Known risk factors of the developmental dysplasia of the hip predicting more severe clinical presentation and failure of Pavlik harness treatment

Utility of routine X-ray surveillance following hip sonography for developmental dysplasia in children: a single-center study spanning a decade

INTRODUCTION

This study evaluates the necessity of routine X-ray follow-ups in children with developmental dysplasia of the hip (DDH), identified through Graf hip ultrasound, a standard component of screening in Germany. The purpose of this study was to investigate the occurrence of radiological deterioration in hips that were initially diagnosed and treated according to established guidelines within a university-based risk-enriched cohort and to identify associated risk factors.

MATERIALS AND METHODS

Patients diagnosed with developmental DDH from 2009 to 2018 with sonographically healthy hips (alpha > 64°) post conservative therapy and at least one follow-up X-ray by the age of two were analysed. Patients with significant comorbidities, syndromes, malformations, non-compliance with treatment, or missing X-ray data were excluded. Descriptive analysis of sonography, X-ray, and patient records were followed by univariate analysis and subsequent multiple logistic regression, identifying risk factors for severe and extreme dysplasia in X-rays.

RESULTS

Of the 450 included hips, 254 were classified as Graf Type 2a or higher, leading to treatment. Subsequent X-rays revealed severe dysplasia in 53 hips and extreme dysplasia in seven hips. Univariate analysis identified sex, initial Graf-Type, therapy type and duration as significantly associated with pathological radiographs. A regression model identified the initial Graf type as the predominant predictor with hip types 3a and 4, cast therapy and overhead extension as independent predictors.

CONCLUSIONS

The data demonstrate pathological findings even after successful conservative treatment of DDH. Worsening of X-ray findings appear less frequent in mild dysplasia. These insights support routine radiographic follow-up assessments after successful conservative therapy. However, further dedicated studies are needed to determine whether patients with initially normal radiographs require radiographic follow-up.

Risk Factors for Developmental Dysplasia of the Hip: A Critical Analysis About an Unclear Relationship

Objective: To evaluate the relationship between prenatal risk factors and developmental dysplasia of the hip using the Graf grade, and to identify the determinants of a higher Graf grade. Materials and Methods: A retrospective analysis of data from 112 newborns with DDH was conducted. The participants were selected on the basis of a DDH diagnosis using sonography. A total of 181 hips of patients with DDH were considered in our study group (Graf types IIa to IV), and the normal hips of those affected unilaterally were excluded from the analyses (43 participants were affected unilaterally). The risk factors considered included female sex, breech presentation, firstborn status, familiarity, association with other orthopedic abnormalities, and uterine packing, which includes factors such as twin pregnancy, macrosomia, and oligohydramnios. Binary logistic regression was used to analyze the relationship between these variables and the Graf type of DDH at presentation, which was defined using two groups: Graf types IIc-IV, which include unstable or decentered hips, and Graf types IIa and IIb, which encompass stable and centered hips. Results: The analyses revealed a significant protective role of the presence of other lower limb congenital malformations such as clubfoot, which was more closely associated with a stable form of DDH (OR = 0.26, p = 0.017), a significant association between the presence of mechanical risk factors in females with an unstable form of DDH (OR = 5.00, p = 0.042), a borderline significant protective role of breech presentation in females, which was more closely associated with a stable form of DDH (OR = 0.25, p = 0.054), and a borderline significant association between the presence of mechanical risk factors and an unstable form of DDH (OR = 4.28, p = 0.054). Conclusions: Prenatal risk factors may have a complex effect on the Graf grade in DDH. The protective effects of some factors in contrast with the increased risk associated with other factors suggest a possible relationship, with some prenatal risk factors affecting the severity of DDH. These findings may have implications for the early identification and management of DDH.

Child Opportunity Index and Diagnosis of Developmental Dysplasia of the Hip: Insights From a Children's Hospital Serving Disadvantaged Communities

INTRODUCTION

Initiation of Pavlik harness treatment for developmental dysplasia of the hip (DDH) by 6 to 7 weeks of age predicts a higher rate of success. Child Opportunity Index (COI) 2.0 is a single metric designed to measure resources and conditions affecting children's healthy development. This study investigates COI in relation to the timing of DDH diagnosis.

METHODS

This is a retrospective cohort study on patients younger than 4 years diagnosed with DDH between 2016 and 2023, treated with a Pavlik harness, rigid hip abduction orthosis, and/or surgery. Demographic and clinical data were recorded, including date of first diagnostic imaging. Patients with syndromes, congenital anomalies, or neuromuscular disorders and those referred with an unknown date of first diagnostic imaging were excluded. A subgroup analysis of patients diagnosed at ≤6 weeks ("early") and >6 weeks ("late") was conducted. Statewide COI scores (total, three domains) and categorical quintile scores (very low, low, moderate, high, and very high) were recorded.

RESULTS

A total of 115 patients were included: 90 female infants (78%), with a median age of 32 days at diagnostic imaging. No notable difference was observed between median age at diagnosis for study patients in low or very low quintiles and those in moderate, high, or very high quintiles for COI total or domains. "Early" and "late" diagnosis subgroups did not differ markedly by COI total or domains, nor insurance type, race, or ethnicity. Subgroups differed markedly by race and insurance status.

DISCUSSION

In an urban children's hospital, COI did not differ markedly between patients diagnosed with DDH by ≤6 weeks and >6 weeks. This is the first study to pose this question on DDH in a population with predominantly low/very low COI scores and public insurance, which may lead to unexpected results. Replicating the study in a different setting could yield different results.

LEVEL OF EVIDENCE

III.

Community Awareness About Developmental Dysplasia of the Hip (DDH) in the Western and Southern Regions of Saudi Arabia

BACKGROUND

Developmental dysplasia of the hip (DDH) is a disorder in which the hip joint does not develop normally in the pediatric age group. It is caused by a confluence of hereditary and environmental factors. We aimed to examine knowledge and awareness of DDH among the general population of the southern and western regions of Saudi Arabia.

METHODOLOGY

A cross-sectional survey-based study was conducted in the western and southern regions of Saudi Arabia. This study included adult male and female participants above 18 years of age. Data were collected using a validated electronic questionnaire that was disseminated via social media platforms. All data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY).

RESULTS

In this study, 1,232 participants were surveyed in Saudi Arabia. The majority were between 21 and 30 years old (663, 53.8%), unmarried (690, 56%), and had a baccalaureate or diploma certificate (886, 71.9%). Regarding knowledge of DDH, 86.4% of participants had poor knowledge of the causes of DDH, and 740 (60%) had poor overall knowledge of DDH. However, 492 (40%) participants had good knowledge. Respondents with a higher monthly income, those who were mothers, and those who obtained information from social media had a better awareness level. Concerning treatment, 531 (43.1%) participants were unsure about the best treatment for DDH, and 850 (69%) believed that early treatment was better.

CONCLUSIONS

According to our literature, DDH is highly prevalent among Saudi populations. However, our findings indicate that the majority of the Saudi population residing in the western and southern regions of Saudi Arabia lacks basic knowledge of DDH. All capable facilities, such as medical schools, hospitals, and primary healthcare centers, must impart cultural education about DDH to address this awareness gap.

Costs of abduction treatment in developmental dysplasia of the hip. Analysis of 900 patients

BACKGROUND

Developmental dysplasia of the hip (DDH) is a disorder of hip development that leads to dysplasia, subluxation, or total hip dislocation. Early detection of DDH is important, and early initiation of abduction treatment is key to successful correction of the hip joint. However, mild forms of DDH, including hip instability without complete dislocation, have good spontaneous healing potential, and a watchful waiting strategy in mild DDH has been found to be safe. In this study, we aimed to evaluate the cost differences between different treatment strategies for DDH.

MATERIAL AND METHODS

Data were collected retrospectively from the medical records of all children diagnosed with diagnosis and treatment of DDH in Tampere University hospital between 1998 and 2018. In total, 948 patients were included in the study. Patients who underwent casting or operative treatment (n = 48) were excluded from the analysis. All Ortolani positive children were subjected to early abduction treatment. Children with Ortolani negative DDH were subjected to either watchful waiting or early abduction treatment, based on the clinicians' decision. The regression model estimates for the number of clinical visits with and without ultrasound examination were assessed together with cost reports from Tampere University Hospital for the calculation of savings per patient in spontaneous recovery.

RESULTS

Alpha angles at one month of age (p < 0.001) and treatment method (p < 0.001) affected the number of clinical visits and ultrasound examinations during the treatment follow-up. A low alpha angle predicted closer follow-up, and children with spontaneous recovery had lower numbers of clinical visits and ultrasound examinations than children in abduction treatment. Spontaneous recovery was found to result in approximately 375€/patient savings compared to successful abduction treatment.

CONCLUSION

With correct patient selection, a watchful waiting strategy is cost-effective in treating mild developmental dysplasia of the hip, considering the high percentage of spontaneous recovery.