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An epidemiological study of developmental dysplasia of the hip in infants in Singapore
1Department of Orthopaedic Surgery, National University Hospital, Singapore.
Insights
The incidence of developmental dysplasia of the hip in Singapore is higher than previously thought, affecting 16.8 per 1000 live births, with Malay infants most impacted. Early screening is crucial for timely diagnosis and management.
Area of Science:
- Orthopedics
- Pediatrics
- Public Health
Background:
- Congenital dislocation of the hip (CDH) incidence in Singapore/Malaysia is traditionally lower than in Western countries.
- An increasing trend of congenital hip dislocation and dysplastic hips has been observed in local hospitals.
Purpose of the Study:
- To prospectively determine the incidence of developmental dysplasia of the hip (DDH) in Singapore.
- To identify risk factors and assess the effectiveness of screening programs for DDH.
Main Methods:
- Prospective study of 20,000 live births over five years (1989-1994).
- Neonatal screening by neonatologist, confirmed by pediatric orthopedic surgeon.
- Plain X-rays at 3 months (acetabular index [AI] ≥ 30° considered dysplastic), with follow-up X-rays at 1 year.
- Ultrasound assessment in a subgroup (n=130) compared with X-rays.
Main Results:
- Incidence of dysplastic hips: 16.8 per 1000 live births.
- Overall incidence of dislocated hips: 4.7 per 1000 live births.
- Highest incidence observed in Malay infants (5.4 per 1000 live births).
- 64% of neonates with AI > 20° showed hip dysplasia via ultrasound (alpha angle < 60°).
- One-third of initially dysplastic hips remained dysplastic at 1 year.
- Babies with "clicking hips" frequently showed acetabular dysplasia (AI > 30°).
Conclusions:
- The incidence of DDH in Singapore is higher than previously reported, particularly among the Malay population.
- A well-organized screening program with experienced examiners is effective for early and accurate clinical diagnosis.
- Early detection and intervention are critical, as a significant proportion of hip dysplasia persists to one year of age.
Abstract:
The incidence of congenital dislocation of the hip (CDH) in Singapore and Malaysia has been reported as being lower than in the West. In our hospital, we have seen an increasing number of congenital hip dislocation as well as dysplastic hips. We undertook a prospective study from December 1989 to December 1994 of 20,000 live births. The neonates were all screened by a consultant neonatologist and the findings were confirmed by a consultant paediatric orthopaedic surgeon. All babies had plain X-rays at 3 months and an acetabular index (AI) of 30 degrees or more was considered dysplastic. All babies with positive signs were followed up for 1 year and again had radiographs taken at 1 year. Comparison of plain X-rays and ultrasound assessment in a subgroup of 130 neonates showed that 64% of patients with AI > 20 degrees had hip dysplasia by ultrasonographic (alpha angle < 60 degrees) The incidence of dysplastic hips was 16.8 per 1000 live births. The overall incidence of neonates with dislocated hips was 4.7 per 1000 live births. The Malays were most affected with an incidence of 5.4 per 1000 live births. The incidence of developmental dysplasia of the hip in Singapore is higher than previously reported, with the Malays having the highest incidence. A significant number of babies with clicking hips have radiological evidence of acetabular dysplasia (AI > 30 degrees). One-third of the babies' hips were still dysplastic at 1 year of age. A well-organised screening programme with experienced examiners has proved to be useful in making early and accurate clinical diagnosis.