Differences in risk factors between early and late diagnosed DDH

Phillipa Sharpe ^1*, Kishore Mulpuri ¹, Annabelle Chan ² and Peter Cundy ¹

¹ Women's and Children's Hospital, Australia
² Department of Health, Australia

^* To whom correspondence should be addressed. E-mail: cywhs.sabdr{at}cywhs.sa.gov.au.

Accepted 26 October 2005

Abstract

Background: Developmental dysplasia of the hip (DDH) is a commonly diagnosed orthopaedic condition affecting 7.3 per 1000 births in South Australia. Clinical screening programmes exist to identify the condition early to gain the maximum benefit from early treatment. Although these screening programmes are effective, there are still cases that are missed. Previous research by the authors has highlighted key risk factors in the development of DDH. This study aimed to compare the risk factors of those cases of DDH identified late with those that were diagnosed early.

Methods: A total of 1281 children with DDH born in 1988-1996 were identified from the South Australian Birth Defects Register (SABDR) Hospital records of those who had surgery for DDH within 5 years of life were examined for diagnosis details. Twenty-seven (2.1%) had been diagnosed at or after three months of age and were considered the late DDH cases (a prevalence of 0.15 per 1000 live births). Their socio-demographic, pregnancy and birth factors were compared with early diagnosed DDH cases.

Findings: The results of this study showed that female babies, vertex presentation, normal deliveries, rural births and discharge from hospital less than four days after birth all significantly increased the risk of late diagnosis among children with DDH.

Interpretation: Our results show differences in the risk factors for early and late diagnosed DDH. Some known risk factors for DDH are in fact protective for late diagnosis. These results highlight the need for broad newborn population screening and continued vigilance and training in screening programmes.

Keywords: developmental dysplasia of the hip, late diagnosis, epidemiology

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