Wrodzona dysplazja bioder

Wrodzona dysplazja bioder
Epidemiologia

Wrodzona dysplazja bioder (DDH) to spektrum zaburzeń rozwojowych stawu biodrowego u niemowląt, o częstości występowania od 1-3% w populacjach noworodków, z cięższymi postaciami (przemieszczenie lub utrwalona dysplazja) u 3-5 na 1000 dzieci. Występuje znaczne zróżnicowanie geograficzne i etniczne, z najwyższą częstością u rdzennych Amerykanów (25-76,1/1000 urodzeń) i najniższą u Afrykanów (0,06/1000). Czynniki ryzyka obejmują płeć żeńską (4-8-krotnie wyższe ryzyko), położenie miednicowe, dodatni wywiad rodzinny (ryzyko do 36% przy obciążeniu rodzinnym), pierwsze urodzenie, małowodzie, makrosomię, ograniczone odwiedzenie biodra, stopę końsko-szpotawą oraz praktykę spowijania. DDH najczęściej dotyczy lewego biodra (60-64%) i jest jednostronne w około 63,4% przypadków. Diagnostyka i nadzór opierają się na okresowych badaniach klinicznych i ultrasonografii, zalecanej szczególnie w 4-6 tygodniu życia, co pozwala na wczesne wykrycie i leczenie, minimalizujące ryzyko powikłań i konieczność interwencji chirurgicznej.

Epidemiologia Wrodzonych Dysplazji Bioder

Wrodzona dysplazja bioder (ang. Developmental Dysplasia of the Hip, DDH) stanowi spektrum schorzeń związanych z rozwojem stawu biodrowego u niemowląt i małych dzieci. Dokładna etiologia tego schorzenia pozostaje nieznana, jednak analiza danych epidemiologicznych i demograficznych dostarcza wielu cennych informacji na temat występowania, czynników ryzyka oraz metod nadzoru nad tym schorzeniem.¹²

Częstotliwość występowania

Częstość występowania wrodzonej dysplazji bioder jest bardzo zróżnicowana i zależy od wielu czynników, takich jak metoda wykrywania, wiek dziecka oraz kryteria diagnostyczne. Dane dotyczące zapadalności różnią się znacząco w zależności od populacji i regionu geograficznego.¹²

Ogólna częstość występowania wynosi około 1-3% u noworodków w niektórych populacjach. Szacuje się, że biodra dysplastyczne z przemieszczeniem lub ciężką lub przetrwałą dysplazją występują u 3-5 na 1000 dzieci. Częstość występowania zwichniętych bioder utrzymuje się historycznie na poziomie 1-2 na 1000 dzieci.¹²

Łagodna niestabilność stawu biodrowego jest częstsza u noworodków, a jej częstość może sięgać nawet 40%. Należy jednak podkreślić, że łagodna niestabilność i/lub łagodna dysplazja w okresie noworodkowym często ustępują bez leczenia. Uwzględnienie tych przypadków w statystykach prowadzi do zawyżenia częstości występowania.¹²

Różnice geograficzne i etniczne

Częstość występowania wrodzonej dysplazji bioder wykazuje znaczące zróżnicowanie geograficzne i etniczne:¹²

Najwyższą częstość notuje się wśród rdzennych Amerykanów – od 25 do 50 na 1000 urodzeń, a w niektórych źródłach nawet 76,1 na 1000 urodzeń
Niska częstość występuje w populacjach chińskich i afroamerykańskich
W Europie wartości wahają się od 0,59 do 27,53 na 1000 żywych urodzeń, z najwyższą częstością odnotowaną na Węgrzech
W Grecji, szczególnie na Krecie, częstość wynosi 10,83 na 1000 żywych urodzeń
W Polsce, u kaukaskich noworodków, częstość klinicznej niestabilności stawu biodrowego przy urodzeniu może sięgać nawet 61,7 na 1000

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Istotną obserwacją jest fakt, że częstość występowania wykazuje znaczące wahania nie tylko pomiędzy krajami europejskimi, ale także pomiędzy różnymi regionami w obrębie tego samego kraju.¹

Czynniki ryzyka

Do najważniejszych czynników ryzyka wystąpienia wrodzonej dysplazji bioder należą:¹²³

Płeć żeńska – dziewczynki są 4-8 razy bardziej narażone na rozwój dysplazji niż chłopcy. Wiąże się to prawdopodobnie z wpływem dodatkowego estrogenu produkowanego przez płód żeński, który zwiększa wiotkość więzadeł
Położenie miednicowe – jest to jeden z najistotniejszych czynników ryzyka. Uważa się, że wewnątrzmaciczne wyprostowanie kolana u niemowlęcia w pozycji miednicowej powoduje utrzymujące się napięcie mięśni kulszowo-goleniowych wokół biodra, co przyczynia się do późniejszej niestabilności biodra
Wywiad rodzinny – dodatni wywiad rodzinny w kierunku DDH stwierdza się u 12-33% pacjentów. Ryzyko DDH dla dziecka udokumentowano na poziomie 6% przy jednym chorym rodzeństwie, 12% przy jednym chorym rodzicu i 36%, jeśli dotknięty chorobą jest zarówno rodzic, jak i rodzeństwo
Pierwsze urodzenie – pierwsze dzieci są dotknięte chorobą dwa razy częściej niż kolejne rodzeństwo, prawdopodobnie z powodu nierozciągniętej macicy i napiętych struktur brzusznych u matki
Małowodzie
Makrosomia
Ograniczone odwiedzenie biodra
Stopa końsko-szpotawa
Spowijanie – częstość występowania DDH jest wysoka w kulturach rdzennych Amerykanów, które stosują spowijanie, wymuszające przywiedzenie i wyprost bioder

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Anatomiczna lokalizacja

Wrodzona dysplazja bioder wykazuje charakterystyczny wzorzec występowania anatomicznego:¹²

Najczęściej dotyczy lewego stawu biodrowego (60-64% przypadków) – prawdopodobnie ze względu na najczęstszą pozycję wewnątrzmaciczną, czyli potylicową lewoprzednią, gdzie lewe biodro jest przywiedzionone w kierunku kręgosłupa lędźwiowo-krzyżowego matki
Jednostronne zajęcie występuje w około 63,4% przypadków
Obustronne zajęcie stwierdza się w około 20-37,7% przypadków

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Metody nadzoru i badania przesiewowe

Obecnie stosuje się różne podejścia do wykrywania i monitorowania wrodzonej dysplazji bioder u niemowląt i dzieci:¹²

Nadzór versus badania przesiewowe

W najnowszych wytycznych proponuje się używanie terminu „nadzór” (surveillance) zamiast „badania przesiewowe” (screening). Jest to zmiana koncepcyjna, gdyż badania przesiewowe sugerują jednorazowy proces, podczas gdy nadzór obejmuje okresowe badania kliniczne przeprowadzane aż do momentu, gdy dziecko zacznie chodzić. Podejście to zwiększa prawdopodobieństwo wykrycia zwichnięć, które mogą rozwinąć się po urodzeniu.¹²

Nadzór opisuje długotrwały proces, w którym badania przesiewowe są powtarzane w określonych odstępach czasu. Częstsze badania inicjowane przez lekarza mogą zmniejszyć wiek diagnozowania. Zasada wielokrotnych ocen do momentu rozpoczęcia chodzenia jest ważniejsza niż dokładne określenie czasu badań.¹

Badania kliniczne i obrazowe

Organizacje takie jak POSNA (Pediatric Orthopaedic Society of North America), Kanadyjska Grupa Zadaniowa ds. DDH, AAOS (American Academy of Orthopaedic Surgeons) i AAP (American Academy of Pediatrics) zalecają okresowy nadzór w kierunku dysplazji rozwojowej stawu biodrowego przez cały okres niemowlęcy. Celem badań przesiewowych jest zapobieganie opóźnionej diagnozie po 6. miesiącu życia.¹

Wytyczne praktyki klinicznej AAP zalecają wykonanie USG biodra w 6. tygodniu życia lub zdjęcia rentgenowskiego biodra w 4. miesiącu życia u dziewczynek z dodatnim wywiadem rodzinnym dysplazji rozwojowej stawu biodrowego lub położeniem miednicowym w trzecim trymestrze.¹

Kontrowersje dotyczące badań przesiewowych

Istnieją znaczące kontrowersje dotyczące stosowania badań ultrasonograficznych w diagnostyce wrodzonej dysplazji bioder:¹²

Proponowane są zarówno powszechne, jak i selektywne programy badań ultrasonograficznych
W badaniu norweskim wskaźnik leczenia chirurgicznego nie zmniejszył się znacząco u noworodków badanych ultrasonograficznie w porównaniu z badanymi tylko fizykalnie
Jednak wskaźnik leczenia niechirurgicznego był prawie dwukrotnie wyższy w grupie badanej USG (34 vs 18 na 1000 badanych niemowląt)
Zakłada się, że wiele dzieci w grupie USG, które następnie otrzymały leczenie, miało w rzeczywistości fałszywie dodatnie wyniki USG

¹²

Uznaje się coraz większą rolę ultrasonografii w nadzorze nad łagodnie nieprawidłowymi biodrami. W szeregu badań wskaźniki fałszywie dodatnich wyników leczenia zmniejszyły się o co najmniej 50%. Kilka badań wykazało wskaźniki zakładania szyn wynoszące sześć lub mniej na 1000 niemowląt badanych ultrasonograficznie i doskonałe wyniki kliniczne.¹

Badacze i klinicyści zgadzają się, że badanie ultrasonograficzne najlepiej wykonać, gdy niemowlę ma 4-6 tygodni. W tym czasie większość niedojrzałych bioder uległa stabilizacji.¹²

Nadzór bioder u dzieci z porażeniem mózgowym

Dzieci z porażeniem mózgowym stanowią szczególną grupę ryzyka wymagającą specjalnego nadzoru:¹²

Jedno na trzy dzieci z porażeniem mózgowym rozwinie problemy z biodrem
Dzieci z porażeniem mózgowym są narażone na zwiększone ryzyko przemieszczenia i zwichnięcia biodra
Wczesne wykrycie poprzez program nadzoru bioder może zachować funkcję dziecka i zapobiec bólowi
Nadzór bioder może wcześniej zidentyfikować przemieszczenie biodra u dzieci z porażeniem mózgowym, umożliwiając bardziej skuteczne i udane leczenie

¹²³

Nadzór bioder jest regularnym harmonogramem badań klinicznych i zdjęć rentgenowskich służących wczesnemu wykrywaniu problemów z biodrami. Wcześniejsze wykrycie oznacza bardziej skuteczne leczenie i lepszą funkcję. Szwecja zdołała całkowicie wyeliminować zwichnięcia bioder u dzieci z porażeniem mózgowym, stosując Program Nadzoru Bioder.¹

Wpływ wczesnego wykrywania na wyniki leczenia

Wczesne wykrywanie i leczenie wrodzonej dysplazji bioder ma kluczowe znaczenie dla uzyskania optymalnych wyników:¹²

Korzyści z wczesnej interwencji

Wczesne wykrycie i leczenie DDH wykorzystuje maksymalny potencjał wzrostu biodra niemowlęcia, zwiększając prawdopodobieństwo powodzenia leczenia, zmniejszając liczbę inwazyjnych procedur i komplikacji.¹²

Ogólnie rzecz biorąc, leczenie dysplazji bioder tak wcześnie, jak to możliwe, może zminimalizować uszkodzenie stawu i zmniejszyć ryzyko wczesnego wystąpienia zapalenia stawów. Wiele niemowląt z DDH jest diagnozowanych w ciągu pierwszych kilku miesięcy życia.¹

Jeśli dysplazja bioder zostanie wykryta w pierwszych kilku miesiącach życia, prawie zawsze można ją skutecznie leczyć za pomocą urządzenia pozycjonującego (szyny). W nielicznych przypadkach konieczna jest operacja, aby umieścić biodro z powrotem w stawie.¹

Konsekwencje późnego wykrycia

Dysplazja bioder, którą wykryto po wczesnym okresie niemowlęcym, może prowadzić do gorszych wyników i może wymagać bardziej złożonej operacji w celu rozwiązania problemu.¹

Dysplazja bioder jest schorzeniem poddającym się leczeniu. Jednak nieleczona może powodować nieodwracalne uszkodzenia, które będą powodować ból i utratę funkcji w późniejszym życiu. Jest główną przyczyną wczesnego zapalenia stawów biodra przed 60. rokiem życia. Ciężkość stanu i późne wykrycie zwiększają ryzyko zapalenia stawów. Dlatego monitorowanie i wczesna interwencja są ważne dla zmniejszenia ryzyka bólu i niepełnosprawności dziecka w wieku dorosłym.¹

Dyskusja na temat leczenia łagodnej dysplazji

Istnieje debata dotycząca najlepszego podejścia do łagodnej dysplazji bioder:¹²

W wieloośrodkowym randomizowanym badaniu klinicznym nie wykazano różnic w wynikach leczenia z wykorzystaniem szyn odwodzeniowych w porównaniu z aktywnym nadzorem u niemowląt w wieku 3-4 miesięcy ze stabilnymi biodrami dysplastycznymi w badaniu sonograficznym.¹

Ustalenia te skłaniają do refleksji nad użytecznością obecnych klasyfikacji ultrasonograficznych dla stabilnej dysplazji bioder, ponieważ nie są one w stanie odróżnić normalnie rozwijających się bioder od prawdziwej patologicznej dysplazji bioder. Ponieważ większość bioder, które są klasyfikowane jako sonograficzne stabilne biodra dysplastyczne, wykazuje spontaniczną normalizację, potrzebne są bardziej specyficzne metody i definicje, aby odróżnić normalnie rozwijające się biodra od prawdziwej dysplazji bioder.¹

Do czasu opracowania lepszych metod diagnozowania prawdziwej dysplazji bioder zaleca się obserwację, a nie leczenie wszystkich dobrze wyśrodkowanych, stabilnych bioder zgodnie z obecnymi klasyfikacjami ultrasonograficznymi. Pozwoliłoby to również uniknąć znacznego nadmiernego leczenia (80%) obciążającego zarówno rodziny, jak i systemy opieki zdrowotnej.¹²

Grupa etniczna/region	Częstość występowania DDH (na 1000 urodzeń)	Charakterystyka
Rdzenni Amerykanie	25-76,1	Najwyższa częstość występowania, związana z praktyką spowijania
Polscy Kaukazi (noworodki)	61,7	Wysoka częstość klinicznej niestabilności biodra przy urodzeniu
Węgry	27,53	Najwyższa częstość w Europie
Grecja (Kreta)	10,83	Znaczące regionalne zróżnicowanie
Arabia Saudyjska	3,1-4,9	Podobne czynniki ryzyka jak w innych krajach
Japonia (zwichnięcie)	0,76	Niewielkie zróżnicowanie regionalne
Afrykanie w Afryce	0,06	Najniższa częstość występowania

Wyzwania w epidemiologicznej ocenie DDH

Ocena epidemiologiczna wrodzonej dysplazji bioder napotyka na szereg wyzwań:¹²

Trudności w ustaleniu rzeczywistej częstości

Epidemiologia DDH jest zawsze uważana za zagadkę ze względu na brak standaryzacji kryteriów przez różnych autorów w literaturze. Istnieje duża różnorodność w badaniach dotyczących definicji samej DDH, a także aspektów takich jak metody diagnostyczne, klasyfikacja i inne.¹

Określenie częstości występowania może być trudne. Dodatkowo istnieje duży margines w wynikach diagnostycznych. Niemieckie badanie porównujące dwie metody wykazało dwukrotnie wyższy wskaźnik dla jednej metody.¹

Częstość występowania DDH w Wielkiej Brytanii przed dostępnością badań przesiewowych USG była podawana jako 12 na 1000. Od czasu wprowadzenia selektywnych badań przesiewowych USG, które selektywnie badają ultrasonograficznie biodra niemowląt uważanych za obarczone wysokim ryzykiem DDH, szacunki częstości występowania DDH w Wielkiej Brytanii wzrosły i wahają się od 5 do 30 na 1000.¹

Wpływ metod diagnostycznych

Szacunki częstości występowania DDH są bardzo zmienne i zależą od środków wykrywania, wieku dziecka i kryteriów diagnostycznych.¹²

W systematycznym przeglądzie populacji niepoddanych badaniom przesiewowym oszacowano częstość występowania klinicznie zdiagnozowanej, utrwalonej dysplazji bioder na 1,3 na 1000, ale w populacjach badanych klinicznie za pomocą testów Ortolaniego i Barlowa częstość jest wyższa i wynosi 1,6-28,5 na 1000, a jeszcze wyższa przy badaniu przesiewowym USG.¹

Zgodnie z badaniem Barlowa, ponad 60% noworodków z niestabilnością bioder stało się stabilnych do 1. tygodnia życia, a 88% stało się stabilnych do 2. miesiąca życia, pozostawiając tylko 12% (z 1 na 60 noworodków, czyli 0,2% ogółem) z resztkową niestabilnością bioder.¹

Zmienność geograficzna i populacyjna

Wrodzona dysplazja bioder pokazuje znaczące zróżnicowanie geograficzne i populacyjne:¹²

Częstość występowania na 1000 żywych urodzeń waha się od 0,06 u Afrykanów w Afryce do 76,1 u rdzennych Amerykanów
Istnieje znacząca zmienność w częstości występowania w każdej grupie rasowej według lokalizacji geograficznej
Częstość występowania klinicznej niestabilności biodra u noworodków przy urodzeniu waha się od 0,4 u Afrykanów do 61,7 u polskich Kaukazów
Wiele badań wykazuje wzrost DDH zimą, zarówno na półkuli północnej, jak i południowej

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Przyszłe kierunki badań

Istnieje szereg obszarów wymagających dalszych badań w dziedzinie epidemiologii i nadzoru nad wrodzoną dysplazją bioder:¹²

Potrzeba standaryzacji

Istnieje wiele prac na temat epidemiologii i czynników ryzyka DDH w literaturze, ale brak znormalizowanych kryteriów dotyczących tego, czy badanie USG biodra powinno być przeprowadzane tylko w wybranych przypadkach mających te czynniki ryzyka.¹

Wyraźnie widać, że decyzje dotyczące programów badań przesiewowych i protokołów leczenia dzieci z DDH powinny opierać się na najlepszych możliwych dowodach.¹

Międzynarodowe rejestry i badania

Międzynarodowy Rejestr Dysplazji Bioder (IHDR) kontynuuje i rozszerza początkowe badania, które rozpoczęły się jako wieloośrodkowe badanie IHDI dotyczące zwichniętych bioder niemowląt.¹

IHDI i IHDR działają równolegle i we współpracy, aby poprawić życie osób z dysplazją bioder. Związek między łagodną dysplazją niemowlęcą a dysplazją bioder występującą w okresie dojrzewania/dorosłości jest niepewny. Jednakże zapobieganie dysplazji bioder u młodzieży lub dorosłych musi rozpocząć się wkrótce po urodzeniu, aby było skuteczne.¹

Zachęca się do badań mających na celu ustalenie, czy prosta opieka zapobiegawcza w okresie niemowlęcym może zmniejszyć obciążenie dysplazją w okresie dojrzewania i dorosłości.¹

Poprawa wczesnego wykrywania

Klasyfikacja IHDI stopniuje ciężkość od stopnia 1 jako najłagodniejszego typu do stopnia 4 jako najcięższego typu zwichnięcia biodra.¹

W badaniach z innych ośrodków Klasyfikacja IHDI poprawiła wczesną identyfikację pacjentów, którzy korzystają z różnych metod leczenia.¹

IHDI zarejestrowało największą liczbę zwichnięć bioder u noworodków, które kiedykolwiek zostały zidentyfikowane za pomocą obrazowania przed leczeniem. Międzynarodowy Rejestr Dysplazji Bioder został od tego czasu rozszerzony o wielu więcej pacjentów z dysplazją bioder z ośrodków na całym świecie.¹

Celem mapy opieki było zmniejszenie zmienności w leczeniu DDH i zmniejszenie kosztów poprzez unikanie niepotrzebnych badań, wszystko w celu poprawy opieki nad pacjentem.¹

Przewiduje się, że wdrożenie mapy opieki DDH zwiększy świadomość i wykorzystanie wytycznych badań przesiewowych przez lekarzy podstawowej opieki zdrowotnej, a następnie zwiększy liczbę wczesnych skierowań do specjalistów w celu przeprowadzenia tanich, skutecznych interwencji w zakresie DDH.¹

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Materiały źródłowe

#1 The Epidemiology and Demographics of Hip Dysplasia
https://pmc.ncbi.nlm.nih.gov/articles/PMC4063216/
The etiology of developmental dysplasia of the hip (DDH) is unknown. There are many insights, however, from epidemiologic/demographic information. […] The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans. There is significant variability in incidence within each racial group by geographic location. […] Predictors of DDH are breech presentation, positive family history, and gender (female). […] Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. Swaddling is strongly associated with DDH. […] The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. […] DDH demonstrates a predominance of left-sided (64.0%) and unilateral involvement (63.4%). […] Archeological studies demonstrate that the epidemiology of DDH may be changing.
#1 Developmental dysplasia of the hip: Epidemiology and pathogenesis – UpToDate
https://www.uptodate.com/contents/developmental-dysplasia-of-the-hip-epidemiology-and-pathogenesis
Developmental dysplasia of the hip: Epidemiology and pathogenesis […] EPIDEMIOLOGY […] Estimates of the incidence of DDH are quite variable and depend upon the means of detection, the age of the child, and the diagnostic criteria. It is estimated that dislocatable hips and hips with severe or persistent dysplasia occur in 3 to 5 per 1000 children. Historically, the incidence of DDH with dislocation is 1 to 2 per 1000 children. Mild hip instability is more common in newborns, with reported incidence as high as 40 percent. However, mild instability and/or mild dysplasia in the newborn period often resolve without treatment. Infants with mild instability and/or mild dysplasia in the newborn period should not be included in estimates of incidence. Their inclusion results in overestimation.
#1 Developmental dysplasia of the hip: Epidemiology and pathogenesis – UpToDate
https://www.uptodate.com/contents/developmental-dysplasia-of-the-hip-epidemiology-and-pathogenesis/print
Developmental dysplasia of the hip (DDH) describes a spectrum of conditions related to the development of the hip in infants and young children. […] The epidemiology and pathogenesis of DDH in otherwise healthy children will be reviewed here. […] Estimates of the incidence of DDH are quite variable and depend upon the means of detection, the age of the child, and the diagnostic criteria. It is estimated that dislocatable hips and hips with severe or persistent dysplasia occur in 3 to 5 per 1000 children. Historically, the incidence of DDH with dislocation is 1 to 2 per 1000 children. Mild hip instability is more common in newborns, with reported incidence as high as 40 percent. However, mild instability and/or mild dysplasia in the newborn period often resolve without treatment. Infants with mild instability and/or mild dysplasia in the newborn period should not be included in estimates of incidence. Their inclusion results in overestimation.
#1 Epidemiology and Screening of Developmental Dysplasia of the Hip in Europe: A Scoping Review
https://www.mdpi.com/2571-841X/7/1/10
The incidence of DDH ranges from 1â7% in neonates among some populations, but this may vary among different ethnicities and countries. […] The incidence of DDH in Europe ranged from 0.59 per 1000 live births to 27.53 per 1000 live births, which was the maximum limit of incidence of DDH in Europe, observed in Hungary. Furthermore, incidence also ranged significantly in Greece, especially in Crete, as it was reported to be 10.83 per 1000 live births. […] The literature is limited regarding the epidemiology of DDH in certain parts of Europe, particularly in Greece, the Balkans, as well as in eastern and southern Europe. […] The incidence of DDH presents fluctuations, not only among European countries, but also between different regions within the same country.
#1 Developmental Dysplasia of the Hip | AAFP
https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html
The incidence of DDH is variable and depends on many factors. Approximately one in 1,000 children is born with a dislocated hip, and 10 in 1,000 may have hip subluxation. Factors contributing to DDH include breech presentation, female sex, positive family history, firstborn status, and oligohydramnios. Intrauterine position, sex, race, and positive family history are the most important risk factors. […] A family history positive for DDH may be found in 12 to 33 percent of affected patients. The risk of DDH for a child has been documented at 6 percent when there is one affected sibling, 12 percent with one affected parent, and 36 percent if a parent and a sibling are affected. Eighty percent of children with DDH are females. This is postulated to be related to the effects of additional estrogen produced by the female fetus, which increases ligamentous laxity.
#1 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK563157/
POSNA, the Canadian Task Force on DDH, the AAOS, and the AAP recommend periodic surveillance for developmental dysplasia of the hip throughout infancy. The goal of screening is to prevent a delayed diagnosis beyond the age of 6 months. AAP clinical practice guidelines recommended a hip ultrasound (US) at 6 weeks of age or a hip x-ray at 4 months of age in girls with a positive family history of developmental dysplasia of the hip or breech presentation in the third trimester.
#1 New Guidelines for Evaluation and Referral of DDH – International Hip Dysplasia Institute
https://hipdysplasia.org/new-guidelines-for-evaluation-and-referral-of-ddh/
Most of the guidelines remain the same as the clinical practice guidelines published in the year 2000. […] The new guidelines recognize the increased awareness that dislocations of the hip may develop after birth and during early childhood. The term Surveillance is recommended instead of the term Screening. This is because screening suggests a one-time process, but surveillance is performed with periodic clinical exams until walking age. Continued surveillance may be more likely to discover dislocations that develop after birth. […] Finally, the report recognizes that the objective of surveillance is to detect significant hip dysplasia so that early treatment may be initiated.
#1 Improving early detection of developmental dysplasia of the hip through general practitioner assessment and surveillance
https://www1.racgp.org.au/ajgp/2018/september/improving-early-detection-of-developmental-dysplas
Increased selective ultrasonography screening for babies with DDH risk factors has been associated with an increase in late-diagnosed DDH in South Australian children without traditional risk factors. […] Surveillance describes a long-term process where screening examinations are repeated at intervals of time. […] More frequent doctor-initiated assessments can reduce the age at diagnosis. […] The principle of multiple assessments until walking age is more important than the exact timing of the examinations. […] There are advantages to supplementing DDH screening with regular GP DDH assessments. […] The GP can order medical imaging when indicated and refer promptly for treatment, minimising communication breakdowns and treatment delays that occur with screening programs generally.
#1 Screening for Developmental Dysplasia of the Hip | AAFP
https://www.aafp.org/pubs/afp/issues/1999/0701/p177.html
Both universal and selective ultrasound screening programs for developmental dysplasia of the hip have been proposed. In a Norwegian study, the surgical treatment rate did not decrease significantly in newborns screened with ultrasonography compared with those screened by physical examination alone. However, the nonsurgical treatment rate was almost double in the ultrasound-screened group (34 versus 18 per 1,000 infants screened). The assumption is that many children in the ultrasound group who subsequently received treatment actually had false-positive ultrasound tests. […] A possible role for ultrasonography in the surveillance of mildly abnormal hips is being increasingly recognized. In a number of studies, false-positive treatment rates have been reduced by at least 50 percent. Several studies have reported splinting rates of six or less per 1,000 infants screened by ultrasonography and excellent clinical outcomes. Investigators and clinicians are coming to agree that ultrasound examination is best performed when an infant is four to six weeks old. By this time, most merely immature hips have stabilized.
#1
https://www.shrinerschildrens.org/en/providers-and-research/for-health-professionals/hipscreen-app
One in three children with cerebral palsy will develop hip problems and children with cerebral palsy are at increased risk for hip displacement and dislocation. […] Early detection through a hip surveillance program can preserve a child’s function and prevent pain. […] Hip surveillance can identify hip displacement in children with cerebral palsy earlier; allowing more effective and successful treatment. […] Unfortunately, substantial barriers to implementation of hip surveillance exist, including lack of education and challenges in the acquisition and interpretation of pelvis radiographs. […] Hip Surveillance is a regular schedule of clinical examinations and X-rays for early detection of hip problems. Earlier detection means more successful treatment and better function. […] Hip Surveillance is a schedule of X-rays and clinical examinations through childhood for early detection of hip disorders in children with cerebral palsy. Closer monitoring is needed for children with more severe cerebral palsy.
#1
https://www.shrinerschildrens.org/en/providers-and-research/for-health-professionals/hipscreen-app
Children with cerebral palsy are at a high risk for developing progressive hip dysplasia, or malformation of the hip joint. […] Over 1/3 of children with cerebral palsy will develop hip displacement or dysplasia. Even children with mild cerebral palsy are at risk. […] Evidence from numerous studies shows that regular hip X-ray examinations can detect problems before they cause symptoms, allowing for earlier / more effective treatment. Hip Surveillance is a regular schedule of clinical examinations and X-rays during childhood, proven to improve function in children with cerebral palsy. […] Sweden was able to completely eliminate hip dislocation in children with cerebral palsy using a Hip Surveillance Program.
#1 Improving early detection of developmental dysplasia of the hip through general practitioner assessment and surveillance
https://www1.racgp.org.au/ajgp/2018/september/improving-early-detection-of-developmental-dysplas
Early DDH detection and treatment harnesses the maximal growth potential of the infant hip, with increased likelihood of treatment success, fewer invasive procedures and fewer complications. […] DDH assessment focuses on clinical examination, supplemented by risk factor identification and consideration of imaging. […] DDH surveillance requires ongoing assessments until walking age. […] GP assessment and surveillance may maximise DDH detection in infancy and lower the age of detection for children who develop signs beyond the newborn period.
#1 Hip Dysplasia | Boston Children’s Hospital
https://www.childrenshospital.org/conditions/hip-dysplasia
Generally speaking, treating hip dysplasia as early as possible can minimize joint damage and reduce the chance of early onset arthritis. […] Many babies with DDH are diagnosed during their first few months of life. […] Infants in the U.S. are routinely screened for hip dysplasia. During the exam, the doctor will ask about your childâs history, including their position during pregnancy. Theyâll also ask if there is any history of hip problems on either parentâs side.
#1 Developmental dysplasia of the hip: MedlinePlus Medical EncyclopediaLock
https://medlineplus.gov/ency/article/000971.htm
Developmental dysplasia of the hip (DDH) is a dislocation of the hip joint that is present at birth. The condition is found in babies or young children. […] DDH occurs in about 1 to 1.5 of 1,000 births. […] Pediatric health care providers routinely screen all newborns and infants for hip dysplasia. There are several methods to detect a dislocated hip or a hip that is able to be dislocated. […] If hip dysplasia is found in the first few months of life, it can almost always be treated successfully with a positioning device (bracing). In a few cases, surgery is needed to put the hip back in joint. […] Hip dysplasia that is found after early infancy may lead to a worse outcome and may need more complex surgery to fix the problem.
#1 Hip Dysplasia | Boston Children’s Hospital
https://www.childrenshospital.org/conditions/hip-dysplasia
Severe cases of hip dysplasia are usually diagnosed during a routine screening within the first few months of a babyâs life. […] Hip dysplasia is a treatable condition. However, if left untreated, it can cause irreversible damage that will cause pain and loss of function later in life. It is the leading cause of early arthritis of the hip before the age of 60. The severity of the condition and catching it late increase the risk of arthritis. Therefore, monitoring and early intervention are both important to reduce a childâs risk of pain and disability in adulthood. […] Hip dysplasia can affect anyone at any age. Although it is believed to develop around birth, a child with mild dysplasia may not have symptoms for years, or even decades. […] Girls and women are two to four times more likely than boys to have hip dysplasia. It also tends to affect first-born children and those who have a close family member with hip problems.
#1 Abduction treatment in stable hip dysplasia does not alter the acetabular growth: results of a randomized clinical trial | Scientific Reports
https://www.nature.com/articles/s41598-020-66634-1
This multicenter randomized-controlled study did not show differences in outcome of treatment with abduction bracing versus active surveillance in infants of 3 to 4 months of age with sonographic dysplastic but well-centered stable hips. […] The findings in this study make us reflect on the usefulness of current ultrasound classifications for stable hip dysplasia as they are not able to distinguish between normal developing hips and true pathologic hip dysplasia. Since the majority of hips that are classified as sonographic stable dysplastic hips show spontaneous normalization, more specific methods and definitions are needed to distinguish between normal developing hips and true hip dysplasia. Until we have better methods for the diagnosis of true hip dysplasia, we recommend observation, rather than treatment, of all well-centered stable hips according to the current ultrasound classifications. This would also avoid significant overtreatment (80%) with a burden to both the families and health care systems. Identifying true DDH cases will show insufficient improvement in time and might need some form of treatment at follow-up.
#1 SciELO Brazil – THE EPIDEMIOLOGY OF DEVELOPMENTAL DYSPLASIA OF THE HIP IN MALES THE EPIDEMIOLOGY OF DEVELOPMENTAL DYSPLASIA OF THE HIP IN MALES
https://www.scielo.br/j/aob/a/BkFpvQhdGsnQbQCqsxfRXRj/
Developmental Dysplasia of the Hip (DDH) is one of the most common orthopedic hip diseases of the pediatric population. There is a predominance in females and patients with known risk factors. […] The incidence of DDH for children without associated risk factors is estimated at 11.5/1,000 live births, based on meta-analysis protocols and multiple logistic regression. When the risk is calculated for each sex separately, the incidence ranged from 4.1/1,000 for boys to 19/1,000 for girls. […] The epidemiology of DDH has always been considered a conundrum due to the lack of standardization of criteria by various authors in the literature. There is much diversity in the studies regarding the definition of DDH itself, as already mentioned in the introduction, and on aspects such as diagnostic methods, classification, among others.
#1 Hip dysplasia – Wikipedia
https://en.wikipedia.org/wiki/Hip_dysplasia
Determining the incidence can be difficult. In addition there is a wide margin in diagnostic results. A German study comparing two methods resulted in twice the usual rate for one method. The condition is eight times more frequent in females than in males. […] Native Americans are more likely to have congenital hip dislocation than any of the other races. The risk for Native Americans is about 2550 in 1000. The overall frequency of developmental dysplasia of the hip is approximately 1 case per 1000 individuals; however, Barlow believed that the incidence of hip instability in newborns can be as high as 1 case for every 60 newborns, with the rate dropping to 1:240 at one week.
#1
https://link.springer.com/article/10.1007/s11832-016-0798-5
The epidemiology and risk factors for developmental dysplasia of the hip (DDH) are still being refined. We investigated the local epidemiology of DDH in order to define incidence, identify risk factors, and refine our policy on selective ultrasound screening. […] The incidence was 4.9 per 1000 live births. Female sex (adjusted OR 7.2, 95% confidence interval [CI] 4.6-11.2), breech presentation (adjusted OR 24.3, 95% CI 13.1-44.9), positive family history (adjusted OR 15.9, 95% CI 11.0-22.9) and first or second pregnancy (adjusted OR 1.8, 95% CI 1.5-2.3) were confirmed as risk factors (p<0.001). [...] The epidemiology and risk factors for DDH are still being refined. The incidence in the UK before ultrasound (US) screening became available was quoted as 12 per 1000. Since the advent of selective US screening, which selectively ultrasounds the hips of babies who are thought to be at high risk of DDH, estimates of the UK incidence have increased and range from 5-30 per 1000.
#1 Developmental Dysplasia of the Hip (DDH)
https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro
DDH affects 1-3% of newborns and is responsible for 29% of primary hip replacements in people up to the age of 60 years. […] A systematic review of unscreened populations estimated the prevalence of clinically diagnosed, established hip dysplasia to be 1.3 per 1,000 but in populations screened clinically with Ortolani and Barlow tests, the prevalence is higher at 1.6-28.5 per 1,000 and it is higher still with ultrasound screening. […] The left hip is dislocated more often than the right, possibly due to the more common left occiput anterior position in utero, limiting abduction of the left hip. 20% of cases are bilateral. […] It is more common in cultures that use swaddling of babies, with lower extremities fully extended and wrapped together. […] In contrast, it is less common in cultures that carry their children in front of the mother with the hips widely abducted, the straddle or jockey position.
#1 Developmental Dysplasia of the Hip (DDH): Practice Essentials, Anatomy, Pathophysiology
https://emedicine.medscape.com/article/1248135-overview
The overall frequency of DDH is usually reported as approximately 1 case per 1000 individuals, though Barlow believed that the incidence of hip instability during newborn examinations was as high as 1 case per 60 newborns. […] According to Barlow’s study, more than 60% of newborns with hip instability became stable by age 1 week, and 88% became stable by age 2 months, leaving only 12% (of the 1 in 60 newborns, or 0.2% overall) with residual hip instability.
#1 Research & Clinical Trials – International Hip Dysplasia Institute
https://hipdysplasia.org/research-and-clinical-trials/
The IHDI focus on innovative new techniques has the potential to substantially decrease the burden of hip dysplasia for infants, children and adults globally, and to profoundly change the way that hip dysplasia is treated if treatment is necessary. […] The International Hip Dysplasia Registry (IHDR) is continuing and expanding the initial research that began as an IHDI multi-center study of dislocated infant hips. […] The IHDI and IHDR are working in parallel, and in cooperation to improve the lives of those with hip dysplasia. […] The connection between mild infant dysplasia and adolescent/adult onset hip dysplasia is uncertain. However, prevention of adolescent or adult hip dysplasia must begin shortly after birth in order to be effective. […] Studies are being encouraged to determine whether simple preventive care during infancy can decrease the burden of adolescent and adult dysplasia.
#1 Developmental Dysplasia of the Hip: How Many Risk Factors Are Needed?
https://www.mdpi.com/2227-9067/10/6/968
There are many papers on the epidemiology and risk factors of DDH in the literature but no standardized criteria on whether a hip ultrasound should be carried out only in selective cases having those risk factors. […] Our research showed a 3.2-times-higher incidence for girls than for boys and a higher incidence among patients with a positive family history by a factor of 4.19. […] It is mandatory for children with two or more risk factors to be evaluated clinically and sonographically. […] DDH screening is recommended for each newborn for the long-term benefits of early DDH diagnosis, regardless of the risk factors.
#1 The management of developmental dysplasia of the hip in children aged under three months | Bone & Joint
https://boneandjoint.org.uk/Article/10.1302/0301-620X.105B2.BJJ-2022-0893.R1
A national screening programme has existed in the UK for the diagnosis of developmental dysplasia of the hip (DDH) since 1969. […] Screening programmes throughout the world vary enormously, and in the UK there is significant variation in screening practice and treatment pathways. […] BSCOS believe that surveillance for DDH is valuable, but recognize that the current model of clinical screening has low accuracy and alternative models should be sought. […] BSCOS advocates for universal ultrasound screening and believes that a randomized clinical trial is necessary to compare universal ultrasound screening to the current screening pathway. […] This consensus exercise has limitations. While the Delphi approach allows the opinion of experts to be formulated with all contributing equally, it cannot replace rigorous scientific evidence. […] It is clear that decisions about screening programmes and treatment protocols for children with DDH should be based on the best possible evidence.
#1 Research & Clinical Trials – International Hip Dysplasia Institute
https://hipdysplasia.org/research-and-clinical-trials/
The IHDI Classification grades severity from Grade 1 as the mildest type to Grade 4 as the most severe type of hip dislocation. […] In studies from other centers, the IHDI Classification has improved early identification of patients that benefit from different treatments. […] The IHDI registered the largest number of newborn hip dislocations that have ever been identified with imaging prior to treatment. […] The International Hip Dysplasia Registry has since expanded to include many more patients with hip dysplasia from centers around the World.
#1 Hip Dysplasia | Pediatric Orthopaedic Research Program | Stanford Medicine
https://med.stanford.edu/pedsortho/education/hip.html
The purpose of the care map was to reduce variation in the treatment of DDH and reduce the cost via avoiding unnecessary testing, all to improve patient care. […] We hypothesize that DDH care map implementation will increase primary care provider awareness and utilization of screening guidelines, followed by an increase in the number of early referrals to specialists for low-cost, successful interventions for DDH.
#2 Developmental dysplasia of the hip: Epidemiology and pathogenesis – UpToDate
https://www.uptodate.com/contents/developmental-dysplasia-of-the-hip-epidemiology-and-pathogenesis/print
Developmental dysplasia of the hip (DDH) describes a spectrum of conditions related to the development of the hip in infants and young children. […] The epidemiology and pathogenesis of DDH in otherwise healthy children will be reviewed here. […] Estimates of the incidence of DDH are quite variable and depend upon the means of detection, the age of the child, and the diagnostic criteria. It is estimated that dislocatable hips and hips with severe or persistent dysplasia occur in 3 to 5 per 1000 children. Historically, the incidence of DDH with dislocation is 1 to 2 per 1000 children. Mild hip instability is more common in newborns, with reported incidence as high as 40 percent. However, mild instability and/or mild dysplasia in the newborn period often resolve without treatment. Infants with mild instability and/or mild dysplasia in the newborn period should not be included in estimates of incidence. Their inclusion results in overestimation.
#2 Epidemiology and Screening of Developmental Dysplasia of the Hip in Europe: A Scoping Review
https://www.mdpi.com/2571-841X/7/1/10
The incidence of DDH ranges from 1â7% in neonates among some populations, but this may vary among different ethnicities and countries. […] The incidence of DDH in Europe ranged from 0.59 per 1000 live births to 27.53 per 1000 live births, which was the maximum limit of incidence of DDH in Europe, observed in Hungary. Furthermore, incidence also ranged significantly in Greece, especially in Crete, as it was reported to be 10.83 per 1000 live births. […] The literature is limited regarding the epidemiology of DDH in certain parts of Europe, particularly in Greece, the Balkans, as well as in eastern and southern Europe. […] The incidence of DDH presents fluctuations, not only among European countries, but also between different regions within the same country.
#2 Developmental Dysplasia of the Hip (DDH): Practice Essentials, Anatomy, Pathophysiology
https://emedicine.medscape.com/article/1248135-overview
The overall frequency of DDH is usually reported as approximately 1 case per 1000 individuals, though Barlow believed that the incidence of hip instability during newborn examinations was as high as 1 case per 60 newborns. […] According to Barlow’s study, more than 60% of newborns with hip instability became stable by age 1 week, and 88% became stable by age 2 months, leaving only 12% (of the 1 in 60 newborns, or 0.2% overall) with residual hip instability.
#2 Hip dysplasia – Wikipedia
https://en.wikipedia.org/wiki/Hip_dysplasia
Determining the incidence can be difficult. In addition there is a wide margin in diagnostic results. A German study comparing two methods resulted in twice the usual rate for one method. The condition is eight times more frequent in females than in males. […] Native Americans are more likely to have congenital hip dislocation than any of the other races. The risk for Native Americans is about 2550 in 1000. The overall frequency of developmental dysplasia of the hip is approximately 1 case per 1000 individuals; however, Barlow believed that the incidence of hip instability in newborns can be as high as 1 case for every 60 newborns, with the rate dropping to 1:240 at one week.
#2
https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh
Developmental Dysplasia of the Hip is a disorder of abnormal development resulting in dysplasia, subluxation, and possible dislocation of the hip secondary to capsular laxity and mechanical instability. […] Epidemiology: Incidence: most common orthopaedic disorder in newborns; dysplasia is 1:100; dislocation is 1:1000. […] Demographics: more common in females (6:1); more commonly seen in Native Americans and Laplanders due to cultural traditions such as swaddling with hips together in extension; rarely seen in African Americans. […] Anatomic location: most common in left hip (60%) due to the most common intrauterine position being left occiput anterior (left hip is adducted against the mother’s lumbrosacral spine); bilateral in 20%. […] Risk factors: firstborn due to unstretched uterus and tight abdominal structures compressing the uterus; female due to increased ligamentous laxity that transiently exists as the result of circulating maternal hormones and the estrogens produced by the fetal uterus; breech more commonly seen in female children, firstborn children, and pregnancies complicated by oligohydramnios; higher risk of DDH with frank/single breech position compared to footling breech position; family history; oligohydramnios; macrosomia; limited hip abduction; talipes; swaddling.
#2 Developmental Dysplasia of the Hip | AAFP
https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html
DDH occurs more often in children who present in the breech position. It is believed that in utero knee extension of the infant in the breech position results in sustained hamstring forces around the hip and contributes to subsequent hip instability. First-born children are affected twice as often as subsequent siblings, presumably because of an unstretched uterus and tight abdominal structures in the mother. In utero postural deformities and oligohydramnios also are associated with DDH. For unknown reasons, DDH is less common in black persons. […] The postnatal extrauterine environment also plays a role in DDH. The incidence of DDH is high in Native American cultures that use swaddling, which forces the hips into adduction and extension.
#2 New Guidelines for Evaluation and Referral of DDH – International Hip Dysplasia Institute
https://hipdysplasia.org/new-guidelines-for-evaluation-and-referral-of-ddh/
Most of the guidelines remain the same as the clinical practice guidelines published in the year 2000. […] The new guidelines recognize the increased awareness that dislocations of the hip may develop after birth and during early childhood. The term Surveillance is recommended instead of the term Screening. This is because screening suggests a one-time process, but surveillance is performed with periodic clinical exams until walking age. Continued surveillance may be more likely to discover dislocations that develop after birth. […] Finally, the report recognizes that the objective of surveillance is to detect significant hip dysplasia so that early treatment may be initiated.
#2 Improving early detection of developmental dysplasia of the hip through general practitioner assessment and surveillance
https://www1.racgp.org.au/ajgp/2018/september/improving-early-detection-of-developmental-dysplas
Increased selective ultrasonography screening for babies with DDH risk factors has been associated with an increase in late-diagnosed DDH in South Australian children without traditional risk factors. […] Surveillance describes a long-term process where screening examinations are repeated at intervals of time. […] More frequent doctor-initiated assessments can reduce the age at diagnosis. […] The principle of multiple assessments until walking age is more important than the exact timing of the examinations. […] There are advantages to supplementing DDH screening with regular GP DDH assessments. […] The GP can order medical imaging when indicated and refer promptly for treatment, minimising communication breakdowns and treatment delays that occur with screening programs generally.
#2 Watchful Waiting or Treatment for Developmental Dysplasia of the Hip?
https://www.medscape.com/viewarticle/720592
Developmental dysplasia of the hip (DDH) is the most common musculoskeletal condition encountered in newborns. […] In recent years, ultrasound screening has been added to the evaluation of DDH, and some centers selectively screen infants at risk or screen all newborn infants for DDH using ultrasound. […] Screening and early treatment of DDH are not universally practiced. In 2006, the United Stated Preventive Services Task Force (USPSTF) concluded that the evidence was insufficient to recommend routine screening for developmental dysplasia of the hip in infants as a means to prevent adverse outcomes. […] The evidence-based recommendation of Mahan and colleagues is to screen all newborns for DDH by physical examination and to use ultrasonography for infants at high risk for DDH. […] Furthermore, the USPSTF found no evidence for the effectiveness of either surgical or nonsurgical interventions for DDH and expressed concern about the potential harms associated with treatment of infants identified by routine screening.
#2 Abduction treatment in stable hip dysplasia does not alter the acetabular growth: results of a randomized clinical trial | Scientific Reports
https://www.nature.com/articles/s41598-020-66634-1
The effect of bracing over natural history of stable dysplastic hips is not well known. This multicenter randomized trial aimed at objectifying the effect of abduction treatment versus active surveillance in infants of 3 to 4 months of age. […] Currently, abduction treatment, preferably started in the first months of life, is viewed as the standard of care for all types of hip dysplasia. There exists, however, a considerable geographic variation in consistency of diagnostic criteria for DDH. While in some countries, clinical findings and/or risk factors will determine the need for ultrasound hip screening, in other countries all newborns are screened for DDH and receive early treatment. Some have questioned the latter as potential for over-diagnosing and therefore unnecessary treatment, as 85% of infantile DDH will resolve spontaneously by the age of 3 months.
#2
https://www.shrinerschildrens.org/en/providers-and-research/for-health-professionals/hipscreen-app
Children with cerebral palsy are at a high risk for developing progressive hip dysplasia, or malformation of the hip joint. […] Over 1/3 of children with cerebral palsy will develop hip displacement or dysplasia. Even children with mild cerebral palsy are at risk. […] Evidence from numerous studies shows that regular hip X-ray examinations can detect problems before they cause symptoms, allowing for earlier / more effective treatment. Hip Surveillance is a regular schedule of clinical examinations and X-rays during childhood, proven to improve function in children with cerebral palsy. […] Sweden was able to completely eliminate hip dislocation in children with cerebral palsy using a Hip Surveillance Program.
#2 Clinical and sonographic improvement of developmental dysplasia of the hip: analysis of 948 patients | Journal of Orthopaedic Surgery and Research | Full Text
https://josr-online.biomedcentral.com/articles/10.1186/s13018-022-03432-7
Selective secondary radiographic screening in 6 weeks of age is used in children with known risk factors of DDH. […] Clinical practice guidelines recommend abduction splintage treatment for hips with Ortolani positive DDH. […] However, treatment with Pavlik harness is the most widely used method in the world. […] Early detection and treatment are key factors in successful non-operative management of the disease. […] The purpose of this study was to investigate the rate of improvement in DDH and evaluate risk factors affecting the rate. […] Of the known risk factors of DDH, female sex and positive family history were associated with slower rate of improvement in first 3 months of age. […] Breech born infants seem to recover fast with correct treatment, and breech presentation does not form a risk of slower recovery of DDH. […] Further clinical trials are needed to confirm these findings and analyze further the impact of spontaneous recovery potential of mild DDH to the benefits of early abduction treatment.
#2 Hip Dysplasia | Boston Children’s Hospital
https://www.childrenshospital.org/conditions/hip-dysplasia
Severe cases of hip dysplasia are usually diagnosed during a routine screening within the first few months of a babyâs life. […] Hip dysplasia is a treatable condition. However, if left untreated, it can cause irreversible damage that will cause pain and loss of function later in life. It is the leading cause of early arthritis of the hip before the age of 60. The severity of the condition and catching it late increase the risk of arthritis. Therefore, monitoring and early intervention are both important to reduce a childâs risk of pain and disability in adulthood. […] Hip dysplasia can affect anyone at any age. Although it is believed to develop around birth, a child with mild dysplasia may not have symptoms for years, or even decades. […] Girls and women are two to four times more likely than boys to have hip dysplasia. It also tends to affect first-born children and those who have a close family member with hip problems.
#2 Watchful Waiting or Treatment for Developmental Dysplasia of the Hip?
https://www.medscape.com/viewarticle/720592
These divergent opinions suggest that more evidence is needed to establish the need for screening and early intervention for infants with DDH. […] In this best evidence study, Rosendahl and associates compared 2 approaches to the management of infants with mild hip dysplasia: active sonographic surveillance and early treatment. […] The researchers found that active sonographic surveillance of infants with stable, mildly dysplastic hips reduced the use of abduction splinting without increasing the risk for persistent or more severe dysplasia. […] The investigators maintain that these results have important implications for families as well as for healthcare costs. […] We have shown that surveillance of these newborns and treatment reconsideration at 6 weeks does not result in more abnormal hips at 1 year of age.
#2 News Update: Active monitoring works for newborns with mild hip dysplasia
https://www.contemporarypediatrics.com/view/news-update-active-monitoring-works-newborns-mild-hip-dysplasia
Employing active sonographic surveillance in newborns with mild hip dysplasia yields results similar to those achieved with immediate splinting treatment, according to a new study. […] Considering the reported prevalence of 1.3% for mild hip dysplasia, these results suggest that a strategy of active surveillance rather than immediate treatment could reduce the overall treatment rate by 0.6%.
#2
https://link.springer.com/article/10.1007/s11832-016-0798-5
The epidemiology and risk factors for developmental dysplasia of the hip (DDH) are still being refined. We investigated the local epidemiology of DDH in order to define incidence, identify risk factors, and refine our policy on selective ultrasound screening. […] The incidence was 4.9 per 1000 live births. Female sex (adjusted OR 7.2, 95% confidence interval [CI] 4.6-11.2), breech presentation (adjusted OR 24.3, 95% CI 13.1-44.9), positive family history (adjusted OR 15.9, 95% CI 11.0-22.9) and first or second pregnancy (adjusted OR 1.8, 95% CI 1.5-2.3) were confirmed as risk factors (p<0.001). [...] The epidemiology and risk factors for DDH are still being refined. The incidence in the UK before ultrasound (US) screening became available was quoted as 12 per 1000. Since the advent of selective US screening, which selectively ultrasounds the hips of babies who are thought to be at high risk of DDH, estimates of the UK incidence have increased and range from 5-30 per 1000.
#2 The Epidemiology and Demographics of Hip Dysplasia
https://search.emarefa.net/en/detail/BIM-456369-the-epidemiology-and-demographics-of-hip-dysplasia
The etiology of developmental dysplasia of the hip (DDH) is unknown. […] There are many insights, however, from epidemiologic/demographic information. […] There is a predominance of left-sided (64.0%) and unilateral disease (63.4%). […] The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans. […] There is significant variability in incidence within each racial group by geographic location. […] The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. […] Predictors of DDH are breech presentation, positive family history, and gender (female). […] Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. […] Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. […] Archeological studies demonstrate that the epidemiology of DDH may be changing.
#2 Research & Clinical Trials – International Hip Dysplasia Institute
https://hipdysplasia.org/research-and-clinical-trials/
The IHDI Classification grades severity from Grade 1 as the mildest type to Grade 4 as the most severe type of hip dislocation. […] In studies from other centers, the IHDI Classification has improved early identification of patients that benefit from different treatments. […] The IHDI registered the largest number of newborn hip dislocations that have ever been identified with imaging prior to treatment. […] The International Hip Dysplasia Registry has since expanded to include many more patients with hip dysplasia from centers around the World.
#3 Epidemiology and Screening of Developmental Dysplasia of the Hip in Europe: A Scoping Review
https://www.mdpi.com/2571-841X/7/1/10
The incidence of DDH ranges from 1â7% in neonates among some populations, but this may vary among different ethnicities and countries. […] The incidence of DDH in Europe ranged from 0.59 per 1000 live births to 27.53 per 1000 live births, which was the maximum limit of incidence of DDH in Europe, observed in Hungary. Furthermore, incidence also ranged significantly in Greece, especially in Crete, as it was reported to be 10.83 per 1000 live births. […] The literature is limited regarding the epidemiology of DDH in certain parts of Europe, particularly in Greece, the Balkans, as well as in eastern and southern Europe. […] The incidence of DDH presents fluctuations, not only among European countries, but also between different regions within the same country.
#3
https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh
Developmental Dysplasia of the Hip is a disorder of abnormal development resulting in dysplasia, subluxation, and possible dislocation of the hip secondary to capsular laxity and mechanical instability. […] Epidemiology: Incidence: most common orthopaedic disorder in newborns; dysplasia is 1:100; dislocation is 1:1000. […] Demographics: more common in females (6:1); more commonly seen in Native Americans and Laplanders due to cultural traditions such as swaddling with hips together in extension; rarely seen in African Americans. […] Anatomic location: most common in left hip (60%) due to the most common intrauterine position being left occiput anterior (left hip is adducted against the mother’s lumbrosacral spine); bilateral in 20%. […] Risk factors: firstborn due to unstretched uterus and tight abdominal structures compressing the uterus; female due to increased ligamentous laxity that transiently exists as the result of circulating maternal hormones and the estrogens produced by the fetal uterus; breech more commonly seen in female children, firstborn children, and pregnancies complicated by oligohydramnios; higher risk of DDH with frank/single breech position compared to footling breech position; family history; oligohydramnios; macrosomia; limited hip abduction; talipes; swaddling.
#3 Epidemiology of developmental dysplasia of the hip at a tertiary hospital in Oman – Journal of Musculoskeletal Surgery and Research
https://journalmsr.com/epidemiology-of-developmental-dysplasia-of-the-hip-at-a-tertiary-hospital-in-oman/
The study included 795 DDH-diagnosed patients, of which 82.0% were female and 18.0% were male, giving a ratio of 4.5:1. Bilateral DDH was diagnosed in 37.7% of patients with left-sided DDH in 38.6%, and right DDH in 23.6% patients. At least half of the DDH cases were 6 months old or younger at the first presentation to the hospital and 16.6% were diagnosed after the age of 18 months. Remarkably, at least one risk factor was present for 73.1% of patients. The remaining patients had no risk factors for DDH at all. The prevalence of the first child in the family was 33.0% and oligohydramnios 10.9%.
#3 Hip Surveillance in Cerebral Palsy | AACPDM – American Academy for Cerebral Palsy and Developmental Medicine
https://www.aacpdm.org/publications/care-pathways/hip-surveillance-in-cerebral-palsy
Hip surveillance is defined as: The process of monitoring and identifying the critical early indicators of hip displacement. […] Children with cerebral palsy (CP) have an increased likelihood of hip displacement. […] Hip surveillance allows for early detection of hip displacement. […] Early detection enables referral for assessment and/or management. […] Hip surveillance for children with CP should be completed using a systematic approach. […] The literature supports the completion of hip surveillance in children and youth with cerebral palsy. […] The content of the care pathway was established through expert consensus after review of the literature and comparison of currently existing international hip surveillance programs in Australia, Canada, USA, Sweden, and United Kingdom.
#4 Hip dysplasia – Wikipedia
https://en.wikipedia.org/wiki/Hip_dysplasia
Determining the incidence can be difficult. In addition there is a wide margin in diagnostic results. A German study comparing two methods resulted in twice the usual rate for one method. The condition is eight times more frequent in females than in males. […] Native Americans are more likely to have congenital hip dislocation than any of the other races. The risk for Native Americans is about 2550 in 1000. The overall frequency of developmental dysplasia of the hip is approximately 1 case per 1000 individuals; however, Barlow believed that the incidence of hip instability in newborns can be as high as 1 case for every 60 newborns, with the rate dropping to 1:240 at one week.
#4 Screening for Developmental Dysplasia of the Hip | AAFP
https://www.aafp.org/pubs/afp/issues/1999/0701/p177.html
The incidence of hip dislocation in unscreened populations is estimated to be one to two cases per 1,000 children of European origin. The abnormality is rare in black Africans. It is more common in populations that practice swaddling or use infant cradle boards. […] The most significant risk factor for hip dysplasia is a positive family history. In a recent British study, more than 20 percent of children who required treatment for developmental dysplasia of the hip had a positive family history for the disorder; 5.5 percent of those children had an apparently normal physical examination at birth. Other risk factors for hip dysplasia include breech presentation, foot deformities, oligohydramnios, primiparity and female sex. Between 30 and 50 percent of infants with hip abnormality have risk factors other than sex.
#4 Developmental Dysplasia of the Hip (DDH)
https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro
DDH affects 1-3% of newborns and is responsible for 29% of primary hip replacements in people up to the age of 60 years. […] A systematic review of unscreened populations estimated the prevalence of clinically diagnosed, established hip dysplasia to be 1.3 per 1,000 but in populations screened clinically with Ortolani and Barlow tests, the prevalence is higher at 1.6-28.5 per 1,000 and it is higher still with ultrasound screening. […] The left hip is dislocated more often than the right, possibly due to the more common left occiput anterior position in utero, limiting abduction of the left hip. 20% of cases are bilateral. […] It is more common in cultures that use swaddling of babies, with lower extremities fully extended and wrapped together. […] In contrast, it is less common in cultures that carry their children in front of the mother with the hips widely abducted, the straddle or jockey position.