The costs of late detection of developmental dysplasia of the hip

Abstract

PurposeDebate currently exists regarding the economic viability for screening for developmental dysplasia of the hip in infants.MethodsA prospective study of infant hip dysplasia over the period of 1998–2008 (36,960 live births) was performed to determine treatment complexity and associated costs of disease detection and hospital treatment, related to the age at presentation and treatment modality. The involved screening programme utilised universal clinical screening of all infants and selective ultrasound screening of at-risk infants.ResultsOne hundred and seventy-nine infants (4.8/1,000) presented with hip dysplasia. Thirty-four infants presented late (> 3 months of age) and required closed or open reduction. One hundred and forty-five infants presented at < 3 months of age, 14 of whom failed early Pavlik harness treatment. A detailed cost analysis revealed: 131 early presenters with successful management in a Pavlik harness at a cost of £601/child; 34 late presenters who required surgery (36 hips, 19 closed/17 open reductions, one revision procedure) at a cost of £4,352/child; and 14 early presenters with failed management in a Pavlik harness requiring more protracted surgery (18 hips, four closed/14 open reductions, seven revision procedures) at a cost of £7,052/child.ConclusionsLate 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.DiscussionImproved strategies are needed for the 10 % of early presenting infants who fail Pavlik harness treatment and require the most complex and costly interventions.

Ultrasound screening for developmental dysplasia of the hip after 4 weeks increases exam accuracy and decreases follow-up visits

“…Early detection by hip screening and early splinting are recommended to prevent surgery and future comorbidities. 2,3 In a nationwide survey for incidence of DDH that required surgical treatment, there were stationary incidences of 0.49, 0.48, and 0.47/1000 in birth year cohorts from 1997, 1998, and 1999, respectively. 4 Hip screenings remain a serious issue in public health promotion, due to high rates of surgical intervention.…”

Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip

“…Early diagnosis provides easier treatment methods to obtain and maintain reduction, increases potential for acetabular and femoral remodeling, lessens the risk of serious complications, and reduces the costs of treatment in developmental dysplasia of the hip (DDH) [28,33]. Arnold Pavlik initially defined ''functional treatment of DDH,'' which included directing the dislocated femoral head into the acetabulum by an orthotic device with straps while allowing the hip to move and holding the hips in flexion, abduction, and knees in flexion [17].…”

Dysplasia of the hip in children-earlier referrals: a key for better outcomes

“…There is evidence to show that acetabular dysplasia is likely to improve spontaneously if treatment is undertaken before 2 years. [18][19][20] On the other hand a closed reduction for late presenters may not be successful or may not adequately address acetabular dysplasia. 21 This needs to be monitored regularly to see if further surgery is needed for acetabular dysplasia.…”