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Impact of Multiple Factors on the Incidence of Developmental Dysplasia of the Hip: Risk Assessment Tool.

ABSTRACT: Background and Objectives: Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal conditions in children. If not treated, it leads to disability, gait abnormalities, limb shortening, and chronic pain. Our study aims to determine the impact of multiple risk factors on the incidence of DDH and to develop an interactive risk assessment tool. Materials and Methods: We conducted a retrospective cohort study in the Outpatient Clinic for Children of the Medical University of Warsaw Hospital. The Graf classification system was used for universal ultrasonographic screening. In total, 3102 infants met the eligibility criteria. Results: The incidence of DDH in the study group was 4.45%. The incidence of DDH in the Warsaw population, Poland, during the study period was 3.73 to 5.17 (95% CI). According to the multivariate analysis, the risk factors for DDH were birth weight (OR = 2.17 (1.41-3.32)), week of delivery (OR = 1.18 (1.00-1.37)), female sex (OR = 8.16 (4.86-13.71)), breech presentation (OR = 5.92 (3.37-10.40)), physical signs of DDH (25.28 (8.77-72.83)) and positive family history in siblings (5.74 (2.68-12.31)). Our results support the recent hypothesis that preterm infants (<37 weeks) have a lower rate of DDH. Conclusions: A multivariate logistic regression predictive model was used to build the risk calculator. The DDH risk calculator will be evaluated in a prospective validation study.

SUBMITTER: Pulik L

PROVIDER: S-EPMC9502116 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Impact of Multiple Factors on the Incidence of Developmental Dysplasia of the Hip: Risk Assessment Tool.

Pulik Łukasz Ł Płoszka Katarzyna K Romaniuk Krzysztof K Sibilska Aleksandra A Jedynak Andrzej A Tołwiński Ignacy I Kumięga Paulina P Wojtyński Paweł P Łęgosz Paweł P

Medicina (Kaunas, Lithuania) 20220825 9

Background and Objectives: Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal conditions in children. If not treated, it leads to disability, gait abnormalities, limb shortening, and chronic pain. Our study aims to determine the impact of multiple risk factors on the incidence of DDH and to develop an interactive risk assessment tool. Materials and Methods: We conducted a retrospective cohort study in the Outpatient Clinic for Children of the Medical University of ...[more]

PMID: 36143835

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Project description:BackgroundPerioperative bleeding requiring blood transfusion is a known complication of hip dysplasia (HD) surgery. Here we examine rates of, risk factors for, and postoperative complications associated with transfusion during HD surgery.MethodsThe National Surgical Quality Improvement Program (NSQIP) Pediatric database was queried for patients treated by an orthopaedist from 2012 to 2013. HD cases were categorized by Current Procedural Terminology codes into femoral osteotomies, acetabular osteotomies, combined femoral/acetabular osteotomies, and open reductions. Patients were grouped by comorbidities: neuromuscular (NM) disease (eg, cerebral palsy) group, non-NM with other comorbidity (Other) group, and no known comorbidity (NL) group. Patients were stratified by weight-normalized transfusion volume. Multivariate regression analysis of transfusion association with procedures, demographics, comorbidities, preoperative laboratory values, and 30-day complications was performed.ResultsA total of 1184 HD cases were included. Transfusion rates for the NL, Other, and NM groups, respectively, were 44/451 (9.8%), 61/216 (28.2%), and 161/517 (31.1%). Transfusion volumes (mean±SD) for the NL, Other, and NM groups, respectively, were 8.4±5.4, 13.9±8.8, and 15.5±10.0 mL/kg (P<0.001). Combined osteotomies had the highest transfusion rates in the NM and Other groups (35.7% and 45.8%, respectively), whereas acetabular osteotomies had the highest rate in the NL group (15.8%). Open reductions had the lowest transfusion rate (all groups). Longer operations were independently associated with transfusion (all groups, per hour increase, OR>1.5, P<0.001). Independent patient risk factors included preoperative hematocrit <31% (NM group, OR=18.42, P=0.013), female sex (NL group, OR=3.55, P=0.008), developmental delay (NM group, OR=2.37, P=0.004), pulmonary comorbidity (NM group, OR=1.73, P=0.032), and older age (NL group, per year increase: OR=1.29, P<0.001). In all groups, transfusion was associated with longer hospitalization (P<0.001). We observed a volume-dependent increase in overall complication rate within the Other group for transfusion volumes >15 mL/kg (25.0% vs. 5.4% for <15 mL/kg, P=0.048).ConclusionsWe identified several risk factors for transfusion in HD surgery. The incidence of transfusion in HD surgery and its association with adverse outcomes warrants development of appropriate patient management guidelines.Level of evidenceLevel III-prognostic.

Project description:The purpose of this study was to assess the role of clinical examination, associated risk factors and plain radiograph of the pelvis in children who had late presentation of DDH.We report on a 7-year prospective study, in children who had late presentation of developmental dysplasia of the hip (DDH). For this purpose, 740 hips in 370 referred children, age range 3-7 months (mean 3.44 months) were clinically and radiologically assessed, and the associated risk factors recorded.Female sex, first born, positive family history and breech presentation were confirmed as risk factors for DDH. Significant findings were an increased risk for vaginal delivery over caesarean section for breech presentation (P = 0.002). There was an increased risk for caesarean section in the absence of breech presentation. Multiple births and preterm births had a reduced risk. For breech presentation, the risk of DDH was estimated to be at least 1.6% for girls and 3.4% for boys; a combination of factors increased the risk. Limitation of abduction (43.2%) and asymmetry of the groin skin folds (72.7%) were found to be the two most common clinical findings associated with DDH. Bilateral acetabular dysplasia is more common than unilateral dysplasia. Foot deformities were rarely encountered in children with acetabular dysplasia.The percentage of first-born babies who had DDH is lower than reported in the literature (34%), but still shows significant risk. We did find that bilateral acetabular dysplasia is more common than unilateral dysplasia. Torticollis and foot deformities are rarely found to be associated with DDH. All these findings needs further evaluation in children who had surgical treatment for DDH, to see if they are different from dysplastic groups. Limitation of abduction is an important clinical finding, but is not always associated with DDH. Asymmetry of the skin folds in the groin were found to be an important clinical finding associated with DDH for all age groups. As clinical examination depends on many factors, and most DDH cases are of the dysplastic type, it is mandatory to depend on further diagnostic tools for confirmation of DDH.

Project description:ImportanceTwo meta-analyses published in 2012 found breech presentation, family history of developmental dysplasia of the hip (DDH), female sex, and primiparity to increase the risk of DDH. However, the DDH definition, reference tests, and the age of the examined children varied considerably, complicating the translation of those findings to current screening guidelines.ObjectiveTo evaluate the association of previously proposed risk factors with the risk of sonography-verified DDH.Data sourcesA literature search strategy used MeSH (Medical Subject Heading) terms and text words associated with DDH and prognostic studies or risk factors. PubMed, Embase, and the Cochrane Library were searched on November 23, 2023, to identify the cohort.Study selectionCriteria included articles that were in English and published from January 1, 1980, to November 23, 2023. Eligible studies included randomized clinical trials and cohort, case-control, and cross-sectional studies that involved participants younger than 3 months in whom a diagnosis of DDH was made by hip ultrasonography using the criterion standard Graf method, reported information on 1 or more of the proposed risk factors, and reported the final diagnosis.Data extraction and synthesisCollected variables included an evaluated risk factor, the number of infants with a risk factor, the number of infants without risk factors, and the number of infants with and without DDH in the at-risk group and in the no-risk group. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines.Main outcomes and measuresThe main outcome measures were risk of DDH (using odds ratios [ORs]) for each of the risk factors.ResultsOf 5363 studies screened, 20 studies comprising 64 543 infants were included. Breech presentation (OR, 4.15 [95% CI, 2.62-6.57]), family history of DDH (OR, 3.83 [95% CI, 2.05-7.15]), female sex (OR, 2.50 [95% CI, 1.74-3.59]), oligohydramnios (OR, 3.76 [95% CI, 1.66-8.53]), and high birth weight (OR, 2.00 [95% CI, 1.60-2.49]) were associated with a significant increased risk of DDH. Cesarean delivery, primiparity, multiple births, low birth weight, and prematurity were not associated with DDH risk. Heterogeneity was high (I2 > 70.00%) in all of the tested factors except high birth weight (I2 = 0%). The subgroup analysis was performed to investigate these heterogeneities.Conclusions and relevanceThe findings of this meta-analysis suggest that family history and breech presentation were associated with a significant increase in the risk of sonography-verified DDH in infants younger than 3 months, and a DDH risk increase of female sex was found to be lower than previously reported. A risk increase was detected for oligohydramnios, which has not been included in many screening programs and might also be considered as a referral criterion for hip ultrasonography.

Dataset Information

Impact of Multiple Factors on the Incidence of Developmental Dysplasia of the Hip: Risk Assessment Tool.

Publications

Impact of Multiple Factors on the Incidence of Developmental Dysplasia of the Hip: Risk Assessment Tool.

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