Family History Of Developmental Dysplasia Of The Hip Research Articles

Incidence, Prevalence, Risk Factors, and Clinical Treatment for Children with Developmental Dysplasia of the Hip in Saudi Arabia. A Systematic Review.

Developmental dysplasia of the hip (DDH) leads to pain, joint instability, and early degenerative joint disease. Incidence, prevalence, and management strategies of DDH have been well-documented in several countries, but not in Saudi Arabia. We synthesized the current evidence regarding incidence, prevalence, risk factors, and clinical treatment for children with DDH in Saudi Arabia. We searched 3 databases to locate studies. Studies that included children with DDH in Saudi Arabia; reported either incidence rate, prevalence, risk factors, and/or clinical practice; and were available in English or Arabic were included. We excluded reviews, case studies, or animal studies. Two independent authors reviewed potential studies and assessed study's quality. Our search yielded 67 potential studies, of which 16 studies were included (total DDH sample = 3,127; age range = 2.5 to 86.4 months). Three studies reported incidence rates ranging from 3.1 to 4.9 per 1000 births, and 3 studies reported prevalence ranging from 6 to 78%. Nine studies reported that female sex, breech position, family history, and age less than 3 years were risk factors associated with DDH. Four studies reported that brace applications and closed reduction were conservative treatments, and 9 studies reported that open hip reduction, adductor tenotomy, and/or pelvic osteotomy were surgical approaches to treat DDH. In Saudi Arabia, the Incidence and prevalence rates of DDH are 3.1 to 4.9 per 1,000 births, and 6-78%, respectively (differ from what has been reported in other countries), but the risk factors of DDH in Saudi Arabia appear to be similar in comparison to other countries (female, breech presentation, family history of DDH).

Risk factors of developmental dysplasia of the hip in infants: A meta-analysis based on cohort studies

IntroductionDevelopmental dysplasia of the hip (DDH) is a prevalent condition in children. Currently, the exact etiology of DDH remains uncertain. The objective of this study was to conduct a meta-analysis to investigate the risk factors associated with DDH in infants. The findings would provide a theoretical foundation for targeted early screening and diagnosis. HypothesisSeveral indicators, such as gender, intrauterine position, family history of DDH, gestational age, delivery mode, amniotic fluid levels, swaddling, parity, fetus number, combined musculoskeletal deformities, birth weight, and physical examination results, may serve as risk factors for DDH. Materials and methodsCohort studies investigating the risk factors of DDH in infants through logistic regression analysis were searched in the Wanfang, VIP citation, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc, Excerpta Medica Database (Embase), PubMed, and Cochrane Library databases up to May 2023. After extracting the data from eligible literature and assessing them using the Newcastle-Ottawa Scale (NOS), articles were selected based on pre-established inclusion and exclusion criteria. ResultsA total of eleven literature reports covering 979,757 infants were included in this meta-analysis. The publication bias did not significantly influence the results. The incidence rate of DDH was 47.99‰ among infants with risk factors compared to 3.21‰ in the general population. Risk factors for DDH included being female (OR=6.97, 95% CI: 5.18–9.39, p<0.001), breech delivery (OR=4.14, 95% CI: 3.09–5.54, p<0.001), positive family history (OR=4.07, 95% CI: 2.20–7.52, p<0.001), cesarean section (OR=1.11, 95% CI: 1.01–1.21, p=0.032), oligohydramnios (OR=3.93, 95% CI: 1.29–12.01, p=0.016), swaddling (OR=6.74, 95% CI: 1.25–36.31, p=0.026), firstborn status (OR=1.84, 95% CI: 1.49–2.53, p<0.001), combined musculoskeletal malformations (OR=2.27, 95% CI: 1.58–3.27, p<0.001), and physical signs of DDH (OR=8.71, 95% CI: 2.44–31.07, p=0.001). Premature delivery (OR=0.91, 95% CI: 0.88–0.95, p<0.001) was a protective factor for DDH. The relationship between multiple pregnancies (OR=0.58, 95% CI: 0.33–1.02, p=0.060) and low birth weight (OR=0.62, 95% CI: 0.14–2.76, p=0.529) in relation to DDH remained uncertain. DiscussionThis meta-analysis shows that female, breech delivery, positive family history, cesarean section, firstborn status, oligohydramnios, swaddling and combined musculoskeletal malformations are associated with DDH. Premature delivery appeared to be a protective factor against DDH. Nevertheless, the other factors need more research to reach more conclusive results. Level of evidenceIII; meta-analysis.

Ultrasound evaluation of the femoral trochlea in newborns: incidence of trochlear dysplasia and associated risk factors.

This study aimed to describe the femoral groove morphology using ultrasound in children under 6 months, estimate the incidence of trochlear dysplasia, and evaluate associated risk factors. A prospective study included 298 patients who underwent universal ultrasound screening for hip dysplasia [developmental dysplasia of the hip (DDH)] and knee ultrasound. Measurements of sulcus angle (SA), trochlear depth (TD), and trochlear facet asymmetry (TFA) were analyzed. Trochlear dysplasia was considered present if the ASO was ≥159°. Reproducibility was assessed using the intraclass correlation coefficient (ICC) in 60 knees. Logistic regression adjusted for confounders, presenting odds ratios (OR) and 95% confidence intervals (CI). Significance was set at P < 0.05. Analysis included 596 knees (298 patients). Females accounted for 51% of patients, with 7% having breech presentation, 4.4% DDH, 6.4% family history of DDH, and 5% family history of patellofemoral instability. ICC showed excellent agreement for SA and TD, but poor for TFA. Trochlear dysplasia incidence was 3% (9/298; 67% bilateral). Median (IQR) values were 147.5 (144.0-150.5) for SA, 2.4 (2.2-2.8) for TD, and 1.1 (1.0, 1.1) for TFA. Breech presentation (OR, 9.68; 95% CI 1.92-48.71, P = 0.006) and concomitant DDH (OR 6.29, 95% CI 1.04-37.78, P = 0.044) were associated with trochlear dysplasia. Ultrasound effectively evaluates femoral groove morphology and diagnoses trochlear dysplasia in newborns. Trochlear dysplasia incidence was 3%, with a 10-fold higher risk in breech presentation and 6-fold higher risk in concomitant DDH. Standardized screening and timely treatment protocols should be further investigated. Level of evidence: Diagnostic Level II.

Does Screening Ultrasound Timing in Developmental Dysplasia of the Hip Need to be Adjusted for Moderate Preterm and Near-term Infants: A Prospective Study.

An initial screening ultrasound is essential for patients at higher risk of developmental dysplasia of the hip (DDH) due to breech presentation or a family history of DDH. The American Academy of Pediatrics recommends screening ultrasounds to be performed after 6 weeks of age to reduce the rate of false positives. However, there is limited evidence regarding whether these screening ultrasounds need to be adjusted for gestational age in prematurity. The purpose of this study was to evaluate the influence of moderate preterm and near-term births on screening hip ultrasounds for high-risk DDH populations. We identified all prospectively enrolled patients in a single-center database referred for screening hip ultrasound for DDH. We included those hips referred for risk factors of DDH, including breech presentation, family history of DDH, or hip click, and excluded those with known dysplasia or referral for hip instability. Each ultrasound was measured by a pediatric radiologist to determine the alpha angle and femoral head coverage. Patients were classified as "premature" if born at <37 weeks gestation or "full term" if born at ≥37 weeks gestation. All patients underwent screening hip ultrasound between 5 and 8 weeks of age. Sonographic markers of dysplasia and the incidences of abnormal ultrasound and Pavlik harness treatment were compared between cohorts. Significance was set at P <0.05. A total of 244 hips in 122 patients were included, 58 hips in the premature cohort and 186 hips in the full-term cohort. The premature cohort had a significantly decreased gestational age compared with the full-term cohort (35.4 ± 1.1 vs 38.5 ± 1.1wk, respectively, P < 0.001). However, there was no difference between premature and full-term cohorts in sex distribution (69% vs 75%, females, P = 0.39), unadjusted age at the time of ultrasound (6.6 ± 0.7 vs 6.8±0.7wk, respectively, P = 0.07), or referral reason (P = 0.14). On hip ultrasound, there was no difference between premature and full-term cohorts with respect to alpha angle (62.6 ± 3.3 vs 62.2 ± 5.3 degrees, P = 0.41), femoral head coverage (54.9 ± 6.3 vs 55.1 ± 10.6, P = 0.19), rate of abnormal ultrasound (18.3% vs 20.7%, respectively, P = 0.68), or the rate of Pavlik harness treatment (0% vs 5.3%, respectively, P = 0.12). There was no significant difference in alpha angle or femoral head coverage between premature and full-term patients at 5 to 8 weeks of unadjusted age. This preliminary data suggests that screening ultrasounds can be performed without adjusting for prematurity. Level II, prognostic study.

Geographical Distribution of Developmental Dysplasia of the Hip: A Brief Epidemiological Study of Iran.

Local epidemiological data are necessary to identify the disease hot spots and running screening programs. In this study, we evaluated the demographic characteristics of developmental dysplasia of the hip (DDH) in a tertiary referral hospital in Iran. In a retrospective study, the medical profiles of 137 DDH children, who were referred to our university hospital between 2014 and 2020, were reviewed for characteristics such as gender, place of birth, age at the diagnosis, gestational age (term or preterm), twin or single birth, mother's age, pregnancy number, breech presentation, associated deformity, family history of DDH, et cetera. The study population included 24 (17.5%) boys and 113 (82.5%) girls with a mean age of 2.3 ± 2 years. In the majority of cases (54.2%), it was the firstborn. Twin delivery was seen in only 5 (4.1%) cases. The associated deformity was noticed in 17 (12.4%) patients. Clubfoot was the most commonly associated deformity that was seen in 6 of 17 (35.3%) patients. A family history of DDH was recorded in 12 (8.8%) patients. The breech presentation was recorded in 19 (13.9%) patients. The mean age of the mother at the delivery was 27.2 ± 6.1 years. Tehran, Lorestan, Kurdistan, and Khuzestan provinces had the most referrals. DDH is associated with the female sex, positive family history, breech presentation at delivery, clubfoot deformity, and geographic district. These associations could be used for identifying the disease hot spots and running screening programs for earlier detection and better management of DDH.

A Global Survey of Patient and Caregiver Experiences Throughout Care for Developmental Dysplasia of the Hip.

Diagnosis and treatment for developmental dysplasia of the hip (DDH) varies greatly depending on condition severity, age at diagnosis, and professional opinion. Little is known about patient experiences across the globe. We aimed to characterize global patient and caregiver experiences during DDH care and to highlight patient-identified priorities. We developed a cross-sectional survey in collaboration with 7 DDH outreach organizations. DDH patients and/or their caregivers (above 18 y old) were invited to complete an international online survey about their experiences. Participants were recruited through web media of all collaborating organizations. Data collection took place over 3 months. Descriptive statistics were used to analyze quantitative results. Qualitative content analysis was used to categorize open-ended responses. A total of 739 participants completed the survey, representing 638 (86.3%) parents/guardians of DDH patients, and 101 (13.7%) patients. Three hundred eighty-six (52.2%) participants received diagnosis by 3 months of age; mean age of diagnosis was 15.96 months (90% confidence interval=12.04, 19.91). Of 211 participants with family history of DDH, 68 (32.3%) did not receive DDH screening. Of 187 patients born breech, 82 (43.9%) did not receive DDH screening. In total, 36/94 (38.3%) participants with both family history and breech birth did not receive DDH screening. Most participants reported treatment (696/730, 95.3%), including bracing (n=461) surgery (n=364), and/or closed reduction (n=141). A total of 144 patients reported >1 surgery; 82 reported >3 surgeries. Participants reported a range of 1 to 400 visits to health care professionals for DDH care across 1 to 66 years. Lack of information and resources on treatment practicalities and timelines, along with emotional burden of diagnosis, were greatest challenges reported. Results demonstrate that DDH diagnosis and treatment can pose significant burden on patients and caregivers. Reliable public information is needed to support those affected. Global educational efforts are needed to raise awareness of DDH risk factors, signs, and symptoms among care providers, to increase awareness and improve identification, screening, and monitoring of at-risk children.

Is foot deformity associated with developmental dysplasia of the hip?

AimsTo assess if congenital foot deformity is a risk factor for developmental dysplasia of the hip (DDH).MethodsBetween 1996 and 2012, 60,844 children were born in Sør-Trøndelag county in Norway. In this cohort study, children with risk factors for DDH were examined using ultrasound. The risk factors evaluated were clinical hip instability, breech delivery, a family history of DDH, a foot deformity, and some syndromes. As the aim of the study was to examine the risk for DDH and foot deformity in the general population, children with syndromes were excluded. The information has been prospectively registered and retrospectively analyzed.ResultsOverall, 494 children (0.8%) had DDH, and 1,132 (1.9%) a foot deformity. Of the children with a foot deformity, 49 (4.3%) also demonstrated DDH. There was a statistically significant increased association between DDH and foot deformity (p < 0.001). The risk of DDH was highest for talipes calcaneovalgus (6.1%) and club foot (3.5%), whereas metatarsus adductus (1.5%) had a marginal increased risk of DDH.ConclusionCompared with the general population, children with a congenital foot deformity had a significantly increased risk for DDH and therefore we regard foot deformity as a true risk factor for DDH.Cite this article: Bone Joint J 2020;102-B(11):1582–1586.

Is foot deformity associated with developmental dysplasia of the hip?

To assess if congenital foot deformity is a risk factor for developmental dysplasia of the hip (DDH). Between 1996 and 2012, 60,844 children were born in Sør-Trøndelag county in Norway. In this cohort study, children with risk factors for DDH were examined using ultrasound. The risk factors evaluated were clinical hip instability, breech delivery, a family history of DDH, a foot deformity, and some syndromes. As the aim of the study was to examine the risk for DDH and foot deformity in the general population, children with syndromes were excluded. The information has been prospectively registered and retrospectively analyzed. Overall, 494 children (0.8%) had DDH, and 1,132 (1.9%) a foot deformity. Of the children with a foot deformity, 49 (4.3%) also demonstrated DDH. There was a statistically significant increased association between DDH and foot deformity (p < 0.001). The risk of DDH was highest for talipes calcaneovalgus (6.1%) and club foot (3.5%), whereas metatarsus adductus (1.5%) had a marginal increased risk of DDH. Compared with the general population, children with a congenital foot deformity had a significantly increased risk for DDH and therefore we regard foot deformity as a true risk factor for DDH.

Association between periacetabular osteotomy and hip dysplasia among relatives: a cross-sectional study.

Previous studies indicate a familial predisposition for developmental dysplasia of the hip (DDH), especially among first-degree relatives. This study investigated the association between unilateral or bilateral periacetabular osteotomy (PAO), family history of DDH and the degree of relationship with relatives with DDH. This cross-sectional study consisted of 815 consecutive patients undergoing PAO from 1998 to 2016. Information regarding unilateral or bilateral PAO, gender and age at the time of surgery was obtained from the clinical PAO database at Aarhus University Hospital, Denmark. A questionnaire was used to collect information about the family history of DDH. The association was assessed by logistic regression analysis, and divided into 615 unilateral and 200 bilateral PAO patients. PAO patients with a first-degree relative with DDH had a 72% (odds ratio [OR] = 1.72, 95% confidence interval [CI] 1.17; 2.50) higher occurrence of bilateral PAO than patients without family relatives with DDH. This association was statistically significant (p = 0.005), even when adjusting for gender and age at the time of surgery. A similar association was not demonstrated among any other degrees of relationship. Danish patients with DDH and a first-degree relative with DDH have an increased risk of being surgically treated with bilateral PAO compared to patients without a family history of DDH. Patients undergoing bilateral PAO may therefore have a strong genetic predisposition for DDH. This study reveals a potential group of patients with DDH where genetic analysis may identify relatives with a higher risk of the disease.

Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors.

Different timing and approaches to screening for developmental dysplasia of the hip (DDH) are used in the orthopaedic community. Thus ultrasonographic screening programs and reports based on clinical examinations produced differing incidence rates of DDH. Furthermore different risk factors and a change of incidence of DDH in the last decades were discussed. The purpose of this study was the evaluation of incidence and risk factors of the very early DDH in a modern cohort based on a universal ultrasound screening program. We analysed the results of the screening program performed at our institution: 5,356 consecutive hips of newborns were screened ultrasonographically and clinically according to the system published by R. Graf within the first two postnatal weeks [1]. A set of risk factors was analysed by univariate and multiple linear regression models. Sonographic signs of developmental dysplasia of the hip were found in 0.24 % of the newborns. A significant negative influence of the risk factors birth weight, family history of DDH and female gender on the α-angle was found. Early or pre-term delivery showed a protective potential for DDH. Our data show a very low incidence of DDH in the first two postnatal weeks. Despite the significance of the risk factors analysed, it has to be considered that these factors only showed low impact on the risk of early DDH. In conclusion we favour universal ultrasound screening for DDH at the age of six to eight weeks.

The demographics of developmental hip dysplasia in the Midwestern United States (Indiana).

BackgroundToday’s society is much more mobile than in the past. This increased mobility has resulted in different marriage/parenting groups. We wished to study the demographics of developmental dysplasia of the hip (DDH) in our area and compare/contrast our findings with those in the literature and specifically look for new findings compared to previous studies.MethodsA retrospective review of all children with DDH from 2003 through 2012 was performed. The age at first visit, gestational age, pregnancy number, gender, race, and family history of DDH was collected. Statistical significance was a p-value < 0.05.ResultsThere were 424 children (363 girls, 61 boys). Ethnicity was White in 80.8 %, Hispanic in 13.8 %, Black in 4.0 %, and Indo-Malay and Indo-Mediterranean in 0.7 % each; 66.8 % were unilateral; 14.2 % had a positive family history. The average gestational age was 38.1 weeks; 94.4 % were full term. The child was vertex presentation in 67.6 % and breech in 32.4 %; 52.8 % were delivered vaginally and 47.2 % by Cesarean section. The child was the first-born in 48.3 %. When compared to the birth statistics of our state, there was a higher proportion of Whites and Hispanics with DDH, and a lower, but not inconsequential, proportion of Blacks (p = 0.0018).ConclusionMixing of gene pools and infant carrying methods (lack of swaddling or marked abduction) occurring with societal change likely explains the higher than expected proportion of DDH amongst those of Hispanic ethnicity and a lower than expected, but not rare, proportion in those of African ancestry.Level of evidenceLevel IV—retrospective case series.

Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991–2006

Early treatment is considered essential for developmental dysplasia of the hip (DDH), but the choice of screening strategy is debated. We evaluated the effect of a selective ultrasound (US) screening programme. All infants born in a defined region during 1991-2006 with increased risk of developmental dysplasia of the hip, i.e. clinical hip instability, breech presentation, congenital foot deformities or a family history of DDH, underwent US screening at age 1-3 days. Severe sonographic dysplasia and dislocatable/dislocated hips were treated with abduction splints. Mild dysplasia and pathological instability, i.e. not dislocatable/dislocated hips were followed clinically and sonographically until spontaneous resolution, or until treatment became necessary. The minimum observation period was 5.5 years. Of 81,564 newborns, 11,539 (14.1%) were identified as at-risk, of whom 11,190 (58% girls) were included for further analyses. Of the 81,564 infants, 2,433 (3.0%) received early treatment; 1,882 (2.3%) from birth and 551 (0.7%) after 6 weeks or more of clinical and sonographic surveillance. An additional 2,700 (3.3%) normalised spontaneously after watchful waiting from birth. Twenty-six infants (0.32 per 1,000, 92% girls, two from the risk group) presented with late subluxated/dislocated hips (after 1 month of age). An additional 126 (1.5 per 1,000, 83% girls, one from the risk group) were treated after isolated late residual dysplasia. Thirty-one children (0.38 per 1,000) had surgical treatment before age 5 years. Avascular necrosis was diagnosed in seven of all children treated (0.27%), four after early and three after late treatment. The first 16 years of a standardised selective US screening programme for developmental dysplasia of the hip resulted in acceptable rates of early treatment and US follow-ups and low rates of late subluxated/dislocated hips compared to similar studies.

A meta-analysis of common risk factors associated with the diagnosis of developmental dysplasia of the hip in newborns

Although there is no clear consensus about the process of screening for developmental dysplasia of the hip (DDH), there are six common risk factors associated with DDH in patients less than 6 months of age (breech presentation, sex, family history, first-born, side of hip, and mode of delivery). A meta-analysis of published studies was conducted to identify the relative risk ratio of the six commonly known risk factors. A total of 31 primary studies consisting of 20,196 DDH patients met the following inclusion criteria: (1) contained empirical data on at least one common risk factor, (2) were peer-reviewed from an English language scientific journal, (3) included patients less or equal to 6 months of age, and (4) identified method of diagnosis (e.g., ultrasound, radiographs or clinical examination). Fixed effect and random effects models with 95% confidence intervals were calculated for each of the six risk factors. Reported relative risk ratio (RR) for each factor in newborns was: breech presentation 3.75 (95% CI: 2.25-6.24), females 2.54 (95% CI: 2.11-3.05), left hip side 1.54 (95% CI: 1.25-1.90), first born 1.44 (95% CI: 1.12-1.86), and family history 1.39 (95% CI: 1.23-1.57). A non-significant RR value of 1.22 (95% CI: 0.46-3.23) was found for mode of delivery. Results suggest that ultrasound and radiology screening methods be used to confirm DDH in newborns that present with one or a combination of the following common risk factors: breech presentation, female, left hip affected, first born and family history of DDH.

Developmental Dysplasia of the Hip in Twins

Developmental dysplasia of the hip (DDH) is a disease of multifactorial etiology. Genetic and intrauterine mechanical factors influence the development of the hip joint and the incidence of DDH. Breech position is a risk factor for DDH. The aim of this study is to analyze whether in twins, the intrauterine mechanical factors, such as a breech position, limitation of fetal mobility, limitation of hip abduction, and increase the incidence of DDH may, therefore, be considered as risk factors. A pair of twins with either breech or cephalic presentation, and no family history of DDH or any other sicknesses were included in this study. During a 6-year period between 2002 and 2007, data were collected on 105 consecutively born twins (210 children with 420 hips) of whom 48 were a cephalic breech, 35 were a cephalic-cephalic, and 22 were a breech-breech presentation. The presentation was defined by regular prenatal ultrasounds and the obstetric records at birth. The average gestational age was 36.7 weeks and average weight at birth was 2290 g. Control group 1 consisted of 274 single gestation children, with a cephalic presentation at birth. The average gestational age was 39.1 weeks and average weight at birth was 3200 g. Control group 2 consisted of 48 single gestation children, with a breech presentation at birth. The average gestational age was 36.8 weeks and average weight at birth was 2870 g. Ultrasonography of the hips was done according to the Graf technique. Statistical analysis was done using a χ² test. The χ² test was used and it showed no significant association between the presence or absence of pathologic hip types in the twins group and in the 2 control groups. A higher incidence of DDH (3.4%) was present in groups 1 and 2. This comparison of a large series of twins with matched controls shows that there is no increased incidence of DDH in twins when compared with single birth infants with no family history of DDH. This study supports the idea that breech presentation in twins is not a risk factor, when knees are flexed. Retrospective study. Level 2 study.

ACR Appropriateness Criteria® on Developmental Dysplasia of the Hip—Child

Developmental dysplasia of the hip (DDH) affects 1.5 of every 1,000 caucasian Americans and less frequently affects African Americans. Developmental dysplasia of the hip comprises a spectrum of abnormalities, ranging from laxity of the joint and mild subluxation to fixed dislocation. Early diagnosis of DDH usually leads to low-risk treatment with a harness. Late diagnosis of DDH in children may lead to increased surgical intervention and complications. Late diagnosis of DDH in adults can result in debilitating end-stage degenerative hip joint disease. Screening decreases the incidence of late diagnosis of DDH. Clinical evaluation for DDH should be performed periodically at each well-baby visit until the age of 12 months. There is no consensus on imaging screening for DDH. Consideration for screening with ultrasound is balanced between the benefits of early detection of DDH and the increased treatment and cost factors. In addition, randomized trials evaluating primary ultrasound screening did not find significant decrease in late diagnosis of DDH. In the United States, hip ultrasound is selectively performed in infants with risk factors, such as family history of DDH, breech presentation, and inconclusive findings on physical examination. Ultrasound for DDH should be performed after 2 weeks of age because laxity is common after birth and often resolves itself. A pelvic radiograph can optimally be performed after the age of 4 months, when most infants will have ossification centers of the femoral heads.

Screening for developmental dysplasia of the hip: results of a 7-year follow-up study.

Screening for developmental dysplasia of the hip (DDH) is widely recommended for all infants to prevent disability from late diagnosis of dislocation of the hip. The present study evaluates the results of screening for developmental dislocation of hip in a clinic in Turkey over the course of 7 years. Hospital records of 5798 infants who were examined regularly until walking age at Gazi University well child clinics between January 1995 and December 2001 were reviewed. Infants with known risk factors for DDH such as breech presentation, family history of DDH or swaddling, and of infants with physical examination findings suggestive of DDH, were referred to orthopedic surgeons for diagnosis. Based on this final diagnosis, sensitivity, specificity, positive and negative predictive values of risk factors and physical examination findings were calculated. Of the 5798 infants, risk factors were detected in the medical history of 111 infants, and in 14 infants a musculoskeletal deformity was detected. In 606 infants the physical examination findings were suggestive of DDH. Ten patients were subsequently diagnosed with DDH. The sensitivity, specificity, positive predictive value and negative predictive values of having a risk factor for DDH in history were 10.0%, 98.1%, 0.9%, 99.8%, and having abnormal hip examination findings were 100.0%, 88.9%, 1.6% and 100.0%, respectively. A careful history and physical examination is the cornerstone of DDH screening. Serial hip examinations performed during health examination visits provide an opportunity to identify DDH cases. The sensitivity of risk factors in history and physical examination findings together is high enough to be accepted as a screening tool.

Risk Factors in Developmental Dysplasia of the Hip

The purpose of the study was to correlate risk factors, clinical and ultrasound findings in children screened for developmental dysplasia of the hip (DDH). A total of 1448 “at risk” infants were prospectively assessed over a 2-year period. The likelihood of hip dysplasia and instability on ultrasound was increased by an extended breech presentation and the presence of a structural foot deformity. Clinically abnormal hips almost invariably showed ultrasonographic dysplasia or displacement. In our series the ultrasound findings bore no statistically significant correlation with obstetric variables such as labour duration, Caesarean section and induced delivery, or with a positive family history of DDH. We have compared the aetiological significance of the various risk factors and associated clinical findings in the causation of DDH, in an “at risk” population.