Developmental dysplasia of the hip: risk markers, clinical screening and outcome.
BACKGROUND
Early detection, diagnosis and treatment of developmental dysplasia/dislocation of hip (DDH) are essential in preventing further disability and quality of life impairment in children. DDH risk markers and association between the age of clinical screening and outcome, were evaluated.


METHODS
Clinical screening at ages birth, 6 and 13 weeks was performed in 8145 infants by pediatricians. Infants suspected for DDH were referred to the community hospital clinic for clinical evaluation by a pediatric orthopedic surgeon, imaging procedures and follow up. Demographic and perinatal characteristics of the children with suspected (n= 77) and diagnosed DDH (n= 51) were compared to matched controls (n= 154).


RESULTS
The rate of suspected DDH was 0.95% and that of diagnosed DDH was 0.63%. Female gender, firstborn child and breech presentation were significantly more frequent among cases versus controls (odds ratio [OR]: 4.3, 2.7, and 6 respectively; P < 0.05). The highest positive predictive value (95.5%) in physical evaluation was any evidence of a dislocatable hip. The proportion of DDH among infants referred from the newborn department was significantly higher (OR, 4.4). DDH diagnosis after 6 weeks of age was associated with a higher likelihood of subsequent surgery and motor disability. Untoward outcome was significantly associated with increasing age of referral both at ages of 6 and 13 weeks (P < 0.05).


CONCLUSIONS
Children with DDH have certain specific demographic and perinatal risk markers. Clinical screening targeted towards early diagnosis may lessen the need for surgical intervention and the risk of disability or motor handicap.
Jerusalem District Health Office, Ministry of Health and Braun School of Public Health and Community Medicine, Hebrew University, Hadassah, Jerusalem, Israel. chen@lbjer.health.gov.il
Chen
C
Stein-Zamir
Irina
I
Volovik
Shmuel
S
Rishpon
Roger
R
Sabi
D001848:Bone Diseases, Developmental / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D019637:Orthopedic Procedures / Q000379:methods; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014463:Ultrasonography