidence intervals (CIs).
Main Results:
- Breech presentation (RR=3.35), family history of DDH (RR=3.64), oligohydramnios (RR=3.59), and female sex (RR=3.74) were identified as significant risk factors for DDH.
- These factors were associated with a three to four-fold increased risk of developing DDH.
- All identified risk factors showed statistically significant associations (P < 0.05).
Conclusions:
- This meta-analysis provides robust quantitative evidence confirming breech presentation, family history, oligohydramnios, and female sex as significant risk factors for DDH.
- The findings emphasize the critical importance of targeted screening for infants presenting with these key risk factors.
- Early identification and intervention for DDH can be improved by focusing on high-risk populations.
Abstract:
Developmental dysplasia of the hip (DDH) is a common pediatric orthopedic disorder. While several risk factors, such as breech presentation, female sex, family history, swaddling, and oligohydramnios, are clinically recognized, their quantitative strength of association has not been well established through pooled evidence. This meta-analysis aims to evaluate the risk factors for DDH quantitatively. A systematic search of PubMed and Embase was conducted through December 2025 to identify comparative cohort studies reporting on DDH risk factors. Data were pooled using random-effects models to calculate relative risks (RRs) with 95% confidence intervals (CIs). Review Manager Web was utilized for statistical analyses, and a P value less than or equal to 0.05 was considered statistically significant. 22 studies involving 133 108 participants (3151 DDH cases) were included. Meta-analysis demonstrated that breech presentation (RR = 3.35, 95% CI: 2.37-4.75, P < 0.001), family history of DDH (RR = 3.64, 95% CI: 2.34-5.68, P < 0.001), oligohydramnios (RR = 3.59, 95% CI: 1.43-9.03, P = 0.007), and female sex (RR = 3.74, 95% CI: 2.48-5.62, P < 0.001) were significant risk factors associated with a three to four-fold increased risk of DDH. This study provides pooled quantitative evidence confirming that breech presentation, family history, oligohydramnios, and female sex are significant risk factors for DDH. These findings underscore the importance of targeted screening for infants with these key risk factors.
