Materiały źródłowe

• #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 (DDH) describes a spectrum of conditions related to the development of the hip in infants and young children. It encompasses abnormal development of the acetabulum and proximal femur and mechanical instability of the hip joint. […] 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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7006538/

  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 objective of this study was to evaluate the epidemiological characteristics of developmental dysplasia of the hip in males and secondly to investigate if these characteristics are the same as those generally reported in the literature. […] 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.

• #3 Update on the management of infant and toddler developmental dysplasia of the hip

  https://www1.racgp.org.au/ajgp/2021/april/infant-and-toddler-developmental-dysplasia-of-the

  Developmental dysplasia of the hip (DDH) encompasses the pathological spectrum of hip instability that produces subluxation or dislocation and radiological features of abnormal acetabular development. […] The aim of this article is to summarise contemporary practice in DDH with an emphasis on recent changes in diagnosis, surveillance and treatment recommendations for general practitioners (GPs), who see infants and toddlers in practice. […] GPs are essential for the early detection of DDH, which then allows for harnessing of the remodelling potential of the hip cartilaginous anlage to achieve a stable and mature hip. GPs also play an important part in surveillance, and this article provides an update on the pivotal points. […] DDH and its sequelae continue to have a major impact on healthcare, with the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) reporting that nearly 7% of total hip replacements in Australia are directly attributable to DDH.

• #4 Screening for developmental dysplasia of the hip: an evidence-based approach to practice | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/developmental-dysplasia-of-the-hip/

  Developmental Dysplasia of the Hip (DDH) is a spectrum of hip joint abnormalities ranging from mild dysplasia to severe, frank dislocations. Left untreated, DDH can lead to serious complications later in life including osteoarthritis of the hip and total hip replacement. DDH is the most common pediatric hip disorder, but its true incidence has been difficult to quantify due to significant variations in diagnostic criteria and inconsistent terminology used throughout the literature to describe hip abnormalities. Recently, the American Academy of Orthopaedic Surgeons (AAOS) published their clinical practice guideline (CPG), Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip (DDH) in Infants up to Six Months of Age, following a rigorous, standardized methodological review of the evidence existing in the literature. This guideline provided nine recommendations for the screening and treatment of DDH; however, only two of these recommendations were of moderate strength, while the other recommendations were of limited strength based upon the quality of evidence available.

• #5 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Developmental dysplasia of the hip occurs due to an abnormal hip development, presenting in infancy or early childhood with a spectrum ranging from dysplasia to dislocation of the hip joint. […] The incidence of developmental dysplasia of the hip in the UK and US is approximately 10 per 1000 live births, and at birth, 1 in 1000 cases have dislocated hips. In Native Americans, the reported incidence is significantly higher, estimated to be more than 10 times higher. However, in African individuals, developmental dysplasia of the hip is rarely identified. Therefore, the incidence varies with age at diagnosis, race, and modality by which diagnosis was made. […] 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.

• #6 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. It encompasses abnormal development of the acetabulum and proximal femur and mechanical instability of the hip joint. […] 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.

• #7 The Epidemiology and Demographics of Hip Dysplasia · 研飞ivySCI

  https://www.ivysci.com/articles/1230680__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. A systematic medical literature review regarding DDH was performed. 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. […] Archeological studies demonstrate that the epidemiology of DDH may be changing.

• #8 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.

• #9 Epidemiology and Screening of Developmental Dysplasia of the Hip in Europe: A Scoping Review

  https://www.mdpi.com/2571-841X/7/1/10

  Developmental hip dysplasia or developmental dysplasia of the hip (DDH) includes a wide range of deformities of the hip, such as congenital dysplasia, subluxation, and dislocation. It is usually identified through neonatal screening during the first 6–8 weeks of life. The incidence of DDH ranges from 1–7% in neonates among some populations, but this may vary among different ethnicities and countries. A consensus about the ideal age for screening has not been reached to date. […] 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. […] There is no consensus regarding the appropriate screening methods for DDH in Europe or the age at which screening should be performed. Most studies recommend sonographic and/or clinical assessment as a screening tool.

• #10

  https://link.springer.com/article/10.1007/s44197-024-00217-5

  Developmental dysplasia of the hip (DDH) leads to pain, joint instability, and early degenerative joint disease. Incidence, prevalence, and management strategies of DDH have been well-documented in several countries, but not in Saudi Arabia. […] We synthesized the current evidence regarding incidence, prevalence, risk factors, and clinical treatment for children with DDH in Saudi Arabia. […] Our search yielded 67 potential studies, of which 16 studies were included (total DDH sample=3,127; age range=2.5 to 86.4 months). Three studies reported incidence rates ranging from 3.1 to 4.9 per 1000 births, and 3 studies reported prevalence ranging from 6 to 78%. Nine studies reported that female sex, breech position, family history, and age less than 3 years were risk factors associated with DDH.

• #11

  https://link.springer.com/article/10.1007/s44197-024-00217-5

  In Saudi Arabia, the Incidence and prevalence rates of DDH are 3.1 to 4.9 per 1,000 births, and 6 to 78%, respectively (differ from what has been reported in other countries), but the risk factors of DDH in Saudi Arabia appear to be similar in comparison to other countries (female, breech presentation, family history of DDH). […] In Saudi Arabia, one previous study reported that incidence rate of DDH was approximately 3.5 per 1000 births. […] Out of 16 included studies, 3 studies reported the incidence rate of DDH in Saudi Arabia. In 1988, the incidence rate of DDH in Saudi Arabia was estimated to be 4.9 cases per 1,000 births. In 2017, another study reported that incidence of DDH in Saudi Arabia was 3.1 cases per 1,000 births. Most recently, in 2022, the incidence rate of DDH in Saudi Arabia was estimated to be 3.8 cases per 1,000 births.

• #12 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/

  Developmental dysplasia of the hip (DDH) is common in Oman in clinical practice, but the incidence in Oman is still unknown. This study aimed to evaluate the incidence and characteristic features of DDH in the Omani population managed at Khoula Hospital (KH). The estimated DDH incidence in this study is 1.05/1000 live births/year. Based on the national live births annual records from Oman National Center for Statistics and Information, this study estimated the DDH incidence to be 1.05/1000 live births. The study included 795 DDH-diagnosed patients, out of which 652 (82.0%) were female and 143 (18.0%) were male, giving a ratio of 4.5:1. At least one risk factor was present for 581 (73.1%) patients. The prevalence of the first child in the family was 33.0% and oligohydramnios 10.9%. The incidence rate is calculated on regional and national bases after getting the annual natality rate from the NCSI. The DDH incidence in the population of this study was 1.05 (0.911.30)/1000 live births/year, which is comparable with the international figures. The calculated incidence for Muscat governate is 1.51/1000 live births/year. The only way to determine the exact incidence is to run a prospective mass screening program. We recommend conducting a multicenter prospective study to estimate DDH incidence in Oman accurately. National guidelines and screening programs must be developed and executed for early diagnosis, documentation, and management.

• #13 Epidemiology of Developmental Dysplasia of the Hip: Analysis of Japanese National Database

  https://www.jstage.jst.go.jp/article/jea/33/4/33_JE20210074/_article

  Developmental dysplasia of the hip (DDH) is a cluster of hip development disorders that affects infants. The incidence of DDH-related dislocation (DDH-dislocation) is reportedly 0.10.3%; however, the nationwide incidence of DDH-dislocation in Japan has not been previously reported. The primary aim of this study was to report the nationwide incidence of DDH-dislocation in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), and to examine its regional variation across Japan. […] Across the 2011, 2012, and 2013 birth cohorts, 2,367 patients were diagnosed with DDH-dislocation, yielding the nationwide incidence of 0.076%. […] This is the first study to report the nationwide incidence of DDH-dislocation in Japan, which was estimated at 0.076%. The regional variation was trivial and unlikely to be clinically significant. Thus, the incidence rates were approximately equal across all regions in Japan.

• #14 Epidemiology and Screening of Developmental Dysplasia of the Hip in Europe: A Scoping Review

  https://www.mdpi.com/2571-841X/7/1/10

  The above results reflect the reality that exists in Europe regarding DDH epidemiology and screening. The incidence of DDH in Europe presents fluctuations in different countries. […] The incidence of DDH presents fluctuations, not only among European countries, but also between different regions within the same country.

• #15

  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. […] Diagnosis can be confirmed with ultrasonography in the first 4 months and then with radiographs after femoral head ossification occurs (~ 4-6 months). […] Treatment varies from Pavlik bracing to surgical reduction and osteotomies depending on the age of the patient, underlying etiology, and the severity of dysplasia. […] 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

• #16

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7006538/

  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 objective of this study was to evaluate the epidemiological characteristics of developmental dysplasia of the hip in males and secondly to investigate if these characteristics are the same as those generally reported in the literature. […] 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.

• #17

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7006538/

  The incidence and prevalence of DDH vary considerably across individuals of different ethnicities and geographical locations. According to the American Academy of Pediatrics, the overall relative risk of DDH incidence in children is 11.5/1000 live births, 4.1/1000 in boys and 19/1000 in girls. […] The mean age at diagnosis of our patients was 22.8 months (median 10.1 months) with 66 boys (45%), i.e. about half of them diagnosed before 6 months of age, and 39 patients (26.5%) had a late diagnosis after 2 years old. […] DDH in males presents different characteristics from those reported in the literature. We found a higher frequency of bilaterality, later age of diagnosis and a higher percentage of high dislocations than in other epidemiological studies. Therefore we recommend the diagnostic investigation in the maternity ward for both sexes, regardless of the presence of risk factors.

• #18 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  Developmental dysplasia of the hip refers to a continuum of abnormalities in the immature hip that can range from subtle dysplasia to dislocation. The identification of risk factors, including breech presentation and family history, should heighten a physicians suspicion of developmental dysplasia of the hip. […] 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.

• #19 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  Developmental dysplasia of the hip refers to a continuum of abnormalities in the immature hip that can range from subtle dysplasia to dislocation. The identification of risk factors, including breech presentation and family history, should heighten a physicians suspicion of developmental dysplasia of the hip. […] 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.

• #20

  https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh

  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.

• #21

  https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh

  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.

• #22 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.

• #23 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.

• #24 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). […] Children born premature, with low birth weights, or to multifetal pregnancies are somewhat protected from DDH. […] Certain HLA A, B, and D types demonstrate an increase in DDH.

• #25

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7006538/

  The incidence and prevalence of DDH vary considerably across individuals of different ethnicities and geographical locations. According to the American Academy of Pediatrics, the overall relative risk of DDH incidence in children is 11.5/1000 live births, 4.1/1000 in boys and 19/1000 in girls. […] The mean age at diagnosis of our patients was 22.8 months (median 10.1 months) with 66 boys (45%), i.e. about half of them diagnosed before 6 months of age, and 39 patients (26.5%) had a late diagnosis after 2 years old. […] DDH in males presents different characteristics from those reported in the literature. We found a higher frequency of bilaterality, later age of diagnosis and a higher percentage of high dislocations than in other epidemiological studies. Therefore we recommend the diagnostic investigation in the maternity ward for both sexes, regardless of the presence of risk factors.

• #26 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  Developmental dysplasia of the hip refers to a continuum of abnormalities in the immature hip that can range from subtle dysplasia to dislocation. The identification of risk factors, including breech presentation and family history, should heighten a physicians suspicion of developmental dysplasia of the hip. […] 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.

• #27 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  Developmental dysplasia of the hip refers to a continuum of abnormalities in the immature hip that can range from subtle dysplasia to dislocation. The identification of risk factors, including breech presentation and family history, should heighten a physicians suspicion of developmental dysplasia of the hip. […] 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.

• #28 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.

• #29 Genome-wide association study of developmental dysplasia of the hip identifies an association with GDF5 | Communications Biology

  https://www.nature.com/articles/s42003-018-0052-4

  Developmental dysplasia of the hip (DDH) is the most common skeletal developmental disease. However, its genetic architecture is poorly understood. We find the heritable component of DDH attributable to common genetic variants to be 55% and distributed equally across the autosomal and X-chromosomes. DDH is a complex disorder, with known associations including female sex, first-born, breech presentation, and family history. There is a seven-fold increase in the incidence between siblings and a 10-fold increase in the parents of probands compared to the general population. While DDH is heritable, its genetic architecture remains poorly characterised. Systematic examination of genome-wide variation in DDH in larger sample sizes is necessary to clarify its heritable biology and inform mechanism-driven preventative strategies. The National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man (NJR) was established in 2003 to collect audit data on all hip and knee replacement surgery in these regions, for which it has a completeness rate of 97%. We use the NJR as a case-ascertainment tool to conduct a nationwide genome-wide association scan to characterise the genetic architecture of DDH. We find the heritable component of DDH attributable to common variants to be 55% with the lead replicating signal at genome-wide significance being rs143384 within the GDF5 promoter. We also find shared genetic architecture between DDH and hip osteoarthritis. We report a scalable, time-efficient recruitment strategy. We establish variation within GDF5 on chromosome 20 as robustly associated with DDH susceptibility with rs143384 as the causal signal by fine-mapping, although GDF5 variation makes only a small contribution to overall DDH heritability. Through gene-based analyses we identify GDF5, UQCC1, MMP24, RETSAT and PDRG1 to be associated with DDH susceptibility. We find no evidence that hip osteoarthritis polygenic risk score predicts DDH status.

• #30 The Epidemiology and Demographics of Hip Dysplasia

  https://search.emarefa.net/en/detail/BIM-456369-the-epidemiology-and-demographics-of-hip-dysplasia

  Chromosome 17q21 is strongly associated with DDH. […] Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. […] Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. […] Swaddling is strongly associated with DDH. […] Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. […] Associated conditions are congenital muscular torticollis and congenital foot deformities. […] The opposite hip is frequently abnormal when using rigorous radiographic assessments. […] The role of acetabular dysplasia and adult hip osteoarthritis is complex. […] Archeological studies demonstrate that the epidemiology of DDH may be changing.

• #31 Developmental Dysplasia of the Hip: How Many Risk Factors Are Needed?

  https://www.mdpi.com/2227-9067/10/6/968

  Developmental dysplasia of the hip (DDH) is a progressive condition that lacks clear diagnostic and management protocols, due to insufficient data. […] In North America ultrasound screening is carried out selectively in infants with risk factors such as breech presentation, family history, and clinical hip instability. […] The goal of early treatment is to assure normal development of the hip joint and prevention of late complications. Therefore, there is a need for high suspicion and routine surveillance of DDH in infants. […] 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. […] 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.

• #32 Developmental Dysplasia of the Hip: How Many Risk Factors Are Needed?

  https://www.mdpi.com/2227-9067/10/6/968

  All of these results are presented in Table 2. Multivariate analysis revealed that gender, prematurity, non-vertex birth presentation, oligohydramnios, gestational diabetes, maternal hypertension, family history, associated deformities, and swaddling are statistically significant risk factors for DDH presence in newborns. […] It is mandatory for children with two or more risk factors to be evaluated clinically and sonographically. […] Children with clinical signs of DDH should be mandatorily evaluated sonographically. […] DDH screening is recommended for each newborn for the long-term benefits of early DDH diagnosis, regardless of the risk factors.

• #33 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. […] 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.

• #34

  https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh

  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.

• #35 DEVELOPMENTAL DYSPLASIA OF THE HIP IN THE EXETER REGION: AN ANALYSIS OF EPIDEMIOLOGY AND RISK FACTORS OVER 11 YEARS | Bone & Joint

  https://boneandjoint.org.uk/doi/10.1302/1358-992X.94BSUPP_XIX.SWOC2010-015

  We investigated the local epidemiology of Developmental Dysplasia of the Hip (DDH), in order to define incidence, identify risk factors, and refine our policy on selective ultrasound screening. […] There were 182 children with DDH (245 hips) and 37,051 without. The incidence was thus 4.9 per 1000 live births. Female sex (adjusted OR 7.2, 95% CI 4.6-11.2), breech presentation (adjusted OR 24.3, 13.1-44.9), positive family history (adjusted OR 15.9, 11.0-22.9) and first or second pregnancy (adjusted OR 1.8, 1.5-2.3) were confirmed as risk factors (p0.001). In addition, there was an increased risk with vaginal delivery (adjusted OR 2.7, 1.6-4.5, p0.001) and postmaturity (OR 1.7, 1.2-2.4, p0.002). […] One in 200 children born in our area requires treatment for DDH. Using both established and novel risk factors, we can potentially calculate an individual child’s risk. Our work may contribute to the debate about selective versus universal ultrasound screening.

• #36 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. […] 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.

• #37 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.

• #38 The Epidemiology and Demographics of Hip Dysplasia

  https://search.emarefa.net/en/detail/BIM-456369-the-epidemiology-and-demographics-of-hip-dysplasia

  Chromosome 17q21 is strongly associated with DDH. […] Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. […] Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. […] Swaddling is strongly associated with DDH. […] Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. […] Associated conditions are congenital muscular torticollis and congenital foot deformities. […] The opposite hip is frequently abnormal when using rigorous radiographic assessments. […] The role of acetabular dysplasia and adult hip osteoarthritis is complex. […] Archeological studies demonstrate that the epidemiology of DDH may be changing.

• #39 Most Accessed | Journal of Epidemiology

  https://jeaweb.jp/journal/mostAccessed/individual.html?entry_id=2330

  Developmental dysplasia of the hip (DDH) is a cluster of hip development disorders that affects infants. […] The incidence of DDH-dislocation among Japanese children born from 2011 through 2013 was 0.076%. […] The rate of late diagnosis was 11.5%, which was similar between the regions. […] The risk of DDH-dislocation among girls is seven times higher than that of DHH-dislocation among boys. […] Infants born during the cold months (November-February) are more vulnerable to DDH-dislocation than infants born during other months.

• #40 The Epidemiology and Demographics of Hip Dysplasia

  https://search.emarefa.net/en/detail/BIM-456369-the-epidemiology-and-demographics-of-hip-dysplasia

  Chromosome 17q21 is strongly associated with DDH. […] Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. […] Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. […] Swaddling is strongly associated with DDH. […] Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. […] Associated conditions are congenital muscular torticollis and congenital foot deformities. […] The opposite hip is frequently abnormal when using rigorous radiographic assessments. […] The role of acetabular dysplasia and adult hip osteoarthritis is complex. […] Archeological studies demonstrate that the epidemiology of DDH may be changing.

• #41 DDH Epidemiology Revisited: Do We Need New Strategies?

  https://abjs.mums.ac.ir/article_8632.html

  Background: Although the developmental dysplasia of the hip (DDH) is well known to pediatric orthopedists, its etiology has still remained unknown and despite dedication of a vast majority of research, the results are still inadequate and confusing. […] The exact incidence of DDH and its relationship with known risk factors in Iran is still unknown. […] A significant correlation was found between DDH and breech presentation (P=0.000), torticollis (P=0.004), metatarsus adductus (P=0.024). […] The incidence of DDH is significantly high in the studied group of neonates, suggesting reevaluation of current approach to DDH. The screening protocols need to be improved with the help of trained pediatricians and other health professions.

• #42 Developmental dysplasia of the hip | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/developmental-dysplasia-of-the-hip?lang=us

  The reported incidence of developmental dysplasia of the hip varies between 1.5-20 per 1000 births, with the majority (60-80%) of abnormal hips resolving spontaneously within 2-8 weeks. […] Risk factors include female gender (M:F ~1:8), firstborn baby, family history, breech presentation, oligohydramnios, metatarsus adductus, and spina bifida.

• #43

  https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh

  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.

• #44 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

  There is ongoing debate as to whether foot abnormalities and oligohydramnios are truly risk factors. […] Early detection for any condition seeks to identify and treat individuals who have developed pathology but not yet sought medical attention. […] 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. […] Late diagnosis may occur as a result of screening failures, inappropriate swaddling or progression of pathology; efforts to minimise late cases may be hampered by lack of consensus in screening guidelines. […] The principle of multiple assessments until walking age is more important than the exact timing of the examinations. […] 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. […] Young children visit the GP for a range of reasons, including immunisations and common childhood illnesses, providing opportunities for repeated DDH assessment. […] DDH surveillance requires ongoing assessments until walking age.

• #45 Developmental Dysplasia of the Hip (DDH)

  https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro

  Screening for DDH is part of the physical examination of newborn and 6- to 8-week-old babies. Ultrasound screening is not currently recommended as a screening tool for all babies. […] There is a suggestion that the national screening programme in the UK, which has operated since 1969, has not resulted in any fewer operations for late disease. […] However, studies have shown that clinical screening for neonatal instability of the hip by experienced orthopaedic examiners significantly reduces the incidence of late-presenting (walking) DDH. […] A Cochrane review found that there was insufficient evidence to give clear recommendations regarding screening for DDH. There was some inconsistent evidence that universal ultrasound results in a significant increase in treatment compared to the use of targeted ultrasound or clinical examination alone. The review concluded that ultrasound strategies have not been demonstrated to improve clinical outcomes including late-diagnosed DDH and surgery. […] A large long-term randomised controlled study of universal or selective ultrasound versus a well-done physical examination, showed higher treatment rates but no reduction in late cases of DDH.

• #46 Screening for developmental dysplasia of the hip: an evidence-based approach to practice | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/developmental-dysplasia-of-the-hip/

  The limited strength of the AAOS recommendations clearly demonstrates the substantive work that remains to be done to strengthen the existing evidence in support of DDH detection and management. However, the guideline also presented some data that helps to answer the gaps in care for this condition. In regards to screening and detection of DDH, moderate evidence suggests universal ultrasound screening of newborn infants is not necessary, and may instead lead to overtreatment in cases that would have spontaneously resolved. […] Two moderate strength studies confirmed a significant relationship between selective prospective ultrasound screening and preventing late dislocations in infants with a history of clinical instability and/or risk factors of breech presentation and family history. […] Finally, the development of the AAOS guidelines for DDH served to emphasize the need to strengthen the existing evidence in order to provide the best treatment recommendations to guide the practicing physician. A concerted and collaborative research effort among the orthopaedic surgeon community will be required to improve the evidence and strengthen the current recommendations.

• #47 Epidemiology and Screening of Developmental Dysplasia of the Hip in Europe: A Scoping Review

  https://www.mdpi.com/2571-841X/7/1/10

  Developmental hip dysplasia or developmental dysplasia of the hip (DDH) includes a wide range of deformities of the hip, such as congenital dysplasia, subluxation, and dislocation. It is usually identified through neonatal screening during the first 6–8 weeks of life. The incidence of DDH ranges from 1–7% in neonates among some populations, but this may vary among different ethnicities and countries. A consensus about the ideal age for screening has not been reached to date. […] 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. […] There is no consensus regarding the appropriate screening methods for DDH in Europe or the age at which screening should be performed. Most studies recommend sonographic and/or clinical assessment as a screening tool.

• #48 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Developmental dysplasia of the hip occurs due to an abnormal hip development, presenting in infancy or early childhood with a spectrum ranging from dysplasia to dislocation of the hip joint. […] The incidence of developmental dysplasia of the hip in the UK and US is approximately 10 per 1000 live births, and at birth, 1 in 1000 cases have dislocated hips. In Native Americans, the reported incidence is significantly higher, estimated to be more than 10 times higher. However, in African individuals, developmental dysplasia of the hip is rarely identified. Therefore, the incidence varies with age at diagnosis, race, and modality by which diagnosis was made. […] 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.

• #49 Developmental Dysplasia of the Hip (DDH)

  https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro

  Screening for DDH is part of the physical examination of newborn and 6- to 8-week-old babies. Ultrasound screening is not currently recommended as a screening tool for all babies. […] There is a suggestion that the national screening programme in the UK, which has operated since 1969, has not resulted in any fewer operations for late disease. […] However, studies have shown that clinical screening for neonatal instability of the hip by experienced orthopaedic examiners significantly reduces the incidence of late-presenting (walking) DDH. […] A Cochrane review found that there was insufficient evidence to give clear recommendations regarding screening for DDH. There was some inconsistent evidence that universal ultrasound results in a significant increase in treatment compared to the use of targeted ultrasound or clinical examination alone. The review concluded that ultrasound strategies have not been demonstrated to improve clinical outcomes including late-diagnosed DDH and surgery. […] A large long-term randomised controlled study of universal or selective ultrasound versus a well-done physical examination, showed higher treatment rates but no reduction in late cases of DDH.

• #50 Screening for developmental dysplasia of the hip: an evidence-based approach to practice | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/developmental-dysplasia-of-the-hip/

  The limited strength of the AAOS recommendations clearly demonstrates the substantive work that remains to be done to strengthen the existing evidence in support of DDH detection and management. However, the guideline also presented some data that helps to answer the gaps in care for this condition. In regards to screening and detection of DDH, moderate evidence suggests universal ultrasound screening of newborn infants is not necessary, and may instead lead to overtreatment in cases that would have spontaneously resolved. […] Two moderate strength studies confirmed a significant relationship between selective prospective ultrasound screening and preventing late dislocations in infants with a history of clinical instability and/or risk factors of breech presentation and family history. […] Finally, the development of the AAOS guidelines for DDH served to emphasize the need to strengthen the existing evidence in order to provide the best treatment recommendations to guide the practicing physician. A concerted and collaborative research effort among the orthopaedic surgeon community will be required to improve the evidence and strengthen the current recommendations.

• #51 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

  There is ongoing debate as to whether foot abnormalities and oligohydramnios are truly risk factors. […] Early detection for any condition seeks to identify and treat individuals who have developed pathology but not yet sought medical attention. […] 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. […] Late diagnosis may occur as a result of screening failures, inappropriate swaddling or progression of pathology; efforts to minimise late cases may be hampered by lack of consensus in screening guidelines. […] The principle of multiple assessments until walking age is more important than the exact timing of the examinations. […] 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. […] Young children visit the GP for a range of reasons, including immunisations and common childhood illnesses, providing opportunities for repeated DDH assessment. […] DDH surveillance requires ongoing assessments until walking age.

• #52 Known risk factors of the developmental dysplasia of the hip predicting more severe clinical presentation and failure of Pavlik harness treatment | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03935-0

  Developmental dysplasia of the hip (DDH) varies from mild instability of the hip to subluxation or total dislocation of the joint. Well-known risk factors of DDH include pre-natal breech position, female sex, positive family history, hip side, primiparity and the mode of delivery. […] The incidence of DDH has varied in the previous studies. Approximately 1 of 1000 child is born with a dislocated hip, but all the mild forms of DDH included, the incidence has reported to be 17% of the newborns. […] If not treated correctly in infancy, DDH can lead to difficult rigid luxation of the femur head, leading to long spica casting treatments or surgical operations and further frequently leading to early total hip replacement. […] Ultrasound screening routinely after birth is not recommended, as it leads to overtreatment of the condition and does not help to avoid late detected cases of DDH.

• #53 Known risk factors of the developmental dysplasia of the hip predicting more severe clinical presentation and failure of Pavlik harness treatment | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03935-0

  However, the evidence of selective ultrasound screening is also inadequate and therefore there is no universal recommendations of ultrasound screening for hip dysplasia. […] The most widely used method for treatment of DDH is Pavlik harness treatment, which has shown over 95% success rates in previous studies. […] Breech presentation was strongly associated with Ortolani positivity. […] Ortolani positivity, positive family history and girl sex were associated with ending up for spica casting and/or operative treatment. […] Breech presentation seems to increase the risk of Ortolani positive DDH. […] Positive family history and girl sex are associated with the most severe cases of developmental dysplasia of the hip, and it may predispose to the failure of the Pavlik harness treatment.

• #54 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

  There is ongoing debate as to whether foot abnormalities and oligohydramnios are truly risk factors. […] Early detection for any condition seeks to identify and treat individuals who have developed pathology but not yet sought medical attention. […] 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. […] Late diagnosis may occur as a result of screening failures, inappropriate swaddling or progression of pathology; efforts to minimise late cases may be hampered by lack of consensus in screening guidelines. […] The principle of multiple assessments until walking age is more important than the exact timing of the examinations. […] 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. […] Young children visit the GP for a range of reasons, including immunisations and common childhood illnesses, providing opportunities for repeated DDH assessment. […] DDH surveillance requires ongoing assessments until walking age.

• #55 Update on the management of infant and toddler developmental dysplasia of the hip

  https://www1.racgp.org.au/ajgp/2021/april/infant-and-toddler-developmental-dysplasia-of-the

  As previously stated by Williams, repeated, carefully performed clinical examinations of the paediatric hip from newborn to walking age remain the best method for early detection of DDH. […] The priority is differentiating between neonatal hip instability, acetabular dysplasia and subluxation or dislocation of the hip, as severity of involvement determines the treatment required to obtain a concentric reduction. […] In the presence of risk factors or with an equivocal clinical examination, ultrasonography is the reference standard in children aged 6 months. […] The pelvic radiograph is the benchmark for surveillance of acetabular development, especially with the introduction of the International Hip Dysplasia Institute (IHDI) classification method, which demonstrates excellent interexaminer reliability even when ossific nuclei are absent or delayed.

• #56 Update on the management of infant and toddler developmental dysplasia of the hip

  https://www1.racgp.org.au/ajgp/2021/april/infant-and-toddler-developmental-dysplasia-of-the

  As previously stated by Williams, repeated, carefully performed clinical examinations of the paediatric hip from newborn to walking age remain the best method for early detection of DDH. […] The priority is differentiating between neonatal hip instability, acetabular dysplasia and subluxation or dislocation of the hip, as severity of involvement determines the treatment required to obtain a concentric reduction. […] In the presence of risk factors or with an equivocal clinical examination, ultrasonography is the reference standard in children aged 6 months. […] The pelvic radiograph is the benchmark for surveillance of acetabular development, especially with the introduction of the International Hip Dysplasia Institute (IHDI) classification method, which demonstrates excellent interexaminer reliability even when ossific nuclei are absent or delayed.

• #57 New Guidelines for Evaluation and Referral of DDH – International Hip Dysplasia Institute

  https://hipdysplasia.org/new-guidelines-for-evaluation-and-referral-of-ddh/

  After 16 years the American Academy of Pediatrics has updated and revised the Guidelines for Evaluation and Referral of Developmental Dysplasia of the Hip (DDH). This new report was published in December, 2016 in Pediatrics a major scientific journal. […] 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. The report notes that no screening program has been shown to completely eliminate the risk of a late-presenting dislocated hip. […] Finally, the report recognizes that the objective of surveillance is to detect significant hip dysplasia so that early treatment may be initiated. However, the diagnosis and treatment of mild dysplasia remains controversial.

• #58 New Guidelines for Evaluation and Referral of DDH – International Hip Dysplasia Institute

  https://hipdysplasia.org/new-guidelines-for-evaluation-and-referral-of-ddh/

  After 16 years the American Academy of Pediatrics has updated and revised the Guidelines for Evaluation and Referral of Developmental Dysplasia of the Hip (DDH). This new report was published in December, 2016 in Pediatrics a major scientific journal. […] 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. The report notes that no screening program has been shown to completely eliminate the risk of a late-presenting dislocated hip. […] Finally, the report recognizes that the objective of surveillance is to detect significant hip dysplasia so that early treatment may be initiated. However, the diagnosis and treatment of mild dysplasia remains controversial.

• #59 Update on the management of infant and toddler developmental dysplasia of the hip

  https://www1.racgp.org.au/ajgp/2021/april/infant-and-toddler-developmental-dysplasia-of-the

  As previously stated by Williams, repeated, carefully performed clinical examinations of the paediatric hip from newborn to walking age remain the best method for early detection of DDH. […] The priority is differentiating between neonatal hip instability, acetabular dysplasia and subluxation or dislocation of the hip, as severity of involvement determines the treatment required to obtain a concentric reduction. […] In the presence of risk factors or with an equivocal clinical examination, ultrasonography is the reference standard in children aged 6 months. […] The pelvic radiograph is the benchmark for surveillance of acetabular development, especially with the introduction of the International Hip Dysplasia Institute (IHDI) classification method, which demonstrates excellent interexaminer reliability even when ossific nuclei are absent or delayed.

• #60 Update on the management of infant and toddler developmental dysplasia of the hip

  https://www1.racgp.org.au/ajgp/2021/april/infant-and-toddler-developmental-dysplasia-of-the

  As previously stated by Williams, repeated, carefully performed clinical examinations of the paediatric hip from newborn to walking age remain the best method for early detection of DDH. […] The priority is differentiating between neonatal hip instability, acetabular dysplasia and subluxation or dislocation of the hip, as severity of involvement determines the treatment required to obtain a concentric reduction. […] In the presence of risk factors or with an equivocal clinical examination, ultrasonography is the reference standard in children aged 6 months. […] The pelvic radiograph is the benchmark for surveillance of acetabular development, especially with the introduction of the International Hip Dysplasia Institute (IHDI) classification method, which demonstrates excellent interexaminer reliability even when ossific nuclei are absent or delayed.

• #61 Update on the management of infant and toddler developmental dysplasia of the hip

  https://www1.racgp.org.au/ajgp/2021/april/infant-and-toddler-developmental-dysplasia-of-the

  Recent advances in surveillance, diagnosis and management of the DDH spectrum have improved outcomes for many patients, but much remains to be discovered. […] In the meantime, the universal tenet in DDH care remains that prompt diagnosis and management are the most important factors related to outcome; it is important to be cognisant about developmental hip pathology in asymptomatic patients through infancy and childhood.

• #62 Update on the management of infant and toddler developmental dysplasia of the hip

  https://www1.racgp.org.au/ajgp/2021/april/infant-and-toddler-developmental-dysplasia-of-the

  As previously stated by Williams, repeated, carefully performed clinical examinations of the paediatric hip from newborn to walking age remain the best method for early detection of DDH. […] The priority is differentiating between neonatal hip instability, acetabular dysplasia and subluxation or dislocation of the hip, as severity of involvement determines the treatment required to obtain a concentric reduction. […] In the presence of risk factors or with an equivocal clinical examination, ultrasonography is the reference standard in children aged 6 months. […] The pelvic radiograph is the benchmark for surveillance of acetabular development, especially with the introduction of the International Hip Dysplasia Institute (IHDI) classification method, which demonstrates excellent interexaminer reliability even when ossific nuclei are absent or delayed.

• #63 Developmental dysplasia of the hip: What has changed in the last 20 years?

  https://www.wjgnet.com/2218-5836/full/v6/i11/886.htm

  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. Early diagnosis and treatment is critical to provide the best possible functional outcome. Different screening programs have been devised to recognize DDH as soon as possible. Despite efforts to recognize and treat all cases of DDH soon after birth, the diagnosis is delayed in some children. Screening is important because the condition is easily treated when caught early, but difficult to treat when detected late and can lead to long-term disability. The physical examination is still the most important means of detection. Periodic physical examination should be performed on all children until walking age. Despite our better understanding of the pathology and all current methods of screening, many young adults with dysplasia who require hip arthroplasty are not detected at birth. In the future, genetic profiling may improve matters.

• #64 Developmental dysplasia of the hip: What has changed in the last 20 years?

  https://www.wjgnet.com/2218-5836/full/v6/i11/886.htm

  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. Early diagnosis and treatment is critical to provide the best possible functional outcome. Different screening programs have been devised to recognize DDH as soon as possible. Despite efforts to recognize and treat all cases of DDH soon after birth, the diagnosis is delayed in some children. Screening is important because the condition is easily treated when caught early, but difficult to treat when detected late and can lead to long-term disability. The physical examination is still the most important means of detection. Periodic physical examination should be performed on all children until walking age. Despite our better understanding of the pathology and all current methods of screening, many young adults with dysplasia who require hip arthroplasty are not detected at birth. In the future, genetic profiling may improve matters.

• #65

  https://pjms.org.pk/index.php/pjms/article/view/10922

  Objective: This study aims to determine prevalence, risk factors and geographic distribution of Developmental Dysplasia of the Hip in Pakistan and to assess the cumulative outcomes of various treatments used and propose recommendations to establish preventive strategies and best treatment practices in Pakistan. […] The study included 755 patients with 1,107 affected hips, aged one day to over eight years. Of these, 86.25% were diagnosed after 18 months, 11.7% were over eight years. […] This study leverages PORP registry data to identify DDH demographics, risk factors, and treatment outcomes. It highlights the need for establishment of MSK screening protocols, to diagnose DDH at earliest, to prevent development of disability of late treatment and enhance best practices in DDH management.

• #66 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

  Cases of late diagnosed developmental dysplasia of the hip (DDH) have increased in Australia in recent years despite an ongoing clinical screening program and increasing use of selective ultrasonography screening. […] The incidence is around seven per 1000 live births. […] For children born in 2003-2009, 11.5% of cases were a late diagnosis after three months of age. […] Current DDH screening practices are criticised for failure to adhere to the general principles of health screening, and there is variability in Australian neonatal hip screening guidelines. […] DDH results from a combination of environmental and genetic factors. […] The highest DDH risk is in female breech babies (absolute risk 120/1000), followed by females with a family history (44/1000), then male breech babies (26/1000).

• #67 Most Accessed | Journal of Epidemiology

  https://jeaweb.jp/journal/mostAccessed/individual.html?entry_id=2330

  Developmental dysplasia of the hip (DDH) is a cluster of hip development disorders that affects infants. […] The incidence of DDH-dislocation among Japanese children born from 2011 through 2013 was 0.076%. […] The rate of late diagnosis was 11.5%, which was similar between the regions. […] The risk of DDH-dislocation among girls is seven times higher than that of DHH-dislocation among boys. […] Infants born during the cold months (November-February) are more vulnerable to DDH-dislocation than infants born during other months.

• #68 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

  There is ongoing debate as to whether foot abnormalities and oligohydramnios are truly risk factors. […] Early detection for any condition seeks to identify and treat individuals who have developed pathology but not yet sought medical attention. […] 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. […] Late diagnosis may occur as a result of screening failures, inappropriate swaddling or progression of pathology; efforts to minimise late cases may be hampered by lack of consensus in screening guidelines. […] The principle of multiple assessments until walking age is more important than the exact timing of the examinations. […] 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. […] Young children visit the GP for a range of reasons, including immunisations and common childhood illnesses, providing opportunities for repeated DDH assessment. […] DDH surveillance requires ongoing assessments until walking age.

• #69 Developmental dysplasia of the hip: What has changed in the last 20 years?

  https://www.wjgnet.com/2218-5836/full/v6/i11/886.htm

  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. Early diagnosis and treatment is critical to provide the best possible functional outcome. Different screening programs have been devised to recognize DDH as soon as possible. Despite efforts to recognize and treat all cases of DDH soon after birth, the diagnosis is delayed in some children. Screening is important because the condition is easily treated when caught early, but difficult to treat when detected late and can lead to long-term disability. The physical examination is still the most important means of detection. Periodic physical examination should be performed on all children until walking age. Despite our better understanding of the pathology and all current methods of screening, many young adults with dysplasia who require hip arthroplasty are not detected at birth. In the future, genetic profiling may improve matters.

• #70 Update on the management of infant and toddler developmental dysplasia of the hip

  https://www1.racgp.org.au/ajgp/2021/april/infant-and-toddler-developmental-dysplasia-of-the

  Recent advances in surveillance, diagnosis and management of the DDH spectrum have improved outcomes for many patients, but much remains to be discovered. […] In the meantime, the universal tenet in DDH care remains that prompt diagnosis and management are the most important factors related to outcome; it is important to be cognisant about developmental hip pathology in asymptomatic patients through infancy and childhood.

• #71 Developmental Dysplasia of the Hip (DDH) in Saudi Arabia: Time to Wake up. A Systematic Review (1980-2018)

  https://www.scirp.org/html/4-1890384_99802.htm

  The objective of this systematic literature review was to assess the incidence of DDH among the Saudi Arabian population. […] The epidemiology of any disease is important to find the incidence and risk factors and implement preventive measures so that early diagnosis and treatment could lead to a reduction in heightened morbidity in later life. DDH is unfortunately common in Saudi Arabian children, and swaddling and consanguineous marriage still remain high. […] In conclusion, this analysis shows that the prevalence of DDH in Saudi Arabia is 10.46/1000 live births, with risk factors of consanguinity, breech presentation, and family history. This study further highlights the reluctance of many trained pediatric orthopedic surgeons to perform epidemiological studies on DDH, which is proved by 5 reports in last 3 decades. Additional multicenter, prospective studies are needed to address the correct incidence, and more efforts are needed to screen newborns for DDH and treat them before they leave the hospitals.

• #72 Screening, diagnosis, treatment and outcomes of developmental dysplasia of the hip in Brazilian population: a scoping review | BMJ Open

  https://bmjopen.bmj.com/content/15/2/e094660

  The published literature about screening for DDH in Brazil is limited. The above epidemiological studies take different approaches to making a diagnosis of DDH but do not provide any data concerning a comparison of screening approaches or long-term outcomes past diagnosis. […] Wide variation among incidence and prevalence of DDH in Brazil was found among reported data, with numbers as low as 0.75/1000 in a study by Ferreira to 56.4/1000 in Motta et al’s study. […] There are currently no national guidelines for DDH screening in Brazil. Without understanding the burden of the disease, it is difficult to make informed decisions about the most appropriate screening protocol. More work should be done to understand the prevalence of DDH in all of Brazil.

• #73 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/

  Developmental dysplasia of the hip (DDH) is common in Oman in clinical practice, but the incidence in Oman is still unknown. This study aimed to evaluate the incidence and characteristic features of DDH in the Omani population managed at Khoula Hospital (KH). The estimated DDH incidence in this study is 1.05/1000 live births/year. Based on the national live births annual records from Oman National Center for Statistics and Information, this study estimated the DDH incidence to be 1.05/1000 live births. The study included 795 DDH-diagnosed patients, out of which 652 (82.0%) were female and 143 (18.0%) were male, giving a ratio of 4.5:1. At least one risk factor was present for 581 (73.1%) patients. The prevalence of the first child in the family was 33.0% and oligohydramnios 10.9%. The incidence rate is calculated on regional and national bases after getting the annual natality rate from the NCSI. The DDH incidence in the population of this study was 1.05 (0.911.30)/1000 live births/year, which is comparable with the international figures. The calculated incidence for Muscat governate is 1.51/1000 live births/year. The only way to determine the exact incidence is to run a prospective mass screening program. We recommend conducting a multicenter prospective study to estimate DDH incidence in Oman accurately. National guidelines and screening programs must be developed and executed for early diagnosis, documentation, and management.

• #74 Update on the management of infant and toddler developmental dysplasia of the hip

  https://www1.racgp.org.au/ajgp/2021/april/infant-and-toddler-developmental-dysplasia-of-the

  Recent advances in surveillance, diagnosis and management of the DDH spectrum have improved outcomes for many patients, but much remains to be discovered. […] In the meantime, the universal tenet in DDH care remains that prompt diagnosis and management are the most important factors related to outcome; it is important to be cognisant about developmental hip pathology in asymptomatic patients through infancy and childhood.

• #75 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). […] Children born premature, with low birth weights, or to multifetal pregnancies are somewhat protected from DDH. […] Certain HLA A, B, and D types demonstrate an increase in DDH.

• #76 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Developmental dysplasia of the hip occurs due to an abnormal hip development, presenting in infancy or early childhood with a spectrum ranging from dysplasia to dislocation of the hip joint. […] The incidence of developmental dysplasia of the hip in the UK and US is approximately 10 per 1000 live births, and at birth, 1 in 1000 cases have dislocated hips. In Native Americans, the reported incidence is significantly higher, estimated to be more than 10 times higher. However, in African individuals, developmental dysplasia of the hip is rarely identified. Therefore, the incidence varies with age at diagnosis, race, and modality by which diagnosis was made. […] 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.

• #77 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

  There is ongoing debate as to whether foot abnormalities and oligohydramnios are truly risk factors. […] Early detection for any condition seeks to identify and treat individuals who have developed pathology but not yet sought medical attention. […] 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. […] Late diagnosis may occur as a result of screening failures, inappropriate swaddling or progression of pathology; efforts to minimise late cases may be hampered by lack of consensus in screening guidelines. […] The principle of multiple assessments until walking age is more important than the exact timing of the examinations. […] 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. […] Young children visit the GP for a range of reasons, including immunisations and common childhood illnesses, providing opportunities for repeated DDH assessment. […] DDH surveillance requires ongoing assessments until walking age.

• #78 Developmental dysplasia of the hip (DDH) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/developmental-dysplasia-hip-ddh

  Developmental dysplasia of the hip (DDH or hip dysplasia) is a relatively common condition in the developing hip joint. It occurs once in every 1,000 live births. […] The greatest incidence of DDH occurs in first-born females with a history of a close relative with the condition and/or history of breech position in utero. […] Newborn screening for congenital hip dysplasia has allowed for earlier detection of this hip condition. If identified early, treatment generally entails a harness or brace and is quite successful. The older a child presents, the more likely that surgery will be necessary. […] Continued follow-up even after successful treatment of hip dysplasia in an infant is very important because as a child grows into an adolescent the socket needs to be monitored to be sure that it, too, is developing properly. Occasionally, additional surgeries will be needed to help deepen a socket and minimize the risk of arthritis as an adult.

• #79 Developmental dysplasia of the hip: What has changed in the last 20 years?

  https://www.wjgnet.com/2218-5836/full/v6/i11/886.htm

  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. Early diagnosis and treatment is critical to provide the best possible functional outcome. Different screening programs have been devised to recognize DDH as soon as possible. Despite efforts to recognize and treat all cases of DDH soon after birth, the diagnosis is delayed in some children. Screening is important because the condition is easily treated when caught early, but difficult to treat when detected late and can lead to long-term disability. The physical examination is still the most important means of detection. Periodic physical examination should be performed on all children until walking age. Despite our better understanding of the pathology and all current methods of screening, many young adults with dysplasia who require hip arthroplasty are not detected at birth. In the future, genetic profiling may improve matters.

• #80 Developmental Dysplasia of the Hip (DDH) in Saudi Arabia: Time to Wake up. A Systematic Review (1980-2018)

  https://www.scirp.org/html/4-1890384_99802.htm

  The objective of this systematic literature review was to assess the incidence of DDH among the Saudi Arabian population. […] The epidemiology of any disease is important to find the incidence and risk factors and implement preventive measures so that early diagnosis and treatment could lead to a reduction in heightened morbidity in later life. DDH is unfortunately common in Saudi Arabian children, and swaddling and consanguineous marriage still remain high. […] In conclusion, this analysis shows that the prevalence of DDH in Saudi Arabia is 10.46/1000 live births, with risk factors of consanguinity, breech presentation, and family history. This study further highlights the reluctance of many trained pediatric orthopedic surgeons to perform epidemiological studies on DDH, which is proved by 5 reports in last 3 decades. Additional multicenter, prospective studies are needed to address the correct incidence, and more efforts are needed to screen newborns for DDH and treat them before they leave the hospitals.

Zobacz więcej