|
1
|
Tirta M, Rahbek O, Kold S, Husum HC. Risk Factors for Developmental Dysplasia of the Hip Before 3 Months of Age: A Meta-Analysis. JAMA Netw Open 2025; 8:e2456153. [PMID: 39853978 PMCID: PMC11762239 DOI: 10.1001/jamanetworkopen.2024.56153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 11/18/2024] [Indexed: 01/26/2025] Open
Abstract
Importance Two meta-analyses published in 2012 found breech presentation, family history of developmental dysplasia of the hip (DDH), female sex, and primiparity to increase the risk of DDH. However, the DDH definition, reference tests, and the age of the examined children varied considerably, complicating the translation of those findings to current screening guidelines. Objective To evaluate the association of previously proposed risk factors with the risk of sonography-verified DDH. Data Sources A literature search strategy used MeSH (Medical Subject Heading) terms and text words associated with DDH and prognostic studies or risk factors. PubMed, Embase, and the Cochrane Library were searched on November 23, 2023, to identify the cohort. Study Selection Criteria included articles that were in English and published from January 1, 1980, to November 23, 2023. Eligible studies included randomized clinical trials and cohort, case-control, and cross-sectional studies that involved participants younger than 3 months in whom a diagnosis of DDH was made by hip ultrasonography using the criterion standard Graf method, reported information on 1 or more of the proposed risk factors, and reported the final diagnosis. Data Extraction and Synthesis Collected variables included an evaluated risk factor, the number of infants with a risk factor, the number of infants without risk factors, and the number of infants with and without DDH in the at-risk group and in the no-risk group. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Main Outcomes and Measures The main outcome measures were risk of DDH (using odds ratios [ORs]) for each of the risk factors. Results Of 5363 studies screened, 20 studies comprising 64 543 infants were included. Breech presentation (OR, 4.15 [95% CI, 2.62-6.57]), family history of DDH (OR, 3.83 [95% CI, 2.05-7.15]), female sex (OR, 2.50 [95% CI, 1.74-3.59]), oligohydramnios (OR, 3.76 [95% CI, 1.66-8.53]), and high birth weight (OR, 2.00 [95% CI, 1.60-2.49]) were associated with a significant increased risk of DDH. Cesarean delivery, primiparity, multiple births, low birth weight, and prematurity were not associated with DDH risk. Heterogeneity was high (I2 > 70.00%) in all of the tested factors except high birth weight (I2 = 0%). The subgroup analysis was performed to investigate these heterogeneities. Conclusions and Relevance The findings of this meta-analysis suggest that family history and breech presentation were associated with a significant increase in the risk of sonography-verified DDH in infants younger than 3 months, and a DDH risk increase of female sex was found to be lower than previously reported. A risk increase was detected for oligohydramnios, which has not been included in many screening programs and might also be considered as a referral criterion for hip ultrasonography.
Collapse
Affiliation(s)
- Maria Tirta
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Kold
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Hans-Christen Husum
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
|
2
|
Chen X, Liu J, Xue M, Zou C, Lu J, Wang X, Teng Y. Risk factors of developmental dysplasia of the hip in infants: A meta-analysis based on cohort studies. Orthop Traumatol Surg Res 2024; 110:103836. [PMID: 38355007 DOI: 10.1016/j.otsr.2024.103836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Developmental 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. HYPOTHESIS Several 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 METHODS Cohort 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. RESULTS A 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. DISCUSSION This 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 EVIDENCE III; meta-analysis.
Collapse
Affiliation(s)
- Xingguang Chen
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, 314000 Jiaxing, China
| | - Jue Liu
- Department of Pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000 Jiaxing, China
| | - Mingfeng Xue
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, 314000 Jiaxing, China
| | - Chengda Zou
- Department of Orthopedics, Suzhou Wujiang District Children's Hospital, 215004 Suzhou, China
| | - Jialing Lu
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, 314000 Jiaxing, China
| | - Xiaodong Wang
- Department of Orthopedics, Children's Hospital of Soochow University, 215000 Suzhou, China
| | - Yiqun Teng
- Department of Pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000 Jiaxing, China.
| |
Collapse
|
|
3
|
Burkhart RJ, McNassor R, Acuña AJ, Kamath AF. Is prematurity a risk factor for developmental dysplasia of the hip? A systematic review and meta-analysis. J Pediatr Orthop B 2023; 32:305-311. [PMID: 36445370 DOI: 10.1097/bpb.0000000000001021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Developmental dysplasia of the hip (DDH) is the most common orthopedic disorder in newborns. Early recognition and diagnosis are critical to prevent long-term complications. While several risk factors have been established, the association between prematurity and DDH remains unclear. Our analysis sought to analyze the literature exploring the relationship between prematurity and DDH. Articles evaluating the relationship between prematurity and DDH published between 1 January 2000 and 1 February 2022 were queried, with 11 studies included for analysis. Overall, a total of 8720 patients were included. The gestational age ranged from 23 to 36 weeks for preterm and ≥37 weeks for term births. Seven studies agreed that gestational age did not have a significant impact on DDH. Pooled analysis of available data demonstrated no significant difference in DDH among preterm and term infants (OR, 1.11; 95% CI, 0.82-1.51; P = 0.49). Sub-group analysis of two studies reporting data on very preterm (≤32 weeks) and term infants revealed no significant difference in the occurrence of DDH (OR, 4.58; 95% CI, 0.09-244.78; P = 0.45). Four studies found early gestational age is associated with a significantly higher incidence of mature hips compared to late preterm or term babies. Similarly, pooled analysis demonstrated significantly lower Graf classification among preterm infants (OR, 0.13; 95% CI, 0.03-0.61; P = 0.009). Based on the current literature, our analysis found that prematurity is not strongly associated with DDH. Furthermore, early gestational age was associated with a significantly higher incidence of mature hips measured by Graf classification.
Collapse
Affiliation(s)
- Robert J Burkhart
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | |
Collapse
|
|
4
|
Ionescu A, Dragomirescu MC, Herdea A, Ulici A. Developmental Dysplasia of the Hip: How Many Risk Factors Are Needed? CHILDREN (BASEL, SWITZERLAND) 2023; 10:968. [PMID: 37371200 DOI: 10.3390/children10060968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/27/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023]
Abstract
Developmental dysplasia of the hip (DDH) is a progressive condition that lacks clear diagnostic and management protocols, due to insufficient data. While some advocate for universal screening, others recommend using risk factors as landmarks. In this study, we aimed to assess the risk factors associated with DDH incidence among a large population. We conducted a retrospective single-center multifactorial study between January 2019 and March 2022, including 3720 children who were investigated anamnestically, clinically, and through an ultrasound scan. We classified them into two groups: the control group with 3300 healthy children and the study group with 420 newborns diagnosed with DDH. Our analysis identified several risk factors associated with DDH, including gender, prematurity, non-vertex birth presentation, oligohydramnios, gestational diabetes, maternal hypertension, family history, associated deformities, and swaddling. We found that every DDH patient had at least two risk factors. Based on our findings, we recommend that children who present two or more risk factors for DDH be mandatorily evaluated sonographically, as well as children with clinical signs. DDH screening is recommended for each newborn for the long-term benefits of early detection and treatment.
Collapse
Affiliation(s)
- Adelina Ionescu
- Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, 011743 Bucharest, Romania
| | - Mihai-Codrut Dragomirescu
- Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, 011743 Bucharest, Romania
| | - Alexandru Herdea
- 11th Department of Pediatric Orthopedics, "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii Sanitari nr. 8, 050474 Bucharest, Romania
- Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, 011743 Bucharest, Romania
| | - Alexandru Ulici
- 11th Department of Pediatric Orthopedics, "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii Sanitari nr. 8, 050474 Bucharest, Romania
- Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, 011743 Bucharest, Romania
| |
Collapse
|
|
5
|
Ghaseminejad-Raeini A, Shahbazi P, Roozbahani G, Sharafi A, Shafiei SH, Fallah Y, Baghdadi S. Preterm birth does not increase the risk of developmental dysplasia of the Hip: a systematic review and meta-analysis. BMC Pediatr 2023; 23:268. [PMID: 37246230 DOI: 10.1186/s12887-023-04083-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND The purpose of this systematic review was to appraise the literature on the association between preterm birth and developmental dysplasia of the hip (DDH). METHODS Medline, Embase, Scopus, and Web of Science databases were queried for all studies pertaining to DDH and preterm birth. Data were imported and analyzed in Revman5 and Comprehensive Meta-Analysis (CMA) for pooled prevalence estimation. RESULTS Fifteen studies were included in the final analysis. There were 759 newborns diagnosed with DDH in these studies. DDH was diagnosed in 2.0% [95%CI:1.1-3.5%] of the premature newborns. Pooled incidence rate of DDH was not statistically different between those groups (2.5%[0.9%-6.8%] vs. 0.7%[0.2%-2.5%] vs. 1.7%[0.6%-5.3%];Q = 2.363,p = 0.307). CONCLUSIONS In this systematic review and meta-analysis, we did not find preterm birth to be a significant risk factor for DDH. Data suggests that female sex and breech presentation are associated with DDH in preterm infants, but the data is scarce in the literature.
Collapse
Affiliation(s)
| | - Parmida Shahbazi
- Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazale Roozbahani
- Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Sharafi
- Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Hossein Shafiei
- Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousof Fallah
- Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soroush Baghdadi
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| |
Collapse
|
|
6
|
Koob S, Garbe W, Bornemann R, Ploeger MM, Scheidt S, Gathen M, Placzek R. Is Prematurity a Protective Factor Against Developmental Dysplasia of the Hip? A Retrospective Analysis of 660 Newborns. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:177-180. [PMID: 32722821 DOI: 10.1055/a-1161-8984] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE In Middle Europe developmental dysplasia of the hip (DDH) has an incidence of up to 5.9 %. The rate of congenital hip dislocation as the worst complication of a growth disorder of the hip is between 1.5 % and 2.5 %. Among known risk factors of DDH are breech position, multiples, foot deformities and family history. The aim of this retrospective study was to investigate prematurity as a risk factor for developmental dysplasia of the hip (DDH). MATERIALS AND METHODS The hips of 283 infants who were born before the 38th week of gestation or earlier, and those of 377 infants who were born after the 37th week of gestation, none of whom had other risk factors for DDH, were compared using the ultrasound technique according to Graf et al., within the first week after birth. Both hips of all infants were included in the study. RESULTS Surprisingly, the difference in alpha angles between the two groups was statistically extremely significant, favoring the preterm infants. Moreover, we found a physiological curve of alpha angle development with a peak after the 31st week of gestation. The incidence of pathological dysplasia was not significantly different in the two groups. CONCLUSION Our results suggest that prematurity is not a predisposing factor for DDH, but rather is protective for hip development.
Collapse
Affiliation(s)
- Sebastian Koob
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Werner Garbe
- Neonatology, GFO-Kliniken Bonn Betriebsstätte St. Marien, Bonn, Germany
| | - Rahel Bornemann
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | | | - Sebastian Scheidt
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Martin Gathen
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Richard Placzek
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| |
Collapse
|
|
7
|
TOPAK D, DOĞAN K, ÖZDEMİR MA, KUŞÇU B, TEMİZ A, BİLAL Ö. Graf Tip 2a kalçalarda sonografik bozulma ile ilişkili faktörlerin incelenmesi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.1000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
|
8
|
Schachinger F, Farr S. The Effects of Preterm Birth on Musculoskeletal Health-Related Disorders. J Clin Med 2021; 10:5082. [PMID: 34768599 PMCID: PMC8584797 DOI: 10.3390/jcm10215082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/21/2022] Open
Abstract
Preterm birth is associated with various diseases and conditions which demand multidisciplinary medical care. Approximately 10% of all neonates are born prematurely with an increasing survival rate in almost all Western countries. This ongoing, yet desirable trend is creating new challenges for sufficient medical treatment regimens, which should be upheld throughout the patients' lives. Orthopedic surgeons are focused on musculoskeletal disorders and the improvement of patients' ability to cope with the challenges of everyday life. The most common conditions associated with preterm birth are cerebral palsy and a dysregulation of the calcium/phosphorus metabolism, which may lead to fractures. These diseases may vary greatly in their organic manifestation and clinical presentation. This demands multidisciplinary cooperation and parental support. Clinical management is aimed on the early enhancement of a patient's physical, as well as neurological condition, and to prevent the development of secondary musculoskeletal disorders. In this article, we give an overview of the current literature on the most common musculoskeletal disorders associated with preterm birth and critically discuss state of the art diagnostic standards and treatment algorithms.
Collapse
Affiliation(s)
| | - Sebastian Farr
- Department of Pediatric Orthopaedics and Foot and Ankle Surgery, Orthopaedic Hospital Speising, Speisingerstrasse 109, A-1130 Vienna, Austria;
| |
Collapse
|
|
9
|
Barbosa RDO, Albernaz EP. Profile of Patients Diagnosed with Developmental Dysplasia of the Hip. Rev Bras Ortop 2019; 54:497-502. [PMID: 31736518 PMCID: PMC6855922 DOI: 10.1016/j.rbo.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/21/2018] [Indexed: 11/26/2022] Open
Abstract
Objective
To describe the profile of patients with developmental dysplasia of the hip (DDH) diagnosed by physical and ultrasound examination, with the implementation of a protocol for the treatment and follow-up of DDH.
Methods
A cross-sectional study with DDH patients born between January 2014 and December 2016, in the city of Pelotas, Southern Brazil. Ethnicity, gender, birth weight, fetal presentation, affected side of the hip, gestational age, maternal age and family history were considered. The data on the medical records were compared with the characteristics of the general population described on the Brazilian National Information System on Live Births (Sistema de Informação sobre Nascidos Vivos [SINASC]).
Results
A total of 33 DDH patients were identified, mostly female, with a four-fold higher probability of having the condition (
p
< 0.001); the left was the most affected side. No statistically significant association was found regarding the following factors: birth weight, gestational age, ethnicity, and maternal age. The newborns in breech presentation had a 15-fold higher probability of presenting DDH (
p
< 0.001). A total of 21 newborns required immediate treatment of the hips, since the ultrasound showed a Graf classification of IIb or higher, or the radiography showed dislocation in DDH patients older than 6 months of age.
Conclusion
Screening for DDH is essential in all newborns; physical examinations revealing alterations must be complemented with ultrasound imaging to avoid the delayed diagnosis of the condition.
Collapse
|
|
10
|
Nguyen JC, Dorfman SR, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, Bardo DM, Brown BP, Chan SS, Chandra T, Garber MD, Moore MM, Pandya NK, Shet NS, Siegel A, Karmazyn B. ACR Appropriateness Criteria® Developmental Dysplasia of the Hip-Child. J Am Coll Radiol 2019; 16:S94-S103. [DOI: 10.1016/j.jacr.2019.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 02/09/2023]
|
|
11
|
Does gestational age affect ultrasonographic findings of the hip in preterm newborns? A sonographic study of the early neonatal period. J Pediatr Orthop B 2019; 28:107-110. [PMID: 30192257 DOI: 10.1097/bpb.0000000000000541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are only a few studies in the literature investigating the effects of gestational age on developmental dysplasia of the hip. The aim of this study was to investigate the effects of gestational age on hip ultrasound findings in the early neonatal period in preterm newborns born between 30th and 36th weeks of gestational age. Between January 2008 and December 2013, a total of 788 hips of 394 premature newborns with a gestational age of up to 36th weeks who underwent hip ultrasonography in the first week of their life were retrospectively examined. The distribution of roof angles and hip types in terms of sexes was compared between groups. Birth weight, birth height, α, and β angles were analyzed in terms of the gestational age. The mean gestational age was 33.07 weeks (SD 2.09; between 30th and 36th). Six hundred and seven hips were classified as type I, 154 as type IIa, 21 as type IIc, and 6 as type III. In the 30th week, type IIc hips in females and type III hips in males were statistically significantly higher (P=0.001). In the 34th week, type IIc hips in males were statistically significantly higher than the females (P=0.013). In the 35th week, type IIa hips in females hips were statistically significantly higher than the males (P=0.008). Among all preterm infants, type IIc hips were more common in the 30th, 31st, 32nd, and 34th weeks, whereas type III hips were statistically significantly more common in the 30th week (P=0.0001). The 30th, 31st, 32nd, and 34th weeks of age are gestational ages that should be considered in terms of dysplastic and subluxed hips in premature newborns.
Collapse
|
|
12
|
Onay T, Gumustas SA, Cagirmaz T, Aydemir AN, Orak MM. Do the risk factors for developmental dysplasia of the hip differ according to gender? A look from another perspective. J Paediatr Child Health 2019; 55:168-174. [PMID: 30069945 DOI: 10.1111/jpc.14143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 05/21/2018] [Accepted: 06/28/2018] [Indexed: 11/28/2022]
Abstract
AIM The aim of the present study was to examine if there were gender differences in risk factors in 4415 infants who were evaluated through a physical examination and hip ultrasonography (USG). METHODS Physical examination of the hip and hip USG were performed on 4415 infants by the same paediatric orthopaedics specialist. Barlow and Ortolani tests were performed together with the evaluation for the limitation of abduction. Ultrasonographic hip examination was performed according to the Graf technique. The birth records of all the infants were examined, and anamneses (genetic disease, maternal age, delivery type, swaddling, multiple pregnancies, duration of gestation period, gravida, birthweight, breech presentation, oligohydramnios and family history) were obtained from the families. Any accompanying musculoskeletal (torticollis, pes equinovarus, congenital knee dislocation) abnormality was recorded. RESULTS Pathological hip was determined in 149 (3.37%) of 4415 infants. In males, gestational week, family history, breech presentation, swaddling, congenital knee dislocation and limited abduction were observed to be significant for the presence of developmental dysplasia of the hip (DDH). In females, significant factors for the presence of DDH were determined to include birthweight, gestational week, breech presentation, multiple pregnancy, accompanying oligohydramnios, torticollis, pes equinovarus and limited abduction. CONCLUSION Risk factors for DDH can differ according to gender.
Collapse
Affiliation(s)
- Tolga Onay
- Department of Orthopaedics and Traumatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Seyit A Gumustas
- Department of Orthopaedics and Traumatology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Talat Cagirmaz
- Department of Orthopaedics and Traumatology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Ahmet N Aydemir
- Department of Orthopaedics and Traumatology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Mehmet M Orak
- Department of Orthopaedics and Traumatology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
|
13
|
Hussain SM, Ackerman IN, Wang Y, Zomer E, Cicuttini FM. Could low birth weight and preterm birth be associated with significant burden of hip osteoarthritis? A systematic review. Arthritis Res Ther 2018; 20:121. [PMID: 29884206 PMCID: PMC5994049 DOI: 10.1186/s13075-018-1627-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Approaches for the prevention and treatment of hip osteoarthritis (OA) remain limited. There are recent data suggesting that low birth weight (LBW) and preterm birth may be risk factors for hip osteoarthritis. This has the potential to change the current paradigm of hip osteoarthritis prevention by targeting early life factors. The aim of this review was to examine the available evidence for an association of LBW and preterm birth with hip OA. The potential cost implications associated with total hip arthroplasty were also evaluated. METHODS Ovid Medline, EMBASE, and Cinahl were searched up until August 2017 using MeSH terms and key words. Methodological quality was evaluated using the National Heart Lung and Blood Institute (NHLBI) quality assessment tool. Qualitative evidence synthesis was performed to summarise the results. Bradford Hill's criteria for causation including the temporal relationship, consistency, strength of the association, specificity, dose-response relationship, and analogy were used to assess the evidence for causation. Economic modelling was used to calculate the potential economic burden associated with LBW or preterm birth related total hip arthroplasty using Australian data from 2012 to 2015. RESULTS Five studies, ranging from high to low quality, were included. Hip bone shape abnormalities examined included developmental hip dysplasia and immature hip, and hip osteoarthritis included osteophytes and total hip arthroplasty. A causal link between low birth weight or preterm birth and hip osteoarthritis was found. Of the 30,477 total hip arthroplasties performed for hip osteoarthritis in Australia in 2015, 5791 were estimated to be born preterm and 5273 with low birth weight. This equated to a potential total hip arthroplasty cost of AU$145,136,082 and AU$132,150,222 for these subgroups, respectively. CONCLUSION Available data suggest that low birth weight and preterm birth are associated with hip bone shape abnormalities and hip osteoarthritis requiring total hip arthroplasty, with a substantial associated financial burden. Given the current lack of effective treatment and prevention strategies for hip osteoarthritis, this offers a new avenue for reducing the future burden of hip osteoarthritis.
Collapse
Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| |
Collapse
|
|
14
|
Swarup I, Penny CL, Dodwell ER. Developmental dysplasia of the hip: an update on diagnosis and management from birth to 6 months. Curr Opin Pediatr 2018; 30:84-92. [PMID: 29194074 DOI: 10.1097/mop.0000000000000574] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Our understanding of the epidemiology, diagnosis, and management of developmental dysplasia of the hip (DDH) is evolving. This review focuses on the most up-to-date literature on DDH in patients from birth to six months of age. RECENT FINDINGS Well known risk factors for DDH include family history, female sex, and breech positioning. Recent evidence suggests higher birth weight is a risk, whereas prematurity may be protective. Screening includes physical examination of all infant hips and imaging when abnormal findings or risk factors are present. Treatment in the first six months consists of a harness, with 70-95% success. Failure risk factors include femoral nerve palsy, static bracing, irreducible hips, initiation after seven weeks of age, right hip dislocation, Graf-IV hips, and male sex. Rigid bracing may be trialed if reduction with a harness fails and closed reduction is indicated after failed bracing. If the hip is still irreducible, nonconcentric, or unstable, open reduction may be required following closed reduction. Evidence does not support delaying hip reduction until the ossific nucleus is present. SUMMARY DDH affects 1-7% of infants. All infants should be examined and selective screening with imaging should be performed for abnormal physical exams or risk factors. Early treatment is associated with optimal outcomes.
Collapse
Affiliation(s)
- Ishaan Swarup
- Hospital for Special Surgery, New York, New York, USA
| | | | | |
Collapse
|
|
15
|
Haddad FS. Established dogma should be challenged. Bone Joint J 2017; 99-B:1409-1410. [PMID: 29092976 DOI: 10.1302/0301-620x.99b11.bjj-2017-1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 11/05/2022]
Affiliation(s)
- F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
| |
Collapse
|
|
16
|
Talbot C, Adam J, Paton R. Late presentation of developmental dysplasia of the hip. Bone Joint J 2017; 99-B:1250-1255. [DOI: 10.1302/0301-620x.99b9.bjj-2016-1325.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/24/2017] [Indexed: 12/25/2022]
Abstract
Aims 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. Patients and Methods 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. Results 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). Conclusion 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.
Collapse
Affiliation(s)
- C. Talbot
- Royal Manchester Children’s Hospital, Oxford
Road, Manchester M13 9WL, UK
| | - J. Adam
- Salford Royal NHS Foundation Trust, Stott
Lane, Salford, Manchester
M6 8HD, UK
| | - R. Paton
- Royal Blackburn Hospital, East
Lancashire Hospitals NHS Trust, Haslingden
Road, Blackburn BB2 3HH, UK, . Visiting
Professor, University of Central Lancashire, Preston, Lancashire, PR1
2HE, Honorary Senior Lecturer, University
Manchester, Oxford Road, Manchester
M13 9PL, UK
| |
Collapse
|
|
17
|
Closed reduction with or without adductor tenotomy for developmental dysplasia of the hip presenting at walking age. CURRENT ORTHOPAEDIC PRACTICE 2017; 28:195-199. [PMID: 28286603 PMCID: PMC5325246 DOI: 10.1097/bco.0000000000000478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Many children with developmental dislocation of the hip especially in underdeveloped countries reach walking age and still remain undiagnosed, which can be detrimental to their growth and development. Because of the lack medical services often encountered in these regions, it would be attractive to find a cheap and effective treatment. Our work evaluated the results of treatment of these children by closed reduction with or without adductor tenotomy in a prospective study. METHODS We included 20 patients in this study with 29 affected hips (15 right and 14 left). Nine patients (45%) had bilateral DDH and 11 (55%) had unilateral DDH. There were 18 girls (90%) and two boys (10%) who were followed up for a mean of 21 mo (18-24 mo). Ages ranged from 9 to 36 mo (mean age 18.3 mo). Patients were divided according to age into two groups: between 9-18 mo and from 19-36 mo. The first group included nine patients (14 hips) while the second had 11 patients (15 hips). RESULTS In the first group, closed reduction failed in two patients (two hips) during the follow-up period (14.3%) and this necessitated shift to open reduction, while in the second group only one patient (bilateral DDH) had a similar failure (13.3%). We identified four hips with avascular necrosis. Three of them required no further treatment, the remaining hip was openly reduced. CONCLUSIONS Closed reduction in older children offers a valid and reproducible treatment modality in the hands of an experienced pediatric orthopaedic surgeon as long as there is close follow-up and thorough knowledge of possible complications and their management including the ability to shift timely to open reduction.
Collapse
|
|
18
|
Kotlarsky P, Haber R, Bialik V, Eidelman M. Developmental dysplasia of the hip: What has changed in the last 20 years? World J Orthop 2015; 6:886-901. [PMID: 26716085 PMCID: PMC4686436 DOI: 10.5312/wjo.v6.i11.886] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/23/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) describes the spectrum of structural abnormalities that involve the growing hip. Early diagnosis and treatment is critical to provide the best possible functional outcome. Persistence of hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength and increased rate of degenerative hip and knee joint disease. Despite efforts to recognize and treat all cases of DDH soon after birth, diagnosis is delayed in some children, and outcomes deteriorate with increasing delay of presentation. Different screening programs for DDH were implicated. The suspicion is raised based on a physical examination soon after birth. Radiography and ultrasonography are used to confirm the diagnosis. The role of other imaging modalities, such as magnetic resonance imaging, is still undetermined; however, extensive research is underway on this subject. Treatment depends on the age of the patient and the reducibility of the hip joint. At an early age and up to 6 mo, the main treatment is an abduction brace like the Pavlik harness. If this fails, closed reduction and spica casting is usually done. After the age of 18 mo, treatment usually consists of open reduction and hip reconstruction surgery. Various treatment protocols have been proposed. We summarize the current practice for detection and treatment of DDH, emphasizing updates in screening and treatment during the last two decades.
Collapse
|