Objectives: To review evidence for the increased incidence of late diagnosed developmental dysplasia of the hip (DDH) in South Australia; to identify perinatal risk factors associated with late DDH in babies born between 2003 and 2009 in SA.
Design: Linkage study of data collected prospectively by the South Australian Birth Defects Register (SABDR) and the Pregnancy Outcome Statistics Unit (SA Department of Health), supplemented by medical records review.
Participants: All children born 2003–2009 in whom DDH was diagnosed between 3 months and 5 years of age and notified to the SABDR (data inclusion range, 2003–2014). Children with teratological hip dislocations and other major congenital abnormalities were excluded.
Main outcome measures: Uni- and multivariable analyses were performed to identify perinatal risk factors for late diagnosed DDH.
Results: The incidence of late diagnosed DDH in babies born 2003–2009 was 0.77 per 1000 live births, contrasting with the figure of 0.22 per 1000 live births during 1988–2003. Significant perinatal risk factors were birth in a rural hospital (v metropolitan public hospital: odds ratio [OR], 2.47; CI, 1.37–4.46; P = 0.003), and being the second child (v being the first-born: OR, 1.69; CI, 1.08–2.66; P = 0.023). Breech presentation was highly significant as a protective factor when compared with cephalic presentation (OR, 0.25; CI, 0.12–0.54; P < 0.001).
Conclusions: The incidence of late DDH has increased in SA despite an ongoing clinical screening program. Increased awareness, education, and avoidance of inappropriate lower limb swaddling are necessary to reverse this trend.
- 1. Tschauner C, Furntrath F, Saba Y, et al. Developmental dysplasia of the hip: impact of sonographic newborn hip screening on the outcome of early treated decentered hip joints-a single center retrospective comparative cohort study based on Graf’s method of hip ultrasonography. J Child Orthop 2011; 5: 415-424.
- 2. Thallinger C, Pospischill R, Ganger R, et al. Long-term results of a nationwide general ultrasound screening system for developmental disorders of the hip: the Austrian hip screening program. J Child Orthop 2014; 8: 3-10.
- 3. Williams N, Foster BK, Cundy PJ. Is swaddling damaging our babies’ hips? Med J Aust 2012; 197: 272. <MJA full text>
- 4. Azzopardi T, Van Essen P, Cundy PJ, et al. Late diagnosis of developmental dysplasia of the hip: an analysis of risk factors. J Pediatr Orthop B 2011; 20: 1-7.
- 5. Birke O, Wallgren L, Bridge C, et al. Late open reduction and pelvic ± femoral osteotomy for increasing numbers of missed walking age DDH hip dislocation vs early treatment with Pavlik harness — evaluation at 5 years follow-up [unpublished presentation]. Australian Paediatric Orthopaedic Society annual scientific meeting, Noosa (Australia), 22 Sept 2012.
- 6. Lisle R, Boekelaar M, Stannage K, Whitewood C. Delayed diagnosis of developmental dislocation of the hip: the Western Australian experience. ANZ J Surg 2012; 82: 612-615.
- 7. Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip; American Academy of Pediatrics. Clinical practice guideline: early detection of developmental dysplasia of the hip. Pediatrics 2000; 105: 896-905.
- 8. Wicart P, Bocquet A, Gelbert N, et al. Congenital dislocation of the hip: optimal screening strategies in 2014. Orthop Traumatol Surg Res 2014; 100(6 Suppl): S339-S347.
- 9. Price KR, Dove R, Hunter JB. Current screening recommendations for developmental dysplasia of the hip may lead to an increase in open reduction. Bone Joint J 2013; 95-B: 846-850.
- 10. Clarke NM. Swaddling and hip dysplasia: an orthopaedic perspective. Arch Dis Child 2014; 99: 5-6.
- 11. Price CT. Swaddling and hip dysplasia: new observations. Commentary on an article by Enbo Wang, MD, PhD, et al.: “Does swaddling influence developmental dysplasia of the hip? An experimental study of the traditional straight-leg swaddling model in neonatal rats”. J Bone Joint Surg Am 2012; 94: e92.
- 12. Shorter D, Hong T, Osborn DA. Cochrane review: screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health 2013; 8: 11-54.
- 13. Lee CB, Mata-Fink A, Millis MB, Kim YJ. Demographic differences in adolescent-diagnosed and adult-diagnosed acetabular dysplasia compared with infantile developmental dysplasia of the hip. J Pediatr Orthop 2013; 33: 107-111.
- 14. International Hip Dysplasia Institute. Hip-healthy swaddling [video]. http://hipdysplasia.org/developmental-dysplasia-of-the-hip/hip-healthy-swaddling/ (accessed Sept 2015).
- 15. Hip Hip Hooray: raising awareness for hip dysplasia [website]. http://www.hiphiphoorayddh.org/ (accessed Sept 2015).
- 16. Healthy Hips Australia [website]. http://www.healthyhipsaustralia.org.au/ (accessed Sept 2015).
- 17. Raimann A, Baar A, Raimann R, Morcuende JA. Late developmental dislocation of the hip after initial normal evaluation: a report of five cases. J Pediatr Orthop 2007; 27: 32-36.
- 18. Donnan L, The Royal Children’s Hospital Melbourne. Developmental dysplasia of the hip [website, video]. Melbourne: Department of Education and Early Childhood Development (Victoria), 2011. http://www.ddheducation.com/ (accessed Sept 2015).
- 19. Mahan ST, Kasser JR. Does swaddling influence developmental dysplasia of the hip? Pediatrics 2008; 121: 177-178.
- 20. Wang E, Liu T, Li J, et al. Does swaddling influence developmental dysplasia of the hip? An experimental study of the traditional straight-leg swaddling model in neonatal rats. J Bone Joint Surg Am 2012; 94: 1071-1077.
- 21. Yamamuro T, Ishida K. Recent advances in the prevention, early diagnosis, and treatment of congenital dislocation of the hip in Japan. Clin Orthop Relat Res 1984; (184): 34-40.
- 22. Graham SM, Manara J, Chokotho L, Harrison WJ. Back-carrying infants to prevent developmental hip dysplasia and its sequelae: is a new public health initiative needed? J Pediatr Orthop 2015; 35: 57-61.
- 23. Roposch A, Graf R, Wright JG. Determining the reliability of the Graf classification for hip dysplasia. Clin Orthop Relat Res 2006; 447: 119-124.
- 24. Tegnander A, Holen KJ, Terjesen T. The natural history of hip abnormalities detected by ultrasound in clinically normal newborns: a 6–8 year radiographic follow-up study of 93 children. Acta Orthop Scand 1999; 70: 335-337.
- 25. Imrie M, Scott V, Stearns P, et al. Is ultrasound screening for DDH in babies born breech sufficient? J Child Orthop 2010; 4: 3-8.
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