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Lee WC, Kao HK, Wang SM, Yang WE, Chang CH, Kuo KN. Cold Weather as a Risk Factor for Late Diagnosis and Surgery for Developmental Dysplasia of the Hip. J Bone Joint Surg Am 2022; 104:115-122. [PMID: 34793368 DOI: 10.2106/jbjs.21.00460] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Newborn hip screening aims to prevent the late diagnosis of and subsequent surgical procedures for developmental dysplasia of the hip (DDH). Weather may affect how parents swaddle their babies in early life, but weather has never been formally regarded as a risk factor in hip screening. This study investigates the association between the incidence of surgically treated DDH and the outdoor temperature. METHODS Surgical procedures for late-diagnosed DDH were investigated in 12 birth-year cohorts (1999 to 2010) using the Taiwan National Health Insurance Research Database. The number of children who underwent a DDH-related surgical procedure between 6 months and 5 years of age per total live births was evaluated as an outcome of hip screening. Trend and regression analyses were used to determine the association between the incidence of surgically treated DDH and birth year, birth month, and the temperature during the birth month and first 3 months of life. RESULTS The mean incidence of surgically treated DDH was 0.48 per 1,000 live births (1,296 surgically treated patients per 2,712,002 live births). The incidence of surgically treated DDH among babies born in winter months (0.70 per 1,000) was significantly higher than that among babies born in summer months (0.32 per 1,000), and it was significantly correlated with mean temperature in the first 3 months of life (r2 = 0.91; p < 0.0001) and birth month (r2 = 0.68; p < 0.001). Multivariable regression revealed that external temperature in the first 3 months of life was the most significant factor (β = -0.034 [95% confidence interval, -0.042 to -0.022]; p < 0.001) for the incidence of surgically treated DDH (adjusted r2 = 0.485). The trend of seasonal differences remained the same throughout the study years following implementation of the hip-screening policy. CONCLUSIONS As the incidence of surgically treated DDH is the ultimate outcome of newborn hip screening, cold weather should be regarded as a risk factor and should be incorporated into future screening programs. Weather patterns of different geographical areas should be studied to determine if children born in the winter are at an increased risk for requiring a surgical procedure for DDH, and newborn hip-screening programs should be revised accordingly. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Wei Chun Lee
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsuan Kai Kao
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu Mei Wang
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen E Yang
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia Hsieh Chang
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ken N Kuo
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.,Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Chu L, He Z, Qu X, Liu X, Zhang W, Zhang S, Han X, Yan M, Xu Q, Zhang S, Shang X, Yu Z. Different subchondral trabecular bone microstructure and biomechanical properties between developmental dysplasia of the hip and primary osteoarthritis. J Orthop Translat 2019; 22:50-57. [PMID: 32440499 PMCID: PMC7231963 DOI: 10.1016/j.jot.2019.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 01/21/2023] Open
Abstract
Objective Developmental dysplasia of the hip (DDH) is recognized as a frequent cause of secondary osteoarthritis (OA). The purpose in this study was to compare structural and biomechanical properties of subchondral trabecular bone and its relationship with cartilage damage between patients with DDH and patients with primary hip OA. Methods Forty-three femoral head specimens obtained from patients who underwent total hip arthroplasty [DDH, n = 17; primary OA, n = 16; and normal control (NC), n = 10] were scanned by microcomputed tomography and analyzed by individual trabecula segmentation to obtain the microstructural types of subchondral trabecular bone. The biomechanical properties were analyzed by micro-finite element analysis, and cartilage damage was evaluated by histology. The linear regression analysis was used to indicate the association between microstructures, biomechanical property, and articular cartilage. Results The DDH group showed the lowest total bone volume fractions (BV/TV) and plate BV/TV in the three groups (p < 0.05). There were also different discrepancies between the three groups in plate/rod trabecular number, plate/rod trabecular thickness, trabecular plate surface area/trabecular rod length, and junction density with different modes (plate-plate, rod-rod, and plate-rod junction density). The micro-finite element analysis, histology, and linear regression revealed that the subchondral trabecular bone in the DDH group had inferior biomechanical properties and cartilage damage of patients with DDH was more serious with different subchondral trabecular bone microstructures. Conclusion Our findings detected deteriorating subchondral trabecular bone microstructures in patients with DDH. The mass and type of subchondral trabecular bone play a key role in mechanical properties in DDH, which might be related to cartilage damage. The translational potential of this article Our findings suggested that changes of subchondral trabecular bone play a critical role in DDH progression and that the improvement on subchondral trabecular bone may be a sensitive and promising way in treatment of DDH.
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Affiliation(s)
- Linyang Chu
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zihao He
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xinhua Qu
- Department of Bone and Joint Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, PR China
| | - Xuqiang Liu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, The Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, PR China
| | - Weituo Zhang
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Shuo Zhang
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Xuequan Han
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Mengning Yan
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Qi Xu
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Shuhong Zhang
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xifu Shang
- Department of Orthopedics, The Affiliated Provincial Hospital of China Science and Technology University, Hefei, 230001, Anhui Province, PR China
| | - Zhifeng Yu
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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