Abstract
AIMS—To identify perinatal risk factors for developmental dysplasia of the hip (DDH) and define the risk for each factor. METHODS—In this case control study, using logistic regression analysis, all 1127 cases of isolated DDH live born in South Australia in 1986-93 and notified to the South Australian Birth Defects Register were included; controls comprised 150 130 live births in South Australia during the same period without any notified congenital abnormalities. RESULTS—Breech presentation, oligohydramnios, female sex and primiparity were confirmed as risk factors for DDH. Significant findings were an increased risk for vaginal delivery over caesarean section for breech presentation (as well as an increased risk for emergency section over elective section), high birthweight (⩾4000 g), postmaturity and older maternal age; multiple births and preterm births had a reduced risk. There was no increased risk for caesarean section in the absence of breech presentation. For breech presentation, the risk of DDH was estimated to be at least 2.7% for girls and 0.8% for boys; a combination of factors increased the risk. CONCLUSIONS—It is suggested that the risk factors identified be used as indications for repeat screening at 6 weeks of age and whenever possible in infancy. Other indications are family history and associated abnormalities. Keywords: congenital hip dislocation; perinatal risk factors; screening; breech presentation.
Full Text
The Full Text of this article is available as a PDF (136.1 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bialik V., Fishman J., Katzir J., Zeltzer M. Clinical assessment of hip instability in the newborn by an orthopedic surgeon and a pediatrician. J Pediatr Orthop. 1986 Nov-Dec;6(6):703–705. doi: 10.1097/01241398-198611000-00010. [DOI] [PubMed] [Google Scholar]
- Bjerkreim I., van der Hagen C. B. Congenital dislocation of the hip joint in Norway. V. Evaluation of genetic and environmental factors. Clin Genet. 1974;5(5):433–448. [PubMed] [Google Scholar]
- Bower C., Stanley F. J., Kricker A. Congenital dislocation of the hip in Western Australia. A comparison of neonatally and postneonatally diagnosed cases. Clin Orthop Relat Res. 1987 Nov;(224):37–44. [PubMed] [Google Scholar]
- Clausen I., Nielsen K. T. Breech position, delivery route and congenital hip dislocation. Acta Obstet Gynecol Scand. 1988;67(7):595–597. doi: 10.3109/00016348809004270. [DOI] [PubMed] [Google Scholar]
- Cole W. G. Screening for congenital dislocation of the hip in Australia. J Paediatr Child Health. 1991 Jun;27(3):143–146. doi: 10.1111/j.1440-1754.1991.tb00375.x. [DOI] [PubMed] [Google Scholar]
- Cyvin K. B. Congenital dislocation of the hip joint. Acta Paediatr Scand Suppl. 1977;(263):1–67. [PubMed] [Google Scholar]
- Czeizel A., Szentpétery J., Tusnády G., Vizkelety T. Two family studies on congenital dislocation of the hip after early orthopaedic screening Hungary. J Med Genet. 1975 Jun;12(2):125–130. doi: 10.1136/jmg.12.2.125. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dunn P. M. Congenital postural deformities. Br Med Bull. 1976 Jan;32(1):71–76. doi: 10.1093/oxfordjournals.bmb.a071327. [DOI] [PubMed] [Google Scholar]
- Dunn P. M., Evans R. E., Thearle M. J., Griffiths H. E., Witherow P. J. Congenital dislocation of the hip: early and late diagnosis and management compared. Arch Dis Child. 1985 May;60(5):407–414. doi: 10.1136/adc.60.5.407. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gunther A., Smith S. J., Maynard P. V., Beaver M. W., Chilvers C. E. A case-control study of congenital hip dislocation. Public Health. 1993 Jan;107(1):9–18. doi: 10.1016/s0033-3506(05)80487-1. [DOI] [PubMed] [Google Scholar]
- Hannah M., Hannah W. Caesarean section or vaginal birth for breech presentation at term. BMJ. 1996 Jun 8;312(7044):1433–1434. doi: 10.1136/bmj.312.7044.1433. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Heikkilä E. Congenital dislocation of the hip in Finland. An epidemiologic analysis of 1035 cases. Acta Orthop Scand. 1984 Apr;55(2):125–129. doi: 10.3109/17453678408992322. [DOI] [PubMed] [Google Scholar]
- Hinderaker T., Daltveit A. K., Irgens L. M., Udén A., Reikerås O. The impact of intra-uterine factors on neonatal hip instability. An analysis of 1,059,479 children in Norway. Acta Orthop Scand. 1994 Jun;65(3):239–242. doi: 10.3109/17453679408995446. [DOI] [PubMed] [Google Scholar]
- Leck I. An epidemiological assessment of neonatal screening for dislocation of the hip. J R Coll Physicians Lond. 1986 Jan;20(1):56–62. [PMC free article] [PubMed] [Google Scholar]
- Luterkort M., Persson P. H., Polberger S., Bjerre I. Hip joint instability in breech pregnancy. Acta Paediatr Scand. 1986 Sep;75(5):860–863. doi: 10.1111/j.1651-2227.1986.tb10303.x. [DOI] [PubMed] [Google Scholar]
- Paz J. E., Otaño L., Gadow E. C., Castilla E. E. Previous miscarriage and stillbirth as risk factors for other unfavourable outcomes in the next pregnancy. Br J Obstet Gynaecol. 1992 Oct;99(10):808–812. doi: 10.1111/j.1471-0528.1992.tb14411.x. [DOI] [PubMed] [Google Scholar]
- RECORD R. G., EDWARDS J. H. Environmental influences related to the aetiology of congenital dislocation of the hip. Br J Prev Soc Med. 1958 Jan;12(1):8–22. doi: 10.1136/jech.12.1.8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Robinson G. W. Birth characteristics of children with congenital dislocation of the hip. Am J Epidemiol. 1968 Mar;87(2):275–284. doi: 10.1093/oxfordjournals.aje.a120818. [DOI] [PubMed] [Google Scholar]
- Woolf C. M., Koehn J. H., Coleman S. S. Congenital hip disease in Utah: the influence of genetic and nongenetic factors. Am J Hum Genet. 1968 Sep;20(5):430–439. [PMC free article] [PubMed] [Google Scholar]
- Wynne-Davies R. Acetabular dysplasia and familial joint laxity: two etiological factors in congenital dislocation of the hip. A review of 589 patients and their families. J Bone Joint Surg Br. 1970 Nov;52(4):704–716. [PubMed] [Google Scholar]