The costs of late detection of developmental dysplasia of the hip

Woodacre, Timothy; Dhadwal, Anil Singh; Cox, Peter

doi:10.1016/j.ijsu.2013.06.474

Cited by 4 publications

(10 citation statements)

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“…Rather, this group reflects that the outcomes associated with early diagnosis, even when early Pavlik harness treatment fails, are still far better than a late diagnosis. The importance of diagnosing DDH as early as possible is clear as late presentation results in higher likelihood of operative intervention and a lower remodelling potential following surgery 2 …”

Section: Discussionmentioning

confidence: 99%

“…Proponents of selective screening also raise concerns that universal screening leads to potential overtreatment of cases that would resolve spontaneously without intervention 11 . The risks of over‐treatment using abduction bracing are difficult to quantify, although bracing is largely considered to be effective and relatively benign 2,11 . Countries employing universal ultrasound screening, however, have the lowest reported rates of open reduction in the world, reporting between 0.07 and 0.27 cases per 1000 live births 12,13 .…”

Section: Discussionmentioning

confidence: 99%

“…Delayed diagnosis is associated with unnecessary morbidity, increasing complexity of treatment and a sevenfold increase in short-term costs. 1,2 Children who have a delayed diagnosis are also more likely to have a poor prognosis, exhibit growth disturbance and develop early degenerative hip disease. 3 There is world-wide variation in screening practices for DDH and strong debate exists between selective and universal screening programmes.…”

Section: What This Paper Addsmentioning

confidence: 99%

“…The importance of diagnosing developmental dysplasia of the hip (DDH) as early as possible is clear. Delayed diagnosis is associated with unnecessary morbidity, increasing complexity of treatment and a sevenfold increase in short‐term costs 1,2 . Children who have a delayed diagnosis are also more likely to have a poor prognosis, exhibit growth disturbance and develop early degenerative hip disease 3 .…”

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confidence: 99%

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Importance of early diagnosis for developmental dysplasia of the hip: A 5‐year radiological outcome study comparing the effect of early and late diagnosis

George

Kulkarni

Bellemore

et al. 2020

J Paediatrics Child Health

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Aim Australia utilises a selective ultrasound screening programme. The rate of late diagnosis of developmental dysplasia of the hip (DDH) in Australia is increasing. The aim of this study is to quantify the treatment required and compare the 5‐year radiological outcomes between early and late diagnosis in children with DDH with frank dislocation. Methods We performed a case‐matched control study of children with frank DDH dislocations from 2000 to 2010 comparing three groups: children with an early diagnosis successfully treated in a Pavlik harness (SP), children with an early diagnosis who failed Pavlik harness treatment (FP) and children with a late diagnosis (LD). Minimum follow‐up was 4 years. Results A total of 115 hips were included. Patients in the LD group required significantly more open reductions (P < 0.001), acetabular osteotomies (P < 0.001) and femoral osteotomies (P < 0.001). LD was also associated with significantly higher rates of growth disturbance at 46.3%, compared to 20.6% in the FP group and 5% in the SP group (P < 0.001). Overall, there were excellent radiological outcomes in 58.5% of the LD group compared to 79.4% in the FP group and 100% in the SP group. Conclusion In Australia, high rates of LD in DDH persist in the context of selective ultrasound screening. While good radiological outcomes are achievable, a significantly greater level of surgical intervention is required and this is associated with significantly higher rates of growth disturbance. Optimisation of screening in Australia is vital.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: What This Paper Addsmentioning

confidence: 99%

mentioning

confidence: 99%

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Importance of early diagnosis for developmental dysplasia of the hip: A 5‐year radiological outcome study comparing the effect of early and late diagnosis

George

Kulkarni

Bellemore

et al. 2020

J Paediatrics Child Health

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“…If DDH is recognized early, treatment is less invasive, and long-term effects are minimized (10). Late detection causes increased treatment complexity and a sevenfold increase in the short-term costs of treatment, compared to early detection and successful management in a Pavlik harness (18).…”

Section: Discussionmentioning

confidence: 99%

The predictive value of the clinical sign of excessive hip abduction for developmental dysplasia of the hip (DDH)

Čustović¹,

Čustović²

2018

Acta Med Sal

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Aim To assess the relationship between the clinical sign of excessive hip abduction (abduction of the hip 90 degrees or more) and developmental dysplasia of the hip (DDH). Methods The research was conducted on 450 newborns in the Neonatal Unit at the Clinic of Gynecology and Obstetrics and the Clinic of Orthopedics and Traumatology of the University Clinical Centre, Tuzla, between 30th August 2011 and 30th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns hip were performed using the Graf method on their first day of life. Results Clinical sign of excessive hip abduction showed significant predictive value for DDH. There were 37 (8.2%) newborns with the clinical sign of excessive hip abduction, of which 13 of them had DDH while 24 of them did not have this clinical sign. There were 89 newborns, in the overall sample, with one of the forms of DDH, 13 (12.7%) of them had this clinical sign, while from 324 newborns witouth DDH, 24 (6.9%) had this clinical sign. Excessive hip abduction had a positive predictive value (PPV) of 35.1% and a negative predictive value (NPV) of 78.5% for DDH. Conclusion Excessive hip abduction is an useful and important clinical sign of DDH. Doctors who perform the first examination of the child after birth, would have to turn their attention to this clinical sign. The newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis.

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Cost Analysis of Screening Programmes for Developmental Dysplasia of the Hip: A Systematic Review

Harper

Gangadharan

Poku

et al. 2021

JOIO

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Aims The aim of this study was to assess screening costs in developmental dysplasia of the hip (DDH), to provide any clarity on the cost-effectiveness of various hip screening programmes internationally. Methods A PROSPERO-registered systematic review was performed by examining cost analysis studies of various DDH screening programmes, including those based around clinical examination, selective ultrasound and universal ultrasound. Costs were analysed using narrative synthesis. Results There were 14 studies included in this review. Two studies found that clinical hip screening is advantageous over no screening at all, both in terms of overall cost and favourable outcomes. When considering selective ultrasound imaging versus clinical screening, two studies found it to be more expensive, one found it cheaper and three studies calculated the overall programme costs to be similar. With universal ultrasound, four studies calculated this to be cheaper than clinical or selective ultrasound screening due to a reduced late detection and surgery rate. However, a comparable number of studies concluded that the increased financial costs of universal ultrasound were greater than the reduction in surgical costs. No studies included any long-term data. Conclusion There is a dearth of information on DDH screening costs, with significant heterogeneity amongst the existing literature. Future research should include the cost analysis of long-term complications of DDH, including the social and psychological impact of early onset arthritis, as well as gender specific ultrasound screening programmes.

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The costs of late detection of developmental dysplasia of the hip

Cited by 4 publications

References 0 publications

Importance of early diagnosis for developmental dysplasia of the hip: A 5‐year radiological outcome study comparing the effect of early and late diagnosis

Importance of early diagnosis for developmental dysplasia of the hip: A 5‐year radiological outcome study comparing the effect of early and late diagnosis

The predictive value of the clinical sign of excessive hip abduction for developmental dysplasia of the hip (DDH)

Cost Analysis of Screening Programmes for Developmental Dysplasia of the Hip: A Systematic Review

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