Risk Of Developmental Dysplasia Of The Hip Research Articles

Environmental and Genetic Risk Factors in Developmental Dysplasia of the Hip for Early Detection of the Affected Population.

Diagnosis of developmental dysplasia of the hip (DDH) mostly relies on physical examination and ultrasound, and both methods are operator-dependent. Late detection can lead to complications in young adults. Current evidence supports the involvement of environmental and genetic factors, such as single nucleotide variants (SNVs). Incorporating genetic factors into diagnostic methods would be useful for implementing early detection and management of affected individuals. Our aim was to analyze environmental factors and SNVs in DDH patients. We included 287 DDH cases and 284 controls. Logistic regression demonstrated an association for sex (OR 9.85, 95% CI 5.55-17.46, p = 0.0001), family history (OR 2.4, 95% CI 1.2-4.5, p = 0.006), fetal presentation (OR 3.19, 95% CI 1.55-6.54, p = 0.002), and oligohydramnios (OR 2.74, 95%CI 1.12-6.70, p = 0.026). A model predicting the risk of DDH including these variables showed sensitivity, specificity, PPV, and NPV of 0.91, 0.53, 0.74, and 0.80 respectively. The SNV rs1800470 in TGFB1 showed an association when adjusted for covariables, OR 0.49 (95% CI 0.27-0.90), p = 0.02. When rs1800470 was included in the equation, sensitivity, specificity, PPV and NPV were 0.90, 0.61, 0.84, and 0.73, respectively. Incorporating no-operator dependent variables and SNVs in detection methods could be useful for establishing uniform clinical guidelines and optimizing health resources.

The risk of DDH between breech and cephalic-delivered neonates using Graf ultrasonography.

Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal disorder in infants. The most significant risk factors include female gender, breech presentation, left hip and family history. In this study, we utilized the Graf method at different time intervals to evaluate both breech-delivered and cephalic-born newborns. The objectives were to compare the incidence of DDH in cephalic and breech-delivered neonates and investigate whether the hip joints of neonates delivered in the breech position exhibit a distinct maturation pattern. We studied prospectively 618 hip joints (309 newborns). Each hip joint was examined with the Graf method in four time periods as follows: Phase #1 (0-1weeks), Phase #2 (1-4weeks), Phase #3 (4-7weeks), and Phase #4 (7-10weeks). The α and β angles for each hip joint were measured, and the hips were classified according to Graf classification. With our statistical analysis within the different phases, we were able to investigate potential variations in the maturation patterns between newborns delivered in the breech and cephalic delivery positions. A significant difference (at the 5% level) was observed in Phase 1 between breech and cephalic-delivered neonates (35.6-8.6%). This difference tended to decrease in next phases (13.6-1% in Phase 2, 2.5-0% in Phase 3 and 1.7-0% in Phase 4). A significant difference (at the 5% level) for cephalic-delivered neonates was also observed between Phase 1 and Phase 4 (8.5-0%), but the percentages were low. Additionally, the breech-delivered had extreme difference in incidence of DDH from Phase 1 to Phase 4 (35.6-11.9%, 2.5%, and 1.7%, respectively). It appears that there is an actual difference in the incidence of DDH between breech-delivered and cephalic-delivered neonates, although the difference may be less significant than previously considered. The majority of the breech-delivered neonates that were initially considered as pathological (Phase 1) are, in fact, healthy. This is ascertained in subsequent ultrasound examinations conducted in later phases (Phases 2-4), when the incidence of pathological cases decreases. This could be attributed to potential different maturation pattern between these groups.

The Risk of Developmental Dysplasia of the Hip in Premature Infants with Breech Presentation at Birth.

This article evaluates the risk (defined here as incidence per 1,000 infants) of developmental dysplasia of the hip (DDH) in premature infants undergoing hip ultrasound (HUS) for breech presentation only compared with other indications. Retrospective study of infants born between January 1, 2009 and December 31, 2018 at <37 weeks' gestation with a HUS obtained in the first year of life, at Nationwide Children's Hospital, the only available facility for pediatric radiology and orthopaedic services in central Ohio. We calculated risk differences and odds ratios of DDH by the indication of HUS. From 2,397 infants reviewed, 89% underwent HUS for breech presentation only. The local incidence of DDH for infants undergoing HUS for breech-only indication was 15 per 1,000 compared with 155 per 1,000 for infants undergoing HUS for other indications. The odds ratio of DDH diagnosis was 12.1 (95% confidence interval: 7.5, 19.6) for infants undergoing HUS for an indication other than breech presentation only relative to infants undergoing HUS for the indication of breech presentation only. The risk of DDH diagnosis in premature infants undergoing HUS for breech presentation is much lower than those undergoing HUS for clinical concerns and other risk factors. Screening these infants with physical examination may be sufficient. · Breech presentation is the most common indication for hip ultrasound in premature infants.. · The risk of DDH is lower in premature infants with breech presentation compared with premature infants with other clinical concerns.. · The risk of DDH is higher in infants born at 33 to 36 weeks of gestation compared with those born at an earlier gestation..

The cost effectiveness of potential risk factors for developmental dysplasia of the hip within a national screening programme

Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate a novel screening programme that included both the primary risk factors of breech presentation and family history, and the secondary risk factors of oligohydramnios and foot deformities. A five-year prospective registry study investigating every live birth in the study's catchment area (n = 27,731), all of whom underwent screening for risk factors and examination at the newborn and six- to eight-week neonatal examination and review. DDH was diagnosed using ultrasonography and the Graf classification system, defined as grade IIb or above or rapidly regressing IIa disease (≥4o at four weeks follow-up). Multivariate odds ratios were calculated to establish significant association, and risk differences were calculated to provide quantifiable risk increase with DDH, positive predictive value was used as a measure of predictive efficacy. The cost-effectiveness of using these risk factors to predict DDH was evaluated using NHS tariffs (January 2021). The prevalence of DDH that required treatment within our population was 5/1,000 live births. The rate of missed presentation of DDH was 0.43/1000 live births. Breech position, family history, oligohydramnios, and foot deformities demonstrated significant association with DDH (p < 0.0001). The presence of breech presentation increased the risk of DDH by 1.69% (95% confidence interval (CI) 0.93% to 2.45%), family history by 3.57% (95% CI 2.06% to 5.09%), foot deformities by 8.95% (95% CI 4.81% to 13.1%), and oligohydramnios nby 11.6% (95 % CI 3.0% to 19.0%). Primary risk factors family history and breech presentation demonstrated an estimated cost-per-case detection of £6,276 and £11,409, respectively. Oligohydramnios and foot deformities demonstrated a cost-per-case detected less than the cost of primary risk factors of £2,260 and £2,670, respectively. The inclusion of secondary risk factors within a national screening programme was clinically successful as they were more cost and resource-efficient predictors of DDH than primary risk factors, suggesting they should be considered in the national guidance.

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

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.

Diagnostic Performance of Clinical Examination Versus Ultrasonography in the Detection of Developmental Dysplasia of Hip: A Systematic Review and Meta-Analysis.

Developmental dysplasia of the hip (DDH) is a spectrum of diseases involving the femoroacetabular joint. Due to the controversies over the value of different strategies used for DDH screening, this systematic review and meta-analysis aimed to assess the diagnostic performance of standard physical examination maneuvers on the diagnosis of DDH, compared to the Graf ultrasonography (US) method. PubMed, Web of Science, and SCOPUS databases were searched until the end of October 2020. Studies that (i) used the Ortolani test, Barlow test, or limited hip abduction (LHA) test to assess the risk of DDH in physical examination, (ii)used the Graf US method to examine DDH in sonography, and (iii) provided adequate data to extract the diagnostic performance were included. Pooled sensitivity and specificity were calculated for clinical examinations. A total of 25 studies (72,079 patients in total) were considered eligible to enter the present study. The pooled data of the Ortolani-Barlow test demonstrated a sensitivity of 36% (95% CI:0.25-0.48) and specificity of 98% (95% CI:0.93-0.99). Calculated pooled sensitivity and specificity for the limited hip abduction exam were obtained at 45% (95% CI:0.24-0.69) and 78% (95% CI:0.62-0.88) respectively. A separate analysis of the studies using both exams revealed a sensitivity of 57% (95% CI:0.30-0.82) and a specificity of 95% (95% CI:0.68-0.99). Based on the results, the investigated clinical examinations have high specificity but low sensitivity to detect the DDH; therefore, they have limited application as a screening test. If obliged to rely on clinical examinations for screening, the combination of Ortolani-Barlow and LHA tests can provide more sensitivity than either of these tests performed independently.

Hip Maturation: Are 2 Diapers Better Than 1?

Hip Maturation: Are 2 Diapers Better Than 1?

The infants who have mature hip on ultrasonography but have risk factors of developmental dysplasia of the hip are required radiographic examination.

Objectives This study aims to evaluate the short-term results of infants who were radiologically diagnosed with developmental dysplasia of the hip (DDH), but in whom hip development was normal ultrasonographically. Patients and methods Between January 2018 and September 2020, a total of 15 infants (2 males, 13 females; median age: 5 months; range, 4 to 6 months) who were diagnosed with DDH radiologically and treated were retrospectively analyzed. Hip ultrasonography was used for early diagnosis, treatment, and for follow-up in infants up to six months of age. While the ultrasonographic findings were normal, radiography was performed in infants between four to six months of age who were at risk for DDH.Results Fifteen patients (22 hips) were diagnosed with DDH radiologically and treated. Radiologic dysplasia continued in seven hips of five patients during short-term follow-up.Conclusion These results suggest that ultrasonographic hip maturation may not be consistent with normal hip development in infants, particularly in those who are at risk for DDH. In infants with DDH which is confirmed by radiography (less than 6 months of age), the diagnosis may be missed on ultrasonographic examination.

Breech Presentation in Twins as a Risk Factor for Developmental Dysplasia of the Hip.

Introduction:Identifying risk factors associated with developmental dysplasia of the hip (DDH) is essential for early diagnosis and treatment. Breech presentation is a major DDH risk factor, possibly because of crowding of the fetus within the uterus. In multifetal pregnancy, fetuses are generally smaller than singletons, which may obscure the effect of breech presentation on fetal hips. Only a few studies have investigated the occurrence of DDH in multifetal pregnancies. In this study, we aimed to evaluate whether the breech presentation is a major risk factor of DDH in twin pregnancies.Methods:This retrospective study included 491 consecutive live births (after 23+0 weeks gestation) delivered through cesarean section with at least 1 baby with noncephalic presentation in single or twin pregnancies from April 2013 to October 2018. We analyzed the incidence of DDH and its associated factors, including sex, breech, and multifetal pregnancy, with a generalized linear mixed model.Results:The incidence of DDH was 12.5% in singleton with breech presentation, 9.8% in twin-breech presentation, and 0.7% in twin-cephalic presentation. Multivariate analysis showed that singleton-breech presentation (P=0.003), twin-breech presentation (P=0.003), and female sex (P=0.008) were independent risk factors for DDH.Conclusion:Breech presentation is an independent risk factor for DDH in twin pregnancies, although twin pregnancy itself is not an independent risk factor for DDH.

Association between timing and duration of breech presentation during pregnancy and developmental dysplasia of the hip: A case-control study.

This case-control study investigated the association between timing and duration of breech presentation in pregnancy and developmental dysplasia of the hip (DDH). Children with DDH aged 3years or younger (n = 191) were compared with healthy controls (n = 209). Data on outcome, exposure and, covariates were collected using a parents' self-report online questionnaire. Term children with breech presentation at one or more check-ups after 30.0weeks gestation had a twofold higher risk of developing DDH compared to children who had never presented in breech (OR 2.01; 95% CI [1.28, 3.15]). The strength of the association increased with duration of breech presentation (5-8weeks: OR 2.65; 95% CI [1.36, 5.18]; 9-12weeks: OR 3.63; 95% CI [1.82, 7.24]). Children who had presented in breech at least once in gestational period 37.0-birth had a 3.24 (95% CI [1.86, 5.65]) times higher risk of DDH, whereas the risk for children with breech presentation in gestational period 30.0-36.6 only was not increased. Also after adjusting for confounders, children who had presented in breech after gestational week 37.0-birth had a more than threefold higher risk of DDH (OR 3.33; 95% CI [1.81, 6.13]) compared to children who were never in breech or in gestational period 30.0-36.6 only.

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.

Developmental dysplasia of the hip and associated risk factors in Saudi children: A retrospective study.

Studies investigating the association between developmental dysplasia of the hip (DDH) and risk factors in Saudi Arabia are rare. Investigate the association between DDH and several risk factors among Saudi children. The medical records of 82 children born in or admitted to King Abdul Aziz Medical City in Riyadh, Saudi Arabia with clinical suspicion of hip dislocation (HD) were included. The association between DDH and the following risk factors was investigated: age < 3 y, female-gender, twinning, first-born child, C-section, breech presentation, prematurity, positive family history and presence of associated abnormalities. HD was confirmed in 73 (89%) children (Positive HD) and excluded in 9 (11%) children (Negative HD). Eleven (13.4%) children were excluded from the positive cases as it was confirmed that they have paralytic hip dislocation not DDH. DDH was confirmed in 62 children (75.6%). The Chi square test (χ2) and odds ratios (OR) revealed that the positive family history, female-gender, age < 3 years, and presence of associated abnormalities had significant associations with the presence of DDH with P values and OR equal 0.00 (16.4), 0.002 (3.1), 0.005 (2.6), and 0.04 (1.9) respectively. Breech presentation, twinning, first-born children, prematurity, and C-section were not associated with DDH with P values and OR equal 0.93 (1.1), 0.46 (0.4), 0.11 (0.4), 0.08 (0.3), and 0.002 (0.3) respectively. Positive family history, female-gender, age < 3 years, and presence of associated abnormalities had approximately 16, 3, 2.5, and 2 times increased risk for DDH.

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.

Predicting developmental dysplasia of the hip in at-risk newborns

BackgroundThe development of developmental dysplasia of the hip can be attributed to several risk factors and often in combination with each other. When predicting the likelihood of developing this condition, clinicians tend to over and underestimate its likelihood of occurring.Therefore, the study aim is to determine among at-risk newborns how to best predict developmental dysplasia of the hip (DDH) within 8 weeks post-partum.MethodsProspective cohort study in secondary care. Patient population included newborns at-risk for DDH – we assessed 13,276 consecutive newborns for the presence of DDH risk factors. Only newborns with at least one of the predefined risk factors and those showing an abnormal examination of the hip were enrolled (n = 2191). For the development of a risk prediction model we considered 9 candidate predictors and other variables readily available at childbirth.The main outcome measure was ultrasonography at a median age of 8 weeks using consensus diagnostic criteria; outcome assessors were blinded.ResultsThe risk model includes four predictors: female sex (OR = 5.6; 95% CI: 2.9–10.9; P < 0.001); first degree family history of DDH (OR = 4.5; 95% CI: 2.3–9.0; P < 0.001), birthweight > 4000 g (OR = 1.6; 95% CI: 0.6–4.2; P = 0.34), and abnormal examination of hip (OR = 58.8; 95% CI: 31.9, 108.5; P < 0.001). This model demonstrated excellent discrimination (C statistic = 0.9) and calibration of observed and predicted risk (P = 0.35). A model without the variable ‘hip examination’ demonstrated similar performance.ConclusionThe risk model quantifies absolute risk of DDH within 8 weeks postpartum in at-risk newborns. Based on clinical variables readily available at the point of childbirth, the model will enhance parental counselling and could serve as the basis for real time decisions prior to discharge from maternity wards.

Associations between risk factors and developmental dysplasia of the hip and ultrasonographic hip type: a retrospective case control study.

PurposeWe aimed to revisit the correlation between the previously defined risk factors and the occurrence of developmental dysplasia of the hip (DDH) and to assess the influence of these factors on the ultrasonographic type of hip dysplasia according to the Graf’s classification in patients with DDH.MethodsData of healthy infants (mean age 33 days) who had bilateral mature (normal) hips (Graf type I) were compared with the data of infants (mean age 105 days) who were treated by abduction brace due to unilateral or bilateral DDH (Graf type IIa- and worse hips).ResultsInfants with at least one risk factor had a significantly higher rate of DDH than those with no risk factors (p < 0.001). Likewise, infants with more than one risk factor had a significantly higher rate of DDH than those with only one risk factor (p = 0.008). Family history, breech presentation and swaddling were found to be the three significant risk factors related to the development of DDH. Family history, swaddling and oligohydramnios were found to be the three significant risk factors correlated with a higher rate of unstable/decentred hip(s) (Graf types D/III/IV) in patients with DDH.ConclusionThe risk of DDH significantly increases in infants who have more than one risk factor for DDH. Positive family history and postnatal traditional swaddling are the two main factors both in the aetiology of DDH and in development of a more severe hip dysplasia in patients with DDH. Besides, breech presentation increases the risk of development of DDH and oligohydramnios leads to development of a more severe hip dysplasia in patients with DDH. By introducing these four variables as ‘absolute risk factors for DDH’ to the selective newborn hip screening programmes, the sensitivity and specificity of these programmes may be optimized and the risk of delayed diagnosis may be lessened.Level of EvidenceLevel III prognostic study

European Society of Biomechanics S.M. Perren Award 2018: Altered biomechanical stimulation of the developing hip joint in presence of hip dysplasia risk factors

Fetal kicking and movements generate biomechanical stimulation in the fetal skeleton, which is important for prenatal musculoskeletal development, particularly joint shape. Developmental dysplasia of the hip (DDH) is the most common joint shape abnormality at birth, with many risk factors for the condition being associated with restricted fetal movement. In this study, we investigate the biomechanics of fetal movements in such situations, namely fetal breech position, oligohydramnios and primiparity (firstborn pregnancy). We also investigate twin pregnancies, which are not at greater risk of DDH incidence, despite the more restricted intra-uterine environment. We track fetal movements for each of these situations using cine-MRI technology, quantify the kick and muscle forces, and characterise the resulting stress and strain in the hip joint, testing the hypothesis that altered biomechanical stimuli may explain the link between certain intra-uterine conditions and risk of DDH. Kick force, stress and strain were found to be significantly lower in cases of breech position and oligohydramnios. Similarly, firstborn fetuses were found to generate significantly lower kick forces than non-firstborns. Interestingly, no significant difference was observed in twins compared to singletons. This research represents the first evidence of a link between the biomechanics of fetal movements and the risk of DDH, potentially informing the development of future preventative measures and enhanced diagnosis. Our results emphasise the importance of ultrasound screening for breech position and oligohydramnios, particularly later in pregnancy, and suggest that earlier intervention to correct breech position through external cephalic version could reduce the risk of hip dysplasia.

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.