Late-presenting developmental dysplasia of the hip in Jordanian males: A retrospective hospital based study

Objectives:

To describe the pattern of developmental dysplasia of the hip (DDH) in late presenting Jordanian male patients and identify the risk factors and associated findings.

Methods:

This is a retrospective study of 1145 male patients who attended the Pediatric Orthopedic Clinic for a DDH check up. This study was carried out in the Orthopedic Section, Special Surgery Department, Faculty of Medicine, The University of Jordan, Amman, Jordan between March 2011 and October 2014. Data was collected from medical records, and x-ray measurements were evaluated.

Results:

Of the 1145 male patients, 43 (3.75%) with 70 involved hips were diagnosed with late- presenting DDH. Being a first-born baby resulted in 41.9% increased risk for DDH. Cesarian delivery was significantly associated with an increased risk of hip dislocation (p=0.004) while normal delivery was significantly associated with acetabular dysplasia (p=0.004). No predictable risk factors were found in 44.2% patients with DDH. Bilateral cases were more common than unilateral cases: (26 [60.5%] versus 17 [39.5%]). Limited abduction was a constant finding in all dislocated hips (p<0.001). Associated conditions, such as club foot and congenital muscular torticollis were not observed.

Conclusion:

Cesarian section is a significant risk for dislocated hips while normal delivery is significantly associated with acetabular dysplasia. Bilateral DDH is more common than the unilateral. Club foot and torticollis were not observed in this series.Developmental dysplasia of the hip (DDH) is a widespread term first used by Klisic1 in 1989, which indicates an extensive variety of vibrant abnormalities present in the immature hip joint in children. Approximately, one in every 1,000 child is delivered with a dislocated hip joint, while every 10 in 1,000 children are delivered with subluxation or dysplasia of the hip joint. The DDH represents a wide spectrum of anatomical abnormalities, which range from slight hip instability to frank dislocation of the hip joint, as well as the mal-development of the acetabulum. These abnormalities are not always apparent clinically at birth, so high index of suspicion should be raised when there are positive risk factors. Early diagnosis and treatment are crucial for optimal outcome and the key to stay out of trouble in dealing with these patients. Developmental dysplasia of the hips is usually developmental and can occur during the first year of a child’s life. Developmental dysplasia of the hip is an evolving process and the clinical examination shows different signs based on the spectrum of the DDH and the age of the patient. In accordance with the clinical practice guideline of the “American Academy of Pediatrics”, no considerable sign was observed, which indicates the pathognomonic for hip dislocation.2 Therefore, the clinical examination is neither 100% sensitive, nor specific to diagnose DDH.3 Developmental dysplasia of the hip is more common in female patients, and has been well studied and analyzed regarding its incidence, presentation, and the associated risk factors.4 First-born infants have a higher incidence of DDH4,5 as well as those born with breech presentation.4 Since the neonatal hips are primarily a cartilaginous structure, it is difficult to observe with standard radiographic techniques, therefore, nowadays ultrasonograms are very popular. It is currently considered a safe tool for young infants and can shed light on pathological changes that cannot be seen using the standard radiological techniques. Only few studies addressed the issue of late-presenting DDH in male children. Kosar et al6 had studied this spectrum in male infants and showed no statistical significance presented between risk factors and DDH in male cases. Jordanians are an ethnically distinct and homogenous population that has not been studied before. In spite of the improvement in screening methods, late diagnosis of DDH occurs and is of great concern for the family and the treating physician. In this study, we investigated the risk factors, the clinical, and radiological findings associated with DDH in late-presenting Jordanian male children.