Risk Factors For Developmental Dysplasia Of The Hip Research Articles

Routine ultrasound screening for hip dysplasia in children with clubfoot is not supported.

Despite the existence of guidelines for screening for developmental dysplasia of the hip (DDH), there remains controversy regarding the need for routine ultrasound screening for DDH in patients with clubfoot due to an unclear correlation between the two conditions. The purpose of this study is to determine whether ultrasound screening for DDH in this population improved the diagnostic accuracy of DDH over standard assessment for patient risk factors and physical exam. This is a retrospective cross-sectional review of infants diagnosed with idiopathic clubfoot who underwent hip ultrasounds to assess for DDH as identified by keyword search in an institutional radiological database at a tertiary care paediatric hospital. Patient demographics, risk factors for DDH, physical exam findings, and ultrasound results were recorded. Of the 120 patients who met the inclusion criteria between 2003 and 2018, 8 had hip dysplasia confirmed on ultrasound (6.7%). All these patients either had known risk factors for hip dysplasia or had an abnormal physical exam finding suggestive of hip instability or dislocation as performed by an orthopaedic surgeon on their initial consultation. A detailed history to determine risk factors and a thorough physical exam are adequate to determine the need for hip ultrasound in infants with idiopathic clubfoot. Routine ultrasound screening of all patients with clubfoot is likely unnecessary and may pose a significant burden on the health care system.

Incidence and characteristics of developmental dysplasia of the hip in a Saudi population: A comprehensive retrospective analysis.

Developmental dysplasia of the hip (DDH) is a common hip disorder in infants. Ultrasonographic screening is considered the most reliable method for early detection of DDH in newborn infants. This study aimed to determine the incidence of DDH at King Abdulaziz University Hospital. From January 2017 to December 2018, this retrospective study analyzed the data of 8031 infants who underwent an early clinical examination of the hips. At the initial evaluation, 212 infants referred to the ultrasound department had risk factors for DDH and/or clinical instability. Different well-known risk factors of DDH have been identified including breech position, skeletal deformities, positive family history, hip side, sex and clicky hip. The findings revealed an incidence rate of 93 cases of DDH among 8031 infants (11.58 per 1000) births. Among the infants diagnosed with DDH, 55 were females (59.14 %), and 38 were males (40.86%). The results of the current study revealed that 45% of infants with DDH exhibited bilateral involvement. Moreover, results showed that the IIa hip joint was more prevalent in female than in male newborns, but without any significant difference. The incidence rate of DDH in this study was 11.58 per 1000 live births, and it was more prevalent among female than male newborns. Ultrasonography (US) should be used as a complementary imaging modality for clinical examination of DDH. Infants with breech presentation, clicky hip, and skeletal deformity should be scanned by US. Further prospective studies are recommended.

Community-Based Hip Screening for Up to Four-Month-Old Infants and Health Guidance for Their Caregivers in Japan: A Nation-Wide Survey.

Early detection of developmental dysplasia of the hip (DDH) in children is crucial. Due to COVID-19, maternal and child health services have been suspended temporarily, increasing the risk of late detection of DDH. This study aimed to reveal Japan's current situation regarding community hip screening for newborns and infants and to provide health guidance for caregivers regarding DDH. A web-based, nationwide cross-sectional survey was conducted between February and March 2023 (n = 1737). One public health nurse overseeing maternal and child health per municipality responded to the 2022 municipality hip screening system. Among the 436 municipalities that responded (response rate: 25.1%), 97.5% implemented hip screening within 4 months, and approximately 60% performed it during newborn home visits, while only 2.3% conducted hip ultrasound screening. Perfect checking of the risk factors for DDH during newborn home visits and training opportunities for home visitors must be improved. Educational programs regarding DDH for home visitors and caregivers are needed to prevent the late diagnosis of DDH. Furthermore, collaboration between pediatric orthopedic surgeons and nurses is crucial for developing effective community-based hip-screening systems by bridging the evidence and practice gap in the early detection of DDH.

Prevalence of Breech Presentation and Other Gestational/Delivery Characteristics Among Patients Born With Developmental Dysplasia of the Hip.

Introduction Developmental dysplasia of the hip (DDH) is the most common congenital disability in newborns. The condition can range from a slight laxity in the hip joint to secondary femoral head injury, early osteoarthritis (OA), and mobility issues. There are several risk factors for DDH, including positive family history, female sex, breech presentation, and the presence of clubfoot. Early detection and treatment are crucial to avoidlong-term hip dysplasia and arthritis, which can cause difficulty in walking and discomfort. Breech presentation, in particular, is a significant risk factor for DDH, with spontaneous vaginal birth increasing the risk of hip pathology and instability compared to elective Caesarean section. However, whether breech presentation continues to be a risk factor for DDH in preterm children is unknown. Objective and methods This study aimed to investigate the prevalence of breech presentation and other gestational/delivery characteristics among newborns diagnosed with DDH.This retrospective study was conducted at Abha Maternity and Children Hospital,Abha, Saudi Arabia, over a period of six months. Data were collected from medical records of DDHcases diagnosed between 2016 and 2023. Data analysis was performed using Microsoft Excel (MicrosoftCorporation, Redmond, Washington, United States)and IBMSPSSStatistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). Descriptive statistics and statistical tests were used to analyze the data. Results Most of the diagnosed children were female (86.7%), and bilateral hip dislocation (40%) was the most common presentation. X-ray was the most common diagnostic tool (48.3%), and operative management was the most common management strategy (73.3%). A positive family history of DDH was reported in more than one-third of cases. The study also analyzed the association between complications during pregnancy and various factors such as mode of delivery, presentation at delivery, gestational age at delivery, and associated maternal diseases. The difference in complication rates between women who delivered via C-section and those who delivered vaginally was insignificant (p = 0.14). Similarly, the difference in complication rates between women with breech and cephalic presentation was not statistically significant (p = 0.094). The difference in complication rates between women who delivered preterm, at term, or post-term was also not statistically significant (p = 0.578). Furthermore, the association between complications during pregnancy and pregnancy-associated maternal diseases was not statistically significant (p = 1.00). Conclusion DDH is a significant health issue in newborns, leading to long-term mobility problems and discomfort. Positive family history of DDH is a significant risk factor. Breech presentation was not significantly associated with DDH in preterm children, and no significant associations were found between complications during pregnancy and various factors. Early detection and treatment of DDH are crucial for preventing long-term complications. Family history should be considered an important risk factor, emphasizing the need for screening programs in families with a history of DDH.

Epidemiology of developmental dysplasia of the hip at a tertiary hospital in Oman

Objectives: Developmental dysplasia of the hip (DDH) is common in Oman in clinical practice, but the incidence in Oman is still unknown. This study aimed to evaluate the incidence and characteristic features of DDH in the Omani population managed at Khoula Hospital (KH). Methods: This is a retrospective study conducted at KH, targeting all Omani pediatric patients who have been officially diagnosed with DDH between the periods from January 2009 to December 2019. The data were collected from the medical record system at the hospital and phone interviews with the patient’s family to fill out the missed information. Results: The study included 795 DDH-diagnosed patients, out of which 652 (82.0%) were female and 143 (18.0%) were male, giving a ratio of 4.5:1. Bilateral DDH was diagnosed in 300 (37.7%) patients, left-sided DDH in 307 (38.6%), and right DDH in 188 (23.6%) patients. At least half of the DDH cases were 6 months old or younger at the first presentation to the hospital and 16.6% were diagnosed after the age of 18 months. Remarkably, at least one risk factor was present for 581 (73.1%) patients. The remaining patients had no risk factors for DDH at all. The prevalence of the first child in the family was 33.0% and oligohydramnios 10.9%. The estimated DDH incidence in this study is 1.05/1000 live births/year. Conclusion: Based on the national live births annual records from Oman National Center for Statistics and Information, this study estimated the DDH incidence to be 1.05/1000 live births. These findings cannot be generalized nationally as they are from a single center. We recommend conducting a multicenter prospective study to identify DDH incidence in Oman accurately. National guidelines and screening programs must be developed and executed for early detection and management.

Developmental Dysplasia of the Hip: How Many Risk Factors Are Needed?

Developmental dysplasia of the hip (DDH) is a progressive condition that lacks clear diagnostic and management protocols, due to insufficient data. While some advocate for universal screening, others recommend using risk factors as landmarks. In this study, we aimed to assess the risk factors associated with DDH incidence among a large population. We conducted a retrospective single-center multifactorial study between January 2019 and March 2022, including 3720 children who were investigated anamnestically, clinically, and through an ultrasound scan. We classified them into two groups: the control group with 3300 healthy children and the study group with 420 newborns diagnosed with DDH. Our analysis identified several risk factors associated with DDH, including gender, prematurity, non-vertex birth presentation, oligohydramnios, gestational diabetes, maternal hypertension, family history, associated deformities, and swaddling. We found that every DDH patient had at least two risk factors. Based on our findings, we recommend that children who present two or more risk factors for DDH be mandatorily evaluated sonographically, as well as children with clinical signs. DDH screening is recommended for each newborn for the long-term benefits of early detection and treatment.

Preterm birth does not increase the risk of developmental dysplasia of the Hip: a systematic review and meta-analysis

BackgroundThe purpose of this systematic review was to appraise the literature on the association between preterm birth and developmental dysplasia of the hip (DDH).MethodsMedline, Embase, Scopus, and Web of Science databases were queried for all studies pertaining to DDH and preterm birth. Data were imported and analyzed in Revman5 and Comprehensive Meta-Analysis (CMA) for pooled prevalence estimation.ResultsFifteen studies were included in the final analysis. There were 759 newborns diagnosed with DDH in these studies. DDH was diagnosed in 2.0% [95%CI:1.1–3.5%] of the premature newborns. Pooled incidence rate of DDH was not statistically different between those groups (2.5%[0.9%-6.8%] vs. 0.7%[0.2%-2.5%] vs. 1.7%[0.6%-5.3%];Q = 2.363,p = 0.307).ConclusionsIn this systematic review and meta-analysis, we did not find preterm birth to be a significant risk factor for DDH. Data suggests that female sex and breech presentation are associated with DDH in preterm infants, but the data is scarce in the literature.

The Significance of Isolated Hip Click as a Sign of DDH: Implications on Referral Guidelines.

The clinical significance of an isolated hip click remains unclear. The rates of developmental dysplasia of the hip (DDH) in those referred for hip click vary from 0% to 28%. The purpose of this study was to evaluate the rate of DDH in patients prospectively referred for isolated hip click. We prospectively enrolled patients referred to a single pediatric orthopaedic center with concern for DDH secondary to isolated hip click felt by the pediatrician on examination. Patients with known sonographic abnormalities or risk factors for DDH (breech presentation or positive family history) were excluded. Ultrasounds were obtained upon initial presentation and defined as abnormal if alpha angle <60 degrees and/or femoral head coverage (FHC) <50%. Mild dysplasia, analogous to Graf IIa physiological immaturity, was defined as alpha angle 50<α<60 and/or <50% FHC in a patient <3 months age. Severe dysplasia was defined as ≤33% FHC, which has been proposed to be sonographically consistent with a hip dislocation. Two hundred fifty-five children were referred for isolated hip click. One hundred eighty-nine patients (74%) had normal ultrasound whereas 66 patients (26%) had sonographic abnormalities (mean age 6.5±6.2wk at initial ultrasound). Fifty patients (19.6%) demonstrated physiological immaturity, 3 patients (1.2%) demonstrated moderate sonographic dysplasia, and 13 patients (5.1%) had sonographic findings consistent with severe dysplasia or dislocated hip. Hips with severe dysplasia were younger than the remaining population (2.8±2.4wk vs. 6.6±6.2wk, P <0.001) with no difference in sex distribution ( P =0.07) or first-born birth order ( P =0.36). For those with sonographic abnormality, 18 (27%) patients were treated with Pavlik harness, 1 (2%) was treated with abduction orthosis, and the remainder (71%) were observed for resolution of physiological immaturity. Infants with isolated hip click identified by their pediatrician may have higher rates of dysplasia than previously reported. We recommend screening ultrasound and/or orthopaedic referral for all infants with isolated hip click. Level II-prospective prognostic study.

Re-Evaluation of DDH Risk Factors in Helena Rehabilitation Center-Erbil, Kurdistan Region of Iraq

Purpose: Developmental dysplasia of the hip (DDH) comprises a spectrum of abnormalities from hip instability to frank dislocation, Hip ultrasonography prior to femoral head ossification, is recognized as an early diagnostic tool for DDH. It is safe and non-invasive procedure, keeping those babies less than 6 months of age away from radiation hazard. Subjects and Methods: From august 2021 until august 2022, we investigated 534 babies [1068 hips] by ultrasound depending on Graf method to identify DDH types. All included infants were in between 6 weeks- 6 months of age and referred due to have high risk factors. The data was analyzed by using the SPSS, version 28 and Chi- square test of association was used to compare the proportions. Results: On the bases of examining 534 babies [with high-risk groups] by ultrasound of hip, about 50.94 % of them were shown to have different types of DDH while 48.06% were normal, bilateral cases were &gt; unilateral cases and Lt. hip &gt;Rt. Hip were affected. Significant association was found between DDH family history (86%), breech presentation (52%)and swaddling (12%). Conclusions: It is crucial to establish the principle of selected screening programs for early detection of DDH in our society and to identify the incidence and associated risk factors for DDH in high-risk group babies between the ages of six weeks and six months in Erbil city of Kurdistan region-Iraq.

Awareness assessment of developmental hip dysplasia among parents in the western region, Saudi Arabia

Background: Developmental dysplasia of the hip (DDH) is a broad spectrum of anatomical hip disorders that ranges from subtle dysplasia to an irreducible dislocation. The present study aimed at evaluating the overall knowledge and perception of DDH among the Saudi Arabian population. Methods: This cross-sectional study was conducted in the western region of Saudi Arabia in four major cities (Jeddah, Mecca, Al-Taif, and Al-Madinah) from May 2022 to September 2022. The data were collected using a self-administered online questionnaire distributed through social media platforms. All age groups were allowed to participate in this study regardless of gender. Results: A total of 463 participants were involved in this study. Over one-third are between 40 and 59 years old (35.2%). The mean knowledge score about DDH was 4.1 ± 3.5 out of 18 (Range 0-15). The prevalence of DDH among the study participants was 1.1%. Only 16.4% of participants heard about DDH, and more than half revealed that social media was the primary source of information. Moreover, family history was the most commonly recognized risk factor for DDH, and leg length discrepancy was the most frequently reported complication of DDH by our participants. Furthermore, we found that age, geographical distribution, educational level, and participants with children diagnosed with DDH were significantly associated with knowledge about DDH. Conclusion: Our study revealed that the population of the western region of Saudi Arabia showed poor knowledge about DDH. In addition, we found that the prevalence of DDH among the study population was 1.1%. Future research should consider associated factors, and interventions to raise public awareness of DDH should be conducted.

Risk factors of developmental dysplasia of the hip in a single clinical center

Developmental dysplasia of the hip (DDH) is the main cause of early-onset hip osteoarthritis in adulthood. Early screening of DDH is the key to avoiding these severe complications. This study aimed to assure the risk factors are suitable for screening patients with DDH in our region. We retrospectively analyzed 10,668 patients (21,336 hips) at our hospital. Overall, 204 patients with pathological DDH and 408 patients with normal hips were included in this study. All patients were diagnosed by performing ultrasound examinations according to the Graf technique. The risk factors were assessed based on patients’ clinical data. Pearson’s chi-square or Fisher’s exact tests and multivariate logistic regression analysis were performed for statistical analysis. A total of 204 patients were diagnosed with pathologic DDH and were treated with the Pavlik harness. Among these, 184 patients were female. There were 73 cases of first birth, 13 had oligohydramnios, 13 had foot deformity, 31 had breech delivery, 6 had congenital muscular torticollis. Female sex, vaginal delivery, breech presentation, oligohydramnios and foot deformity were identified as the risk factors for DDH. The risk factors of DDH in our clinical center were confirmed in our clinical center, this can supply the screening advice for the doctors.

Radiological screening for DDH among risky infants in Abha Maternity &amp; Children Hospital from 2019-2021

Background: Developmental Dysplasia of the Hip (DDH) is the most common musculoskeletal condition diagnosed in neonates. Different timings and approaches to screening for DDH are used in the orthopedic community. Objectives: To provide evidence that DDH can be screened using sonarograph at the age of 2 months to decrease the risk of misdiagnosed DDH and determine the most common method of treatment regarding the radiological screening the infants underwent. Methods: This is a retrospective observational study that targeted all infants at risk of DDH who were born between 01-01-2019 to 31-12-2020 at Abha Maternity and Children Hospital (AMCH), Abha, Saudi Arabia. Included in the study were newborns who underwent radiological screening for hip with known risk factors for DDH. Demographic and clinical data were collected from the hospital electronic system. These data included subjects' age and sex, documented ultrasonography screening, documented X-ray diagnosis of DDH, and type of treatment. Results: A total of 201 infants (101 female, 100 male) aged from one day to six months (mean age 51.46 days, standard deviation 19.21 days) were included in the study. Ultrasonography screening revealed 40 subjects (19.9%) with positive DDH findings. X-rays done at age 4 to 6 months confirmed 26 (12.9%) DDH cases. Ultrasonography correctly detected 24 (11.9%) and excluded 159 (79.1) patients with DDH. However, two cases (1.0%) were not detected by ultrasonography and were later detected by X-ray, and 16 cases (8.0%) were falsely detected as positive DDH. Twenty-five subjects (12.4%) were treated conservatively, and one subject (0.5%) was treated surgically. Twenty-four cases of DDH showed hip abnormalities on ultrasound, giving a sensitivity rate of 92%. On the other side, 159 subjects who did not have DDH were screened negative with ultrasound (specificity rate 91%). Conclusions: The present study reveals that early US screening for DDH has high sensitivity and specificity and was associated with a lower rate of invasive intervention. Further research is needed to confirm these findings and examine potential factors influencing the accuracy of US-based screening programs in Saudi Arabia. Keywords: DDH; Ultrasound; Radiological screening

Factors for selective ultrasound screening in newborns with developmental dysplasia of the hip (DDH).

Hip ultrasound screening for DDH provides better sensitivity compared to physical examination. Due to a lower prevalence and limited resources, selective hip ultrasound in newborns at risk could be considered a proper screening protocol in Thailand and Asian countries. This study was aimed to evaluate risk factors and define criteria for selective screening. A case-control study was conducted in 2020. All newborns with hip ultrasound screening were included. Cases were defined as newborns with abnormal hip ultrasounds, while controls were those with normal studies. Inter and intra-rater reliability were evaluated. All factors were analyzed using univariate and multivariate logistic regression. The model performance was tested by Hosmer-Lemeshow goodness of fit. Internal validity was performed by the split data method. Area under the receiver operating characteristic (ROC) curve was estimated. Ninety-five newborns (29 cases and 66 controls) were included. Eighty percent of cases and 58% of controls were female. The gestational age was 36.6 and 37.7 weeks in case and control, respectively. Female, breech presentation, positive Ortolani test, positive Barlow test, and limited hip abduction were significant factors with odds ratio of 2.82, 5.12, 34.21, 69.64, and 5.48, respectively. The final model included breech presentation, positive Ortolani test, and positive Barlow test. The model cut-off value 15.02 provided sensitivity (93.10%) and specificity were (80.30%). The area under the ROC curve was 0.9308. The split data remained significant internal validity for all factors with p-value < 0.05. Careful history taking and physical examination are essential to identify the risk factors for DDH. Newborns with breech presentation, positive Ortolani test and positive Barlow test should be screened by hip ultrasound.

Assessment of Community Levels of Knowledge About Developmental Dysplasia of the Hip, its Risk Factors, Treatment, and Complications in the Riyadh Region, Saudi Arabia.

BackgroundDevelopmental dysplasia of the hip (DDH) can involve an immature hip, acetabular dysplasia with or without subluxation, or dislocation of the femoral head. The prevalence of DDH in Saudi Arabia is 10.46 per 1000 live births, highlighting the importance of community knowledge of DDH risk factors and treatment to facilitate early diagnosis, treatment, and avoiding complications.AimOur goal is to assess community awareness of DDH and the knowledge of its risk factors, treatment, and complications among the population in the Riyadh Region, Saudi Arabia.MethodsA cross-sectional study on a sample of 412 participants of the general population in the region of Riyadh, Saudi Arabia was conducted using the snowball sampling technique of sending invitations via social media. All statistical analyses were conducted using SPSS Statistics v.23 (IBM Corp., Armonk, NY).ResultsOur results revealed that out of the 412 participants almost half reported never hearing about DDH (45.6%). Breech presentation, family history, and female gender were unknown as risk factors to 63%, 58%, and 63.60% of participants respectively. Around 60% of the participant viewed age as the determining factor for DDH treatment. Additionally, 42.70% of participants reported no knowledge about DDH complications, and 72.8% had a low knowledge level regarding DDH. Significant higher knowledge scores were found in females participants (p = 0.026), participants with higher education level (p = 0.01), healthcare professionals (p < 0.001), parents of children who have been screened (p < 0.001), and participants having a first-degree relative with DDH (p < 0.001).ConclusionOur study revealed that residents of the Riyadh Region were unaware of DDH and their knowledge regarding its risk factors, treatment, and complications was poor. Therefore, it is important to implement DDH awareness campaigns to increase the community's knowledge of all aspects of DDH.

Impact of Multiple Factors on the Incidence of Developmental Dysplasia of the Hip: Risk Assessment Tool.

Background and Objectives: Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal conditions in children. If not treated, it leads to disability, gait abnormalities, limb shortening, and chronic pain. Our study aims to determine the impact of multiple risk factors on the incidence of DDH and to develop an interactive risk assessment tool. Materials and Methods: We conducted a retrospective cohort study in the Outpatient Clinic for Children of the Medical University of Warsaw Hospital. The Graf classification system was used for universal ultrasonographic screening. In total, 3102 infants met the eligibility criteria. Results: The incidence of DDH in the study group was 4.45%. The incidence of DDH in the Warsaw population, Poland, during the study period was 3.73 to 5.17 (95% CI). According to the multivariate analysis, the risk factors for DDH were birth weight (OR = 2.17 (1.41–3.32)), week of delivery (OR = 1.18 (1.00–1.37)), female sex (OR = 8.16 (4.86–13.71)), breech presentation (OR = 5.92 (3.37–10.40)), physical signs of DDH (25.28 (8.77–72.83)) and positive family history in siblings (5.74 (2.68–12.31)). Our results support the recent hypothesis that preterm infants (<37 weeks) have a lower rate of DDH. Conclusions: A multivariate logistic regression predictive model was used to build the risk calculator. The DDH risk calculator will be evaluated in a prospective validation study.

Redislocation After Posteromedial Open Reduction in Developmental Dysplasia of the Hip: Analyzing the Risk Factors and Determining the Optimal Treatment Method.

Redislocation, which is one of the most serious problems in developmental dysplasia of the hip (DDH), might occur because of several reasons. Regardless of the treatment, redislocations are reported to be associated with high complication rates in the literature. Our objective was to identify the risk factors for redislocation in the patients treated for DDH and to determine the optimal treatment method for redislocations. Patients with DDH who were treated with the limited posteromedial approach in our clinic between 1993 and 2021 and followed up prospectively were examined in this single-centered study. The participants were assigned into 2 groups: a study group consisting of 25 hips of 17 patients with redislocation and a control group consisting of 502 hips of 390 patients without redislocation. To determine the risk factors for redislocation, demographic data, known risk factors for DDH, preoperative Tönnis stage, and whether the capsule was opened or not were evaluated. To determine the optimal treatment method, a subgroup analysis based on applied treatment (closed reduction and cast replacement vs. repeating open reduction) was conducted, and recurrent redislocation, complication, and secondary surgery rates were evaluated. Bilaterality and high-grade hip dislocations were found to be associated with higher odds ratio (OR) for redislocation [ P =0.007, OR=3.64, 95% confidence interval (CI), 1.3 to 8.8; and P =0.006, OR=4.52, 95% CI, 1.37 to 14.91, respectively]. Recurrent redislocation and complication rates were found to be significantly higher in redislocations treated with closed reduction and cast replacement ( P =0.007 and P =0.015, respectively). Bilaterality and higher preoperative Tönnis stage are critical risk factors for redislocation after open reduction in DDH. It should be kept in mind that closed reduction and cast replacement is associated with higher rates of recurrent redislocation and complications, and redislocation cases should be treated by repeating open reduction. Level II-therapeutic study.

Incidence and Risk Factors for Concurrent Syndromic Diagnosis in Presumed Idiopathic Developmental Dysplasia of the Hip.

Background:Infants referred for developmental dysplasia of the hip (DDH) may have a previously unidentified concomitant diagnosis of syndromic pathology. Our purpose was to examine the incidence of syndromic pathology in infants referred to a tertiary center with presumed idiopathic DDH and identify risk factors and difference in treatment courses between idiopathic and nonidiopathic cohorts.Methods:A retrospective analysis of a prospective cohort of infants younger than 3 years who were evaluated for DDH between 2008 and 2013 with a minimum 2-year follow-up. The clinical history and treatment were noted to determine the incidence and nature of concomitant syndromic diagnoses, after a confirmed diagnosis of DDH.Results:There were 202 patients: 177 were females (87.6%). Thirteen patients (6.4%) were later diagnosed with a neurologic/syndromic diagnosis. The workup leading to additional diagnosis was initiated by the orthopaedic surgeon in 8 of 13 patients (61.5%). Half of the referrals (4 of 8) made to other specialists were because of an abnormal treatment course (three—failure of typical DDH treatment and one—relapsed clubfeet). 7 of the 8 referrals were made because of developmental delays and decreased tone. 5 of the 13 nonidiopathic patients had other orthopaedic problems. The syndromic diagnoses included three cerebral palsy, two Kabuki syndrome, one Down syndrome, one myopathy, and one neuropathy. The diagnosis was made at an average of 2.3 years (0.04 to 4.7). No notable difference was observed in the incidence of the four known risk factors for DDH in syndromic patients compared with the idiopathic group. The syndromic patients required more open reductions (P = 0.002).Discussion:By the age of 3 years, 6% of the patients treated for DDH were found to have a syndrome or neurologic abnormality, and the referral for workup was made by the treating surgeon greater than 60% of the time.

Fluoride increases the susceptibility of developmental dysplasia of the hip via increasing capsular laxity triggered by cell apoptosis and oxidative stress in vivo and in vitro

The etiology of developmental dysplasia of the hip (DDH) is multifactorial, including breech presentation and hip capsular laxity. In particular, hip laxity is the main contributor to DDH by changing the ratio and distribution of collagens. Also, fluoride (F) affects collagens from various tissue besides bone and tooth. To investigate the association of DDH and excessive F intake, we conducted this research in lab on cell and animal model simultaneously. We established animal model of combination of DDH and F toxicity. The incidence of DDH in each group was calculated, and hip capsules were collected for testing histopathological and ultrastructural changes. The primary fibroblasts were further extracted from hip capsule and treated with F. The expression of collagen type I and III was both examined in vivo and in vitro, and the level of oxidative stress and apoptosis was also tested identically. We revealed that the incidence of DDH increased with F concentration. Furthermore, the oxidative stress and apoptosis levels of hip capsules and fibroblasts both increased after F exposure. Therefore, this study shows that excessive F intake increases susceptibility to DDH by altering hip capsular laxity in vivo and in vitro respectively. We believe that F might be a risk factor for DDH by increasing hip laxity induced by triggering fibroblast oxidative stress and apoptosis.

Developmental Dysplasia of the Hip: A Review.

Developmental dysplasia of the hip (DDH) is the most common musculoskeletal disorder of the infant age. Its incidence ranges from 0.06/1000 to 76.1/1000 live births and is more frequent in female infants. Breech position, family history and firstborn children are the main risk factors for DDH and this disorder is also associated with the presence of other congenital deformities. Anatomically, the acetabulum remains shallow and the femoral head grows in a wrong position. Clinical examination is important and tests such us Barlow and Ortolani give indications only for a part of the spectrum of this entity. Nowadays the sonographic examination is the most accurate option for the diagnosis. Graf classification categorizes the DDH cases in four types, from normal to dislocated hip, by description and measuring specific angles in sonographic examination. The wide usage of ultrasonography has decreased the non-diagnosed or neglected cases; treatment begins immediately in young age and is usually conservative with the usage of devices such as Pavlik harness and hip spica. To enhance the literature, we searched for published studies on DDH, to summarize the pathogenesis and the diagnosis and to discuss the treatment and outcome of the patients with this disorder.

Risk factors and screening timing for developmental dysplasia of the hip in preterm infants.

Background The delayed diagnosis of developmental dysplasia of the hip (DDH) requires complex treatment and sometimes progresses to hip osteoarthritis.Purpose This study aimed to evaluate the risk factors and screening time for DDH in preterm infants.Methods A total of 155 preterm infants with a gestational age <32 weeks screened for DDH with ultrasonography were enrolled in this retrospective chart review.Results The incidence of DDH was 6.45% (10 of 155). Gestational age, birth weight, sex ratio, and breech presentation did not differ significantly between infants treated for DDH (n=10) and nontreated infants (n=145) (gestational age, 29.2±1.4 weeks vs. 29.6±2.0 weeks, P=0.583; birth weight, 1,240±237 g vs. 1,295±335 g, P=0.607; female sex, 7 of 10 (70.0%) vs. 77 of 145 (53.1%), P=0.346; and breech presentation, 5 of 10 (50.0%) vs. 43 of 145 (29.7%), P=0.286, respectively). Performing the first ultrasonography earlier than 38 weeks of postmenstrual age (PMA) increased the risk of an abnormal finding by 3.76 times compared to performing it at ≥38 weeks of PMA. These abnormal findings on ultrasonography resolved spontaneously. Breech presentation increased the risk of minor abnormal findings on the first ultrasonography by 3.11 times versus nonbreech presentation and resolved spontaneously. DDH in preterm infants did not occur predominantly on the left side or in infants born with breech presentation.Conclusion Performing ultrasonography screening earlier than 38 weeks of PMA caused unnecessary subsequent ultrasonography and overtreatment. Breech presentation was not a risk factor for DDH in preterm infants. However, breech presentation could increase the risk of minor abnormal findings at the 1st ultrasonography compared to nonbreech presentation, which resolved spontaneously. The etiology and risk factors for DDH in preterm infants are somewhat different from those for DDH in term infants.