Positive family history and girl sex might increase the risk of failure of abduction treatment in developmental dysplasia of the hip

Abstract

Background. Mild Barlow positive but Ortolani negative developmental dysplasia of the hip (DDH) has a great spontaneous recovery potential. Despite that, in many cases abduction treatment is needed. Known risk factors of DDH include girl sex, family history and breech presentation. Risks of failure of the abduction treatment are not well established. Material and methods. The Children with DDH diagnosis treated in Tampere University hospital in the years 1998-2018 were retrospectively found. Only the children with early evaluation (under 2 weeks of age) of pediatric surgeon or pediatric surgery resident were included in the analysis. Total of 759 children were included. Results. Girl sex (p=0.008) and family history (p=0.003) were associated with the most sever forms of DDH in dynamic ultrasound at one month of age. Major hip instability in dynamic ultrasound (p=0.016), and not the alpha angles (p=0.426), was associated with the risk of operative and/or casting treatments. Watchful waiting strategy in mild DDH was safe regarding the major hip instability (p= 0.260) and duration of abduction treatment, as treatment duration was shorter in these children (p<0.001). Conclusion. Family history and girl sex increase a risk of more severe form of DDH which increases the risk of failure of the abduction treatment. The observation period of four to six weeks seems safe in clinically diagnosed mild DDH regarding the risk of operative treatment and treatment duration. Level of evidence: Level II Retrospective study