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Epidemiological study confirms higher developmental dysplastic hip rates

Issue: Issue 4 2011

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COPENHAGEN – According to a study conducted by British investigators, the rate of developmental dysplastic hip is likely closer to 4 or 5 cases per 1,000 births. However, they found that late presentations of this condition have decreased during the period between 1998 and 2008.

Female babies, infants born in the breech position or after 38 weeks, during a woman’s first or second pregnancy, and with vaginal deliveries all positively correlated with an increased risk of developmental dysplastic hip (DDH) in a study conducted by Thomas Ball and colleagues.

“Family history is associated with a 15 times increased risk of DDH,” Ball said in a presentation at the 12th EFORT 2011 Congress, here. “What we really ought to do is calculate the risk, case by case.”

The investigation, spearheaded by pediatric orthopaedic surgeon Peter J.A. Cox, FRCS, compared 182 children in the study group with controls consisting of other births in the area. The study was conducted from 1998 to 2008 in the Exeter region of England. Cox and colleagues collected the data prospectively for the study, which was designed to assess the screening skills of their existent DDH screening program.

Standard protocol is to screen all newborns for DDH and then perform a hip exam or ultrasound selectively in children with a positive family history or those who were born in breech position, but Ball suggested this may soon change based on these results.

Reference:

• Ball T, Day C, Strain D, Cox P. Developmental dysplasia of the hip in the Exeter Region: An analysis of epidemiology and risk factors over 11 years. Paper #2929. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen.

There is quite a bit of bias because you do not know about all the other children who have had no imaging like ultrasound or X-rays because we know there are many of them below the age 10 that have significant dysplasia undetected and clinically we find them so far. So there is some concern about this and I feel that 4% or 5% or 4.9 per 1,000 is rather low compared to figures from Germany or Austria. But, it was a great study and you should keep on in this field.

— Rüdiger Krauspe, MD, PhD
Session moderator
Department of Orthopedics, Heinrich-Heine University Dusseldorf
Germany

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