Late-Presenting Developmental Dysplasia of the Hip

Abstract

Research Article| March 01 2018 Late-Presenting Developmental Dysplasia of the Hip AAP Grand Rounds (2018) 39 (3): 31. https://doi.org/10.1542/gr.39-3-31 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Late-Presenting Developmental Dysplasia of the Hip. AAP Grand Rounds March 2018; 39 (3): 31. https://doi.org/10.1542/gr.39-3-31 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: developmental hip dysplasia, hip abduction, leg length inequality, live birth Source: Talbot C, Adam J, Paton R. Late presentation of developmental dysplasia of the hip: a 15-year observational study. Bone Joint J. 2017; 99-B(9): 1250– 1255; doi: https://doi.org/10.1302/0301-620X.99B9.BJJ-2016-1325.R1Google Scholar Investigators from multiple institutions in the United Kingdom conducted an observational cohort study to assess the incidence and characteristics of late-presenting irreducible developmental dysplasia of the hip (DDH). All infants referred to a regional pediatric orthopedic clinic from 1997–2011 with DDH were included. This was the referral clinic for all infants identified by the regional DDH screening program, a program that required a clinical hip exam for all infants within 48 hours of birth and referral within 1–2 weeks for those with clinical hip instability (ie, positive Ortolani or Barlow maneuvers) and 6–9 weeks for those without hip instability but with DDH risk factors present (ie, breech birth and/or family history). All referred infants had risk factors confirmed, hips reexamined, and hip ultrasound performed. Irreducible DDH was diagnosed by ultrasound, and late-presenting DDH was defined as the diagnosis after 3 months of age or having a delayed review or investigation as part of the regional screening program. Investigators calculated the incidence of late-presenting irreducible DDH as the ratio of cases over the number of live births in the region during the study period. The clinical characteristics of infants with late-presenting irreducible DDH were described. There were 64,670 live births and 18 infants with late-presenting irreducible DDH over the study period, resulting in an incidence of 0.48 per 1,000 live births. Each of the 18 infants had a normal clinical examination at birth and no recorded abnormality at 6–8 weeks of age. Two infants were late-presenting because of delayed review despite having DDH risk factors (both had missed appointments). An additional 3 infants had a positive family history (2 parents did not know their family history prior to referral to the orthopedic clinic, and the other was never asked about their family history at the 48-hour exam). The most common reasons for referral for infants who were diagnosed with late-presenting irreducible DDH were leg length discrepancy and limited hip abduction. The investigators conclude that despite universal DDH screening, late-presenting irreducible DDH still occurs and can present as leg length discrepancy and limited hip abduction. Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Early diagnosis and treatment of DDH is important to provide the optimal clinical outcome.1 The incidence of DDH varies depending on the criteria used for diagnosis, the population studied, and the method of screening2 ; the incidence is approximately 1 in 1,000 live births.2 Important risk factors for DDH include breech position, female gender, being first born, and a positive family history. Breech presentation is the most important single risk factor.3 Screening for DDH is important because the condition is initially occult, is easier to treat... You do not currently have access to this content.