J Korean Orthop Assoc JKOA Journal of the Korean Orthopaedic Association 1226-2102 2005-8918 The Korean Orthopaedic Association 10.4055/jkoa.2011.46.6.501 Original Article An Analysis of Cases Referred from the Primary Healthcare Institution with Suspected Developmental Dysplasia of the Hip: A Prospective Study Cha Soo-Min M.D. Shin Hyun-Dae M.D. Lee Seung-Hyun M.D. Kim Bo-Kun M.D. * Department of Orthopaedic Surgery, Chungnam National University College of Medicine, Daejeon, Korea. Department of Orthopaedic Surgery, Dong-A University College of Medicine, Busan, Korea. Correspondence to: Hyun-Dae Shin, M.D. Department of Orthopaedic Surgery, Chungnam National University College of Medicine, 640, Daesa-dong, Jung-gu, Daejeon 301-721, Korea. TEL: +82-42-280-7349, FAX: +82-42-252-7098, hyunsd@cnu.ac.kr 12 2011 29 12 2011 46 6 501 506 09 06 2011 20 07 2011 Copyright © 2011 by The Korean Orthopaedic Association 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

 Purpose

A prospective, epidemiological investigation was performed in the patients referred to our hospital with suspected developmental dysplasia of the hip (DDH).

 Materials and Methods

Of the 121 patients referred from the primary healthcare institutions, with suspected DDH from January 2006 to December 2007, 82 patients who were able to be followed up for at least 2 years were enrolled in this study. Confirmation of the diagnosis was determined by patient history, physical examination, simple radiographs, and ultrasonography. Epidemiological investigation was performed in the total 82 cases which were referred from the primary healthcare institution and were confirmed as having DDH, and at least a 2-year follow up was performed in all these cases.

 Results

Of the 82 cases, 56 cases (68.3%) were within normal limits (W.N.L.), 15 cases (18.29%) were confirmed as having DDH, and 11 cases (13%) were diagnosed with several different diseases other than DDH. Compared to the total 82 cases, the percentage of females, presence of family history was statistically higher in the cases confirmed as having DDH. However, the incidence of breech presentation was not statistically different between all cases. 61 cases were referred by pediatricians and 21 cases were referred by orthopedic surgeons to the primary healthcare institution, and the diagnostic rate of DDH was statistically higher in the cases referred by orthopedic surgeons (p>0.05).

 Conclusion

The rate of confirmation of the suspected diagnosis of DDH would hopefully increase through the establishment of physical examination protocols or radiologic study and systematic training programs that could be applied in the primary healthcare institution.

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Bright-gray column is showing the data of total referred cases, dark-gray column means the cases of diagnosed as developmental dysplasia of hip (DDH). The ratio of female, and the presence of familial history are statistically higher in the cases, diagnosed to DDH (p=0.018, 0.034). No statistical difference was seen in the ratio of breech presentation (p=0.393). Between two groups, the most common chief complaint was different, but there was no statistical significance in analyzing the each chief complaint (p=0.174, 0.231). Hx., history; LLD, leg length discrepancy.

Bright-gray column is the data of cases referred from orthopedic surgeons, dark-gray column is the data of cases from pediatricians. The mean age in each cases was not statistically significant, but the ratio of confirmation to developmental dysplasia of hip (DDH) in each referred cases was statistically significant (p=0.171, 0.001).

Summary of the Cases of Confirmed as Developmental Dysplasia of Hip

F, female; P, physical examination; S, simple radiographs; U: ultrasonography.