Developmental Dysplasia of the Hip
Conditions
Keywords
Developmental dysplasia of the hip,, DDH,, avascular necrosis,, late detected cases
Brief summary
Early treatment is considered essential for developmental dysplasia of the hip (DDH), but the choice of screening strategy is debated. The investigators evaluated the effect of a selective ultrasound (US) screening programme. All infants born in a defined region during 1991-2006 with increased risk of DDH, i.e. clinical hip instability, breech presentation, congenital foot deformities or a family history of DDH, were subjected to US screening at age one to three days. Severe sonographic dysplasia and/or dislocatable/dislocated hips were treated with abduction splints. Mild dysplasia and/or pathological instability, i.e. not dislocatable/dislocated hips were followed clinically and sonographically until spontaneous resolution, or until treatment became necessary. The minimum observation period was 5,5 years.
Detailed description
Of 81564 newborns, 11539 (14,1%) were identified as at risk, of which 11190 (58% girls) were included for further analyses. Of the 81564 infants, 2433 (3•0%) received early treatment; 1882 (2,3%) from birth and 551 (0,7%) after six weeks or more of clinical and sonographic surveillance. Another 2700 (3,3%) normalised spontaneously after watchful waiting from birth. Twenty-six infants (0,32 per 1000, 92% girls, two from the risk group) presented with late subluxated/dislocated hips (after one month of age). Another 126 (1,5 per 1000, 83% girls, one from the risk group) were treated after isolated late residual dysplasia. Thirty-one children (0,38 per 1000) had surgical treatment before age five years. Avascular necrosis was diagnosed in seven of all children treated (0.27%), four after early and three after late treatment. Interpretation The first 16 years of a standardised selective US screening programme for DDH resulted in acceptable rates of early treatment and US follow-ups, and low rates of late subluxated/dislocated hips compared to similar studies.
Interventions
None listed
Sponsors
Helse Vest
University of Bergen
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* born at Haukeland University hospital January 1991-December 2006
Exclusion criteria
* Children with DDH due to neuromuscular syndromes were excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| late dislocated or subluxated hips | first 5 years of life | late detected after 1 month of life, requiring treatment |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of participants who receive ultrasound follow-up for 6 weeks or more | first months of life | Number of participants who receive ultrasound follow-up (i.e sonographic surveillance) for 6 weeks or more |
| early treatment | first months of life | abduction treatment for DDH |
| first surgical treatment | first five years of life | the need for a first surgical treatment the first 5 years of life (closed and open reductions, osteotomies) |
| avascular necrosis of femoral head | first five years of life | avascular necrosis of femoral head as complication to treatment |
Countries
Norway
Outcome results
None listed