From the Guidelines
Hip dysplasia in newborns is primarily associated with risk factors such as female gender, breech positioning in utero, and a positive family history, carrying relative risks of 2.5,3.8, and 1.4, respectively, as identified in a large meta-analysis 1. The most significant risk factors for developmental dysplasia of the hip (DDH) in newborns include:
- Female gender
- Breech positioning in utero
- Positive family history
- Infant swaddling, particularly when done tightly with the legs in an extended and adducted position 1 Other factors that may contribute to the risk of DDH include:
- Oligohydramnios (reduced amniotic fluid)
- Firstborn infants
- Prolonged breech positioning
- Genetic predisposition, as suggested by studies demonstrating increased prevalence of DDH among monozygotic twins and chromosomal analysis in familial DDH 1 It is essential to note that preterm infants are not at an increased risk for DDH 1, and there is a lack of consensus on the association between multiparity and DDH 1. Parents and healthcare providers should be aware of these risk factors and take steps to minimize them, such as avoiding tight swaddling and allowing for natural hip abduction with the "healthy hip position" where legs can move freely in a frog-like position 1. Early detection through routine screening is crucial, as treatment is most effective when started within the first few months of life 1. The American Academy of Pediatrics (AAP) recommends selective screening of children with risk factors or based on physical examination findings 1, and the most important screening method is a hip examination at every well-baby visit 1.
From the Research
Risk Factors for Hip Dysplasia in Newborns
The risk factors for hip dysplasia in newborns are not explicitly stated in the provided studies. However, the following points can be inferred:
- Developmental dysplasia of the hip (DDH) is the most common congenital abnormality in newborns, as stated in the study 2.
- Untreated DDH can cause significant impairments, including chronic hip pain, osteoarthritis, limb length discrepancy, altered gait, and joint contractures, highlighting the importance of early screening and detection 2.
- The studies provided focus on the treatment and management of DDH, rather than the risk factors for its development.
Treatment and Management of Hip Dysplasia
Some key points related to the treatment and management of hip dysplasia in newborns include:
- The Pavlik harness is a commonly used treatment for DDH, with studies showing its effectiveness in achieving good therapeutic success and low rates of residual dysplasia 3, 4, 5.
- The Tübingen hip flexion splint is another effective option for the early management of DDH, although it may not be suitable for patients with severe forms of the condition 6.
- Early screening and detection are critical, as treatment outcomes are significantly worse with increasing delay in presentation 2.
Key Findings
Some key findings from the studies include:
- The Pavlik harness has a high success rate in treating DDH, with a low rate of residual dysplasia and no cases of avascular necrosis reported in some studies 3, 5.
- The Tübingen hip flexion splint has a higher failure rate compared to the Pavlik harness, particularly in bilateral cases and severe forms of DDH 6.
- A normal x-ray at 2 years of age may indicate that long-term follow-up is not necessary for patients treated with the Pavlik harness under a strict protocol 5.