Late Presentation Of Developmental Dysplasia Research Articles

Single-Center Experience of Surgical Treatment of Subjects with Late-Presenting Developmental Dysplasia of the Hip

Aim: This study aimed to delineate the single-center experience surrounding the long-term consequences of surgical reconstruction in subjects with late-presenting DDH (developmental dysplasia of the hip). Methods: We analyzed 23 hips of 21 subjects aged >6 years who underwent surgical interventions, such as pelvic osteotomy, open reduction, femoral shortening, and derotation, for developmental hip dysplasia. Results: After a median follow-up of 23.34 (8–120) months, there were no noteworthy alterations in the Harris score and anteversion. Nevertheless, significant improvements were observed in SHARP, CE angle, and depth and width index over the follow-up duration. Using Sever’s radiological criteria, 87.1% of subjects achieved excellent and good results. Assessment of femoral head avascular necrosis, based on Bucholz and Ogden’s classification, produced the subsequent findings: 52% of hips were Type I; 13% were Type II; 22% were Type III; and 13% were categorized as Type IV. Conclusion: Despite achieving favorable postoperative radiological outcomes, there's a noticeable decline in clinical success in these subjects, especially as their age increases. Additionally, they face an elevated risk of avascular necrosis. The juxtaposition of a 75% radiological success rate with a 50% clinical success rate accentuates this contrast. Crucially, the success rate of surgical corrections in late-presenting DDH is tied to the age of the patient, with the success rate decreasing as age progresses.

Hybrid Therapy of Hip-Spica Cast Followed by Static Abduction Orthosis Provides a Similar Successful Outcome as Hip-Spica Cast Only in Infants with LatePresenting Developmental Dysplasia of the Hip

Hybrid Therapy of Hip-Spica Cast Followed by Static Abduction Orthosis Provides a Similar Successful Outcome as Hip-Spica Cast Only in Infants with LatePresenting Developmental Dysplasia of the Hip

Status quo of screening for hip dysplasia

Since the first description of the ultrasound examination of the infant hip by Graf in 1980 this technique has impressively demonstrated that it lives up to its promise very well. In the implementation of hip ultrasound in the German pediatric guidelines it was hoped that it would improve the sensitivity and specificity of the early detection of dislocated and dysplastic joints in comparison to ageneral clinical hip screening. Furthermore, it has been repeatedly shown that general newborn hip ultrasound screening according to Graf can significantly reduce not only the treatment rate but also the invasiveness. Consequentially, the cost of treatment as well as the rate of late presenting developmental dysplasia of the hip (DDH) can also be significantly reduced. Despite those proven merits the meaningfulness of general hip ultrasound screening in infancy is still questioned, especially in the Anglo-American world. This article reviews how this misconception came about.

Functional and radiological outcome of single-stage surgical treatment of late presenting developmental dysplasia of the hip

Background: Developmental dysplasia of the hip (DDH) is the second-most common pediatric orthopedic condition in our country. The management of children presenting with DDH in the walking stage is primarily by surgical approach due to the changes in the femoral head, acetabulum, and other soft tissues surrounding the joint. This study evaluated the functional and radiological outcome of children with DDH in the walking age group who underwent open reduction with or without femur or pelvic osteotomy. Materials and Methods: Retro-prospective Cohort Study was conducted in tertiary care hospital. All children underwent open reduction through a standard anterior approach. The hip was reduced, and stability was assessed intraoperatively, and osteotomy was performed. The functional and radiological outcome was assessed at the end of follow-up; various variables which influence the outcome were looked. Chi-square test was used to measure the association between the types of surgery with the outcome, Tonnis grade with the outcome, and these are expressed as frequency and percentage. Results: Sixty-six percent of hips in our study had excellent functional outcomes, 27% had a good outcome. About 68% of hips in our study had excellent, and 2.5% of hips in our study had a poor radiological outcome. Conclusions: The assessment of outcomes suggested that appropriate surgery based on age and intraoperative assessment will give satisfactory functional outcome, irrespective of whether acetabular/femoral procedures are done. The re-surgeries rate in our study was low as all of them had single staged combined surgical intervention.

Outcome of surgical management of late presenting developmental dysplasia of hip with pelvic and femoral osteotomies

Introduction: Patients with Developmental dysplasia of hip many a times present later in the age due to missed or delayed diagnosis. The treatment of DDH is mainly dependent upon the age of the child at the time of presentation and varies according to it. In the late presenting cases it is mostly surgical with open reduction alone or in combination with pelvic and femoral osteotomies. Materials and Methods: This study between October 2012 and October 2014 includes 21 patients with unilateral dysplastic hips, surgically treated with a single stage procedure of open reduction and Acetabuloplasty of Pemberton, along with Varus derotation osteotomy and femoral shortening when necessary. Preoperatively they were classified according to Tonnis grade. Clinical assessment was done using Modified McKay’s criteria; Radiological evaluation was done using Severin’s radiographic criteria. Results: The mean follow up period was 15.14 months and the mean age at surgery was 66.86 months. McKay’s grades were excellent in 8 hips, good in 11 hips, fair in 1 hip and poor in 1 hip. Severin’s score was excellent in 4 hips, good in 15 hips, fair in 1 hip and poor in 1 hip. Conclusions: Every case of DDH is unique. The type of surgery chosen depends on the clear understanding of each hip after using the available resources. The combination of open reduction with pelvic and/ or femoral osteotomy when needed gives good immediate stability and promotes remodelling. This surgery is a technically demanding procedure but when performed properly by an experienced surgeon, it does give satisfactory results. Keywords: Developmental dysplasia of hip, Late presentation, Open reduction, Pelvic and/ or femoral osteotomy.

The presence of the ossific nucleus and its relation to avascular necrosis rates and the number of secondary procedures in late-presenting developmental dysplasia of the hip.

Late-presenting developmental dysplasia of the hip (DDH) has an incidence reported between 0.07 and 2:1000 live births. Avascular necrosis (AVN) of the femoral head secondary to treatment of DDH is a feared complication and may lead to adverse long-term sequelae. This study aims to investigate the relationship between the ossific nucleus (ON) presence and AVN in late-presenting DDH. This is a retrospective study of prospectively collected data over a 24-year period, at a single UK centre. Late-presenting DDH who were treated surgically with a closed or open reduction were included in the series. The presence of ON was monitored, and outcomes measured included AVN and whether delaying surgery affected the number of secondary procedures. Seventy-six patients with 79 hips (mean age at presentation 13.8 months) were included in the analysis. The mean age at presentation was 13.8 months. About 45.5% of hips with no ON present developed clinically significant AVN (Kalamchi and MacEwen grades 2-4, P = 0.12), compared to 20.6% of hips with the ON present. Delaying surgery did not affect AVN rates or the number of secondary procedures. Looking at long-term outcomes, 86.7% of hips had a Severin grade of I or II and 13.3% had a grade ≥III. Factors that affected long-term outcomes were absent ON (P = 0.04) and open reduction (P = 0.03). In the multiple logistic regression model, only open reduction could increase AVN rates (P value 0.027). The presence of ON at the time of surgery may have an impact on the rate and significance of AVN. Absence of the ON at the time of reduction negatively affects long-term outcomes in late-presenting DDH.

Proposal of a novel predictive radiological method to assess the possibility of closed reduction in late presenting developmental dysplasia of the hip: the femoro-acetabular zones.

Late presentation of developmental dysplasia of the hip (DDH) remains a major orthopedic problem. However, existing management is not standardized and is highly surgeon dependent. The theory behind femoro-acetabular zones (FAZ) system is to find a relationship between acetabular maturity and severity of dislocation in one hand, and the outcome of closed reduction, on the other hand in late presenting cases. A retrospective study was performed on children with untreated DDH that underwent closed treatment. Our series consisted of 65 hips; mean patient age was 24 months (range: 9-30 months) with a minimum follow-up of 3 years. FAZ classification was applied to the pre-reduction pelvic radiograph, while the results were evaluated according to Severin's scoring system. Overall, 37 of 65 hips (57%) achieved a satisfactory outcome (Severin I and II), while 22 hips (33%) were found to be unsatisfactory (Severin III). Six hips (10%) needed an open reduction. FAZ expressed a simple and reliable classification in predicting the success of closed reduction. This novel X-ray-based classification system can easily predict patients with DDH in whom a closed reduction is likely to succeed and defer patients with higher grades to surgical intervention. Yet, its validity has to be verified in larger cohort studies and directly compared to the established International Hip Dysplasia Institute classification.

The effect of femoral shortening in the treatment of developmental dysplasia of the hip after walking age.

PurposeThe optimal treatment for late-presenting developmental dysplasia of the hip (DDH) is controversial. High tension forces after hip reduction increase the pressure on the femoral head, potentially causing avascular necrosis. Femoral shortening (FS) is commonly used as a means to decrease the pressure on the femoral head. We examined the effect of FS on the outcomes of patients with late-presenting DDH.MethodsA total of 645 hips of a late-presenting DDH cohort treated with open reduction and iliac osteotomies were retrospectively reviewed; 328 hips had a FS performed (FS+) and 317 (FS-) had not. The mean age was 3.9 years (sd 1.55). We classified the hips with the Tönnis and International Hip Dysplasia Institute (IHDI) methods; and the Pediatric Outcomes Data Collection Instrument (PODCI), Iowa Hip Score (IHS) and Severin classification as outcome measurements.ResultsThe FS- group had higher scores in PODCI (median 95 points; interquartile range (IQR) 78 to 91) and IHS (median 91 points; IQR 64 to 88) than the FS+ group (PODCI: median 94 points; IQR 69 to 89 points; IHS: median 89 points; IQR 62 to 87). The mean Severin scores were similar (FS- 2.65; FS+ 2.5; p = 0.93) but the FS– group had higher rates of good and excellent outcomes (FS- 56%; FS+ 41%; p < 0.00001) and lesser dislocation rates (FS- 6%; FS+ 14%; p = 0.16).ConclusionAlthough FS should be used when a hip cannot be reduced without undue tension, our results indicate that this procedure is not necessarily related to a better outcome.Level of evidence:Therapeutic, Level III.

Long-term outcome after anterolateral open reduction and Salter osteotomy for late presenting developmental dysplasia of the hip.

IntroductionOnly a handful of studies report outcomes after open reduction for developmental hip dislocation beyond skeletal maturity. For successfully reduced hips it is the outcome into late adulthood on which the results of this intervention should be judged. These studies indicate clearly the importance of preservation of the acetabular growth centres during surgery. The acetabulum must also be addressed when insufficient growth remains reliably to remodel residual dysplasia even after stable, concentric reduction.SummaryComparing the longest-term outcome studies for open reduction to less invasive, but mainly historical, techniques of gradual traction reduction it is unsettling to note that the latter protocols are associated with the best results. Whereas open reduction and innominate osteotomy are practised as originally described by Salter, gradual traction reduction has largely been abandoned.ConclusionsThere are probably aspects of the more time-consuming methods of gradual reduction that do not violate the hip joint capsule that expose the femoral head to a lower risk of femoral head osteonecrosis leading to better long-term outcomes.

Outcomes following open reduction for late-presenting developmental dysplasia of the hip

PurposePatients with late-presenting developmental dysplasia of the hip (DDH) are more likely to require an open reduction. Since many developing countries do not have mandated screening, there continues to be a relatively high incidence of late-presenting DDH. We report the clinical and radiographic outcomes of open reduction in a series of patients who presented late.Patients and methodsThis was a retrospective review of 712 hips in 645 patients that underwent open reduction, alone or in combination with a pelvic osteotomy. In all, 91 hips had open reduction alone and 621 had open reduction and pelvic osteotomy. Femoral shortening was performed in 221 hips. The mean age at the time of surgery was 2.1 years (1 to 6.5) and the mean follow-up time was 9.3 years (6 to 14). We used the Children’s Hospital Oakland Hip Evaluation Score (CHOHES) to determine functional outcomes and the Severin classification was used to evaluate radiographic outcomes. The rate of avascular necrosis (AVN) and the need for a reoperation were also recorded and analyzed.ResultsIn all 80% (570 hips) had good radiographic outcomes (Severin type I or II) and 87% had a CHOHES score of > 90 at final follow up. There was a 14% rate of AVN and only a 2% rate of redislocation. Better radiographic outcomes and lower reoperation rates were seen with patients who underwent both an open reduction and pelvic osteotomy. A trend was observed towards worse outcomes in older patients.ConclusionsThere was a high rate of good clinical and radiographic outcomes at a minimum six-year follow-up in patients with late-presenting DDH who underwent open reduction. Those who underwent open reduction in combination with a pelvic osteotomy had a higher rate of good radiographic outcomes and a lower rate of complications, particularly reoperation.

Outcomes following open reduction for late-presenting developmental dysplasia of the hip.

Patients with late-presenting developmental dysplasia of the hip (DDH) are more likely to require an open reduction. Since many developing countries do not have mandated screening, there continues to be a relatively high incidence of late-presenting DDH. We report the clinical and radiographic outcomes of open reduction in a series of patients who presented late. This was a retrospective review of 712 hips in 645 patients that underwent open reduction, alone or in combination with a pelvic osteotomy. In all, 91 hips had open reduction alone and 621 had open reduction and pelvic osteotomy. Femoral shortening was performed in 221 hips. The mean age at the time of surgery was 2.1 years (1 to 6.5) and the mean follow-up time was 9.3 years (6 to 14). We used the Children's Hospital Oakland Hip Evaluation Score (CHOHES) to determine functional outcomes and the Severin classification was used to evaluate radiographic outcomes. The rate of avascular necrosis (AVN) and the need for a reoperation were also recorded and analyzed. In all 80% (570 hips) had good radiographic outcomes (Severin type I or II) and 87% had a CHOHES score of > 90 at final follow up. There was a 14% rate of AVN and only a 2% rate of redislocation. Better radiographic outcomes and lower reoperation rates were seen with patients who underwent both an open reduction and pelvic osteotomy. A trend was observed towards worse outcomes in older patients. There was a high rate of good clinical and radiographic outcomes at a minimum six-year follow-up in patients with late-presenting DDH who underwent open reduction. Those who underwent open reduction in combination with a pelvic osteotomy had a higher rate of good radiographic outcomes and a lower rate of complications, particularly reoperation.

Socioeconomic and Demographic Risk Factors for Late Presentation of Developmental Dysplasia of the Hip

Purpose: The American Academy of Pediatrics (AAP) recommends physical examination screening for developmental dysplasia of the hip (DDH) for all newborns at birth and again periodically at well baby visits every 2 months for the first 6 months of life. Despite these recommendations, dislocated hips still go undiagnosed past 6 months of age at which time treatment becomes more complex and challenging with additional operative procedures. Risk factors for late presentation, such as female sex, vertex birth, and normal delivery …

Socioeconomic and Demographic Risk Factors for Late Presentation of Developmental Dysplasia of the Hip

Socioeconomic and Demographic Risk Factors for Late Presentation of Developmental Dysplasia of the Hip

Late-Presenting Developmental Dysplasia of the Hip

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.

Late presentation of developmental dysplasia of the hip : a 15-year observational study.

Despite the presence of screening programmes, infants continue to present with late developmental dysplasia of the hip (DDH), the impact of which is significant. The aim of this study was to assess infants with late presenting dislocation of the hip despite universal clinical neonatal and selective ultrasound screening. Between 01 January 1997 to 31 December 2011, a prospective, longitudinal study was undertaken of a cohort of 64 670 live births. Late presenting dislocation was defined as presentation after three months of age. Diagnosis was confirmed by ultrasound and plain radiography. Patient demographics, referral type, reason for referral, risk factors (breech presentation/strong family history) and clinical and radiological findings were recorded. There were 31 infants with an irreducible dislocation of the hip, an incidence of 0.48 (95% confidence interval (CI) 0.34 to 0.68) per 1000 live births. Of these, 18 (0.28 (95% CI 0.17 to 0.44) per 1000 live births; 58%) presented late. All infants had a documented normal newborn clinical examination and no abnormality reported in the six to eight week check. Of the 18 late presenting cases 72% (n = 13) had no risk factors: 16 were referred by GPs and two were late due to administrative issues (missed appointments). The mean time to diagnosis was 62.4 weeks (19 to 84). Despite universal clinical neonatal and selective ultrasound screening, late cases of irreducible hip dislocation still occur. We recommend an update of the national screening programme for DDH, a review of training and education of healthcare professionals involved in the physical examination of neonates and infants, and the addition of a further assessment after the six to eight week check. Cite this article: Bone Joint J 2017;99-B:1250-5.

Late-presenting developmental dysplasia of the hip in Jordanian males. A retrospective hospital based study.

Objectives:To describe the pattern of developmental dysplasia of the hip (DDH) in late presenting Jordanian male patients and identify the risk factors and associated findings.Methods:This is a retrospective study of 1145 male patients who attended the Pediatric Orthopedic Clinic for a DDH check up. This study was carried out in the Orthopedic Section, Special Surgery Department, Faculty of Medicine, The University of Jordan, Amman, Jordan between March 2011 and October 2014. Data was collected from medical records, and x-ray measurements were evaluated.Results:Of the 1145 male patients, 43 (3.75%) with 70 involved hips were diagnosed with late- presenting DDH. Being a first-born baby resulted in 41.9% increased risk for DDH. Cesarian delivery was significantly associated with an increased risk of hip dislocation (p=0.004) while normal delivery was significantly associated with acetabular dysplasia (p=0.004). No predictable risk factors were found in 44.2% patients with DDH. Bilateral cases were more common than unilateral cases: (26 [60.5%] versus 17 [39.5%]). Limited abduction was a constant finding in all dislocated hips (p<0.001). Associated conditions, such as club foot and congenital muscular torticollis were not observed.Conclusion:Cesarian section is a significant risk for dislocated hips while normal delivery is significantly associated with acetabular dysplasia. Bilateral DDH is more common than the unilateral. Club foot and torticollis were not observed in this series.

The Economic Impact of Managing Late Presentation of Developmental Dysplasia of Hip (DDH).

Delayed presentation of Developmental Dysplasia of Hip (DDH) comes with challenges in treatment as well as high surgical cost. Therefore the objective of this study is to quantify the economic impact of management of late presentation of DDH during a last 3-year period. We conducted a retrospective study with analysis of DDH cases managed between years 2012 to 2014. Early and late presentations of DDH were identified and cost management for both was estimated. Out of twenty-four DDH cases, thirteen cases fulfilled the inclusion criteria. All were female with majority of them presenting with unilateral DDH predominantly of the left hip. Most patients presented after age of six months and the principal complaint was abnormal or limping gait. The grand total cost for managing DDH during the three years period was USD 12,385.51, with 86% of the amount having been used to manage late presentation of DDH that was mostly contributed by the cost of surgery. We concluded that delayed presentation of DDH contributes heavily to high national expenditure. Early detection of DDH cases with systematic neonatal screening may help to minimize the incidence of the late presenting DDH and subsequently reduce the economic burden to the government.

Pubo-femoral distance: an easy sonographic screening test to avoid late diagnosis of developmental dysplasia of the hip

To propose an easy and reproducible sonographic screening test able to avoid late presentation of developmental dysplasia of the hip (DDH). The pubo-femoral distance (PFD) cut-off point was determined on 980 infants who underwent ultrasonography of the hips in comparison with the final diagnosis, based on clinical, ultrasound data and follow-up. PFD reproducibility was tested on 52 hips by both an experienced and an inexperienced radiologist. After teaching this screening method to general radiologists, its impact was evaluated by analysing the rate of late diagnosis in an entire administrative area. An abnormal PFD threshold above 6 mm gave a sensitivity of 97.4 % for the diagnosis of DDH (271 hips) and a specificity of 84 %. Sensitivity increased to 100 % when taking into consideration children of 1 month or older. The PFD measurement stayed reproducible even in inexperienced hands (k = 0.795). For 3 years, following the extension of screening to all female infants, there was no late diagnosis of DDH in girls in amongst a catchment area of 1 million inhabitants. PFD measurement with a threshold for abnormality of 6 mm at the age of 1 month, without asymmetry above 1.5 mm, could eradicate DDH late diagnosis.

The Height-to-Width Index for the Assessment of Femoral Head Deformity Following Osteonecrosis in the Treatment of Developmental Dysplasia

The principal complications that follow the treatment of developmental dysplasia of the hip are redislocation and growth disturbance of the femoral head and neck as a result of osteonecrosis of the femoral epiphysis. Growth disturbance secondary to osteonecrosis is difficult to determine until long after the treatment episode has passed. Consequently, the treating surgeon has little early feedback regarding the long-term consequences of management interventions. We therefore sought to devise a quantitative method to identify early evidence of growth disturbance related to osteonecrosis. The width and height of the epiphyses were measured on anteroposterior radiographs of the pelvis made twelve to eighteen months after successful closed reduction and on the latest available radiograph for each patient (mean age, 8.6 years). The epiphyseal index was calculated by dividing the height by the width. The radiographs were also scored for osteonecrosis with use of the Kalamchi and MacEwen classification system and were also assessed for sphericity with use of Mose rings. Forty-seven patients with late-presenting developmental dysplasia of the hip who subsequently underwent successful closed reduction were included. An index of <0.357 on the twelve to eighteen-month post-treatment radiograph strongly predicted the development of a nonspherical femoral head on the latest radiograph (sensitivity, 0.83; specificity, 0.95; positive predictive value, 0.55; and negative predictive value, 0.99). The height-to-width index appears to be a simple and quantifiable measurement of the severity of growth disturbance as a consequence of osteonecrosis following treatment for developmental dysplasia of the hip. It is predictive of asphericity at the time of intermediate-term follow-up and appears likely to predict asphericity at maturity, but this must be confirmed with follow-up to maturity. Unlike the currently used methods of assessing osteonecrosis, the index allows for the quantifiable evaluation of growth disturbance within a few years after the corrective procedure.

Associated risk factors in children who had late presentation of developmental dysplasia of the hip

The purpose of this study was to assess the role of clinical examination, associated risk factors and plain radiograph of the pelvis in children who had late presentation of DDH. We report on a 7-year prospective study, in children who had late presentation of developmental dysplasia of the hip (DDH). For this purpose, 740 hips in 370 referred children, age range 3-7 months (mean 3.44 months) were clinically and radiologically assessed, and the associated risk factors recorded. Female sex, first born, positive family history and breech presentation were confirmed as risk factors for DDH. Significant findings were an increased risk for vaginal delivery over caesarean section for breech presentation (P = 0.002). There was an increased risk for caesarean section in the absence of breech presentation. Multiple births and preterm births had a reduced risk. For breech presentation, the risk of DDH was estimated to be at least 1.6% for girls and 3.4% for boys; a combination of factors increased the risk. Limitation of abduction (43.2%) and asymmetry of the groin skin folds (72.7%) were found to be the two most common clinical findings associated with DDH. Bilateral acetabular dysplasia is more common than unilateral dysplasia. Foot deformities were rarely encountered in children with acetabular dysplasia. The percentage of first-born babies who had DDH is lower than reported in the literature (34%), but still shows significant risk. We did find that bilateral acetabular dysplasia is more common than unilateral dysplasia. Torticollis and foot deformities are rarely found to be associated with DDH. All these findings needs further evaluation in children who had surgical treatment for DDH, to see if they are different from dysplastic groups. Limitation of abduction is an important clinical finding, but is not always associated with DDH. Asymmetry of the skin folds in the groin were found to be an important clinical finding associated with DDH for all age groups. As clinical examination depends on many factors, and most DDH cases are of the dysplastic type, it is mandatory to depend on further diagnostic tools for confirmation of DDH.