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The Incidence, Diagnosis, and Treatment practices of Developmental Dysplasia of Hip (DDH) in India: A Scoping Systematic Review

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Abstract

Purpose

To identify literature on variations and knowledge gaps in the incidence, diagnosis, and management of developmental dysplasia of hip (DDH) in India.

Methods

Following standard methodology and PRISMA-ScR guidelines, a scoping systematic review of literature on incidence, diagnosis, and treatment of DDH in India was conducted. Studies conducted in India, published in indexed or non-indexed journals between 1975 and March 2021, were included in the search.

Results

Of 57 articles which met the inclusion criteria, only 33 studies (57.8%) were PubMed-indexed. Twenty-eight studies (49%) were published in Orthopaedic journals and majority had orthopaedic surgeon as the lead author (59.6%). Sixteen studies were mainly epidemiological, 20 reported screening/diagnosis, and 21 reported treatment of DDH. Almost 90% of the studies (51) were Level 4 or 5 according to the levels of evidence in research. There is lack of clarity in the definition of hip dysplasia and screening/diagnostic guidelines to be used. The incidence of hip dysplasia in India is reported to be 0–75 per 1000 live births, with true DDH between 0 and 2.6/1000. Late-presenting DDH is common in India, with most studies reporting a mean age of > 20 months for children presenting for treatment. The treatment is also varied and there is no clear evidence-based approach to various treatment options, with lack of long-term studies.

Conclusion

This systematic scoping review highlights various knowledge gaps pertaining to DDH diagnosis and management in India. High-quality, multicentric research in identified gap areas, with long-term follow-up, is desired in future.

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References

  1. What is Hip Dysplasia?—International Hip Dysplasia Institute. Retrieved July 20, 2021, from https://hipdysplasia.org/developmental-dysplasia-of-the-hip

  2. Loder, R. T., & Skopelja, E. N. (2011). The epidemiology and demographics of hip dysplasia. ISRN Orthopedics, 2011, 1–46.

    Google Scholar 

  3. Herring, J. A. (2020). Tachdjians pediatric orthopaedics (6th ed.). New York: Elsevier.

    Google Scholar 

  4. Shaw, B. A., & Segal, L. S. (2016). Evaluation and referral for developmental dysplasia of the hip in infants. Pediatrics. https://doi.org/10.1542/peds.2016-3107

    Article  PubMed  Google Scholar 

  5. Mulpuri, K., & Song, K. M. (2015). AAOS Clinical Practice Guideline: Detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age. Journal of the American Academy of Orthopaedic Surgeons, 23(3), 206–7. https://doi.org/10.5435/JAAOS-D-15-00008

    Article  Google Scholar 

  6. Developmental dysplasia of the hip—NHS. Retrieved July, 20, 2021, from https://www.nhs.uk/conditions/developmental-dysplasia-of-the-hip

  7. Lipton, E. L., Steinschneider, A., & Richmond, J. B. (1965). Swaddling, a childcare practice: Historical, cultural and experimental observations. Pediatrics, 35(SUPPL), 519–567.

    Google Scholar 

  8. Rabin, D. L., Barnett, C. R., Arnold, W. D., Freiberger, R. H., & Brooks, G. (1965). Untreated congenital hip disease. A study of the epidemiology, natural history and social aspects of disease in Navajo population. American Journal of Public Health and the Nation’s Health, 55(Suppl 2), 1–44.

    Google Scholar 

  9. Pinto, D. A., Aroojis, A., & Mehta, R. (2020). Swaddling practices in an Indian institution: are they hip-safe? a survey of paediatricians, nurses and caregivers. Indian Journal of Orthopaedics, 55(1), 147–157. https://doi.org/10.1007/s43465-020-00188-2

    Article  PubMed  PubMed Central  Google Scholar 

  10. Al-Essa, R. S., Aljahdali, F. H., Alkhilaiwi, R. M., Philip, W., Jawadi, A. H., & Khoshhal, K. I. (2017). Diagnosis and treatment of developmental dysplasia of the hip: A current practice of paediatric orthopaedic surgeons. Journal of Orthopaedic Surgery (Hong Kong). https://doi.org/10.1177/2309499017717197

    Article  Google Scholar 

  11. Census of India Website: Office of the Registrar General & Census Commissioner, India. Retrieved July 20, 2021, from https://censusindia.gov.in/2011-Common/CensusInfo.html

  12. Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5, 69. https://doi.org/10.1186/1748-5908-5-69

    Article  PubMed  PubMed Central  Google Scholar 

  13. Arksey, H., & O’Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616

    Article  Google Scholar 

  14. Tricco, A. C., Lillie, E., Zarin w, O’Brian KK, Colquhoun H, Levac D, , et al. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine., 169(7), 467–73.

    PubMed  Google Scholar 

  15. Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009)—Centre for Evidence-Based Medicine (CEBM), University of Oxford. Retrieved July 20, 2021, from https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009

  16. Slim, K., Nini, E., Forestier, D., Kwiatkowski, F., Panis, Y., & Chipponi, J. (2003). Methodological index for non-randomized studies (minors): Development and validation of a new instrument. ANZ Journal of Surgery, 73(9), 712–716.

    PubMed  Google Scholar 

  17. Kaushal, V., Kaushal, S., & Bhakoo, O. (1976). Congenital dysplasia of the hip in northern India. International Surgery, 61, 29.

    CAS  PubMed  Google Scholar 

  18. Gupta, A. K., Kumari, S., Arora, P. L., Kumar, R., Mehtani, A. K., & Sood, L. K. (1992). Hip instability in newborns in an urban community. National Medical Journal of India, 5(6), 269–272.

    CAS  Google Scholar 

  19. Marya, K. M., & Yadav, V. (2006). Unusual K-wire migration. Indian Journal of Pediatrics, 73(12), 1107–8. https://doi.org/10.1007/BF02763056

    Article  CAS  PubMed  Google Scholar 

  20. Mootha, A. K., Saini, R., Dhillon, M., Aggarwal, S., Wardak, E., & Kumar, V. (2010). Do we need femoral derotation osteotomy in DDH of early walking age group? A clinico-radiological correlation study. Archives of Orthopaedic and Trauma Surgery, 130(7), 853–8. https://doi.org/10.1007/s00402-009-1020-8

    Article  PubMed  Google Scholar 

  21. Mootha, A., Saini, R., Dhillon, M., Aggarwal, S., Kumar, V., & Tripathy, S. (2010). MRI evaluation of femoral and acetabular anteversion in developmental dysplasia of the hip: A study in an early walking age group. Acta Orthopaedica Belgica, 76(2), 174–180.

    PubMed  Google Scholar 

  22. Bhalvani, C., & Madhuri, V. (2011). Ultrasound profile of hips of south Indian infants. Indian Pediatrics, 48(6), 475–477.

    PubMed  Google Scholar 

  23. Agarwal, A., & Gupta, N. (2012). Risk factors and diagnosis of developmental dysplasia of hip in children. Journal of Clinical Orthopaedics and Trauma, 3(1), 10–4. https://doi.org/10.1016/j.jcot.2011.11.001

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bhuyan, B. K. (2012). Outcome of one-stage treatment of developmental dysplasia of hip in older children. Indian Journal of Orthopaedics, 46(5), 548–55. https://doi.org/10.4103/0019-5413.101035

    Article  PubMed  PubMed Central  Google Scholar 

  25. Narasimhan, R., Patil, M., & Mahna, M. (2014). Outcome of surgical management of developmental dysplasia of hip in children between 18 and 24 months. Indian Journal of Orthopaedics, 48(5), 458–462.

    Google Scholar 

  26. Karnik, A. S., Karnik, A., & Joshi, A. (2016). Ultrasound examination of pediatric musculoskeletal diseases and neonatal spine. Indian Journal of Pediatrics, 83(6), 565–77. https://doi.org/10.1007/s12098-015-1957-2

    Article  PubMed  Google Scholar 

  27. Kumar, R. K., Shah, P., Ramya, A. N., & Rajan, R. (2016). Diagnosing developmental dysplasia of hip in newborns using clinical screen and ultrasound of hips—An Indian experience. Journal of Tropical Pediatrics, 62(3), 241–5. https://doi.org/10.1093/tropej/fmv107

    Article  Google Scholar 

  28. Bhaskar, A., Desai, H., & Jain, G. (2016). Risk factors for early re-dislocation after primary treatment of developmental dysplasia of the hip: Is there a protective influence of the ossific nucleus? Indian Journal of Pediatrics, 50(5), 479–485. https://doi.org/10.4103/0019-5413.189610

    Article  Google Scholar 

  29. Hooper, N., Aroojis, A., Narasimhan, R., Schaeffer, E. K., Habib, E., Wu, J. K., et al. (2020). Developmental Dysplasia of the Hip: An examination of care practices of orthopaedic surgeons in India. Indian Journal of Pediatrics, 55(1), 158–168. https://doi.org/10.1007/s43465-020-00233-0

    Article  Google Scholar 

  30. Kulshreshtha, R., Nath, L. M., & Upadhyay, P. (1983). Congenital malformations in live born infants in a rural community. Indian Pediatrics, 20(1), 45–49.

    Google Scholar 

  31. Singh, M., & Sharma, N. (1980). Spectrum of congenital malformations in the newborn. Indian Journal of Pediatrics, 47(386), 239–44. https://doi.org/10.1007/BF02758201

    Article  CAS  PubMed  Google Scholar 

  32. Chaturvedi, P., & Banerjee, K. (1989). Spectrum of congenital malformations in the newborns from rural Maharashtra. Indian Journal of Pediatrics, 56(4), 501–7. https://doi.org/10.1007/BF02722424

    Article  CAS  PubMed  Google Scholar 

  33. Bhide, P., & Kar, A. (2018). A national estimate of the birth prevalence of congenital anomalies in India: Systematic review and meta-analysis. BMC Pediatrics, 18(1), 175. https://doi.org/10.1186/s12887-018-1149-0

    Article  PubMed  PubMed Central  Google Scholar 

  34. Agrawal, D., Biswa, B. M., Sarangi, R., Kumar, S., Mahapatra, S. K., & Chinara, P. K. (2014). Study of incidence and prevalence of musculoskeletal anomalies in a tertiary care hospital of eastern India. Journal of Clinical and Diagnostic Research. https://doi.org/10.7860/JCDR/2014/7882.4380

    Article  PubMed  PubMed Central  Google Scholar 

  35. Rebello, G., & Joseph, B. (2003). Developmental dysplasia of the hip in children from southwest India—Will screening help? Indian Journal of Orthopaedics, 37(4), 210–214.

    Google Scholar 

  36. Choudhury, A. R., Mukherjee, M., Sharma, A., Talukder, G., & Ghosh, P. K. (1989). Study of 1,26,266 consecutive births for major congenital defects. Indian Journal of Pediatrics, 56(4), 493–9. https://doi.org/10.1007/BF02722422

    Article  CAS  PubMed  Google Scholar 

  37. Verma, M., Chhatwai, J., & Singh, D. (1991). Congenital malformations—A Retrospective study of 10,000 cases. Indian Journal of Pediatrics, 58(2), 245–52. https://doi.org/10.1007/BF02751129

    Article  CAS  PubMed  Google Scholar 

  38. Bhat, B. V., & Babu, L. (1998). Congenital malformations at birth—A prospective study from south India. Indian Journal of Pediatrics, 65(6), 873–81. https://doi.org/10.1007/BF02831352

    Article  CAS  PubMed  Google Scholar 

  39. Baruah, J., Kusre, G., & Bora, R. (2015). Pattern of gross congenital malformations in a tertiary referral hospital in northeast India. Indian Journal of Pediatrics, 82(10), 917–22. https://doi.org/10.1007/s12098-014-1685-z

    Article  PubMed  Google Scholar 

  40. Pandey, R. A., & Johari, A. N. (2021). Screening of newborns and infants for developmental dysplasia of the hip: A systematic review. Indian Journal of Orthopaedics. https://doi.org/10.1007/s43465-021-00409-2

    Article  PubMed  PubMed Central  Google Scholar 

  41. Sriram, K. (2003). Developmental dysplasia of the hip: Management under six months of age. Indian Journal of Orthopaedics, 37(4), 223–226.

    Google Scholar 

  42. Joseph, B. (2003). Editorial: Developmental dysplasia of hip. Indian Journal of Orthopaedics, 37(4), 209–210.

    Google Scholar 

  43. Narsimhan, R. (2003). Complications of management of developmental dysplasia of the hip. Indian Journal of Orthopaedics, 37(4), 237–240.

    Google Scholar 

  44. Chinara, P. K., & Singh, S. (1982). East-West differentials in congenital malformations in India. Indian Journal of Pediatrics, 49(398), 325–9. https://doi.org/10.1007/BF02834415

    Article  CAS  PubMed  Google Scholar 

  45. Barik, S., Pandita, N., Paul, S., Kumari, O., & Singh, V. (2021). Prevalence of congenital limb defects in Uttarakhand state in India—A hospital-based retrospective cross-sectional study. Clinical Epidemiology and Global Health, 9, 99–103.

    Google Scholar 

  46. Johari, A. N. (2003). The role of hip arthrography in developmental dysplasia of the hip. Indian Journal of Orthopaedics, 37(4), 244–246.

    Google Scholar 

  47. Johari, A. N., & Wadia, F. D. (2003). Revision surgery for developmental dysplasia of the hip. Indian Journal of Orthopaedics, 37(4), 233–236.

    Google Scholar 

  48. Bhatia, M., & Joseph, B. (2003). Is routine pre-reduction traction necessary for children with developmental dysplasia of the hip? Indian Journal of Orthopaedics., 37(4), 241–243.

    Google Scholar 

  49. Bhaskar, A., & Kansara, P. (2020). A review of “capture rate’’ between physicians and care-giver suspicion leading to diagnoses of late-presenting DDH: A single centre perspective. International Journal of Paediatric Orthopaedics, 6(2), 7–11.

    Google Scholar 

  50. Chauhan, H. (2020). Can we predict the need for secondary procedures in walking DDH? International Journal of Paediatric Orthopaedics, 6(2), 53–58.

    Google Scholar 

  51. Singh, V., Yasam, R., Garg, V., & Barik, S. (2020). Re-dislocation after primary open reduction in DDH-management and early results. International Journal of Paediatric Orthopaedics, 6(2), 48–52.

    Google Scholar 

  52. Pasupathy, B., & Sathish, M. (2020). Reliability of a new radiographic classification for developmental dysplasia of the hip. International Journal of Paediatric Orthopaedics, 6(1), 16–19.

    Google Scholar 

  53. Behera, P. (2020). Role of proximal femoral osteotomy in the management of developmental dysplasia of hip. International Journal of Paediatric Orthopaedics, 6(2), 27–32.

    Google Scholar 

  54. Sahu, S., Nayak, M. K., Mohapatra, I., Biswal, S. R., & Jha, A. (2017). Burden of developmental dysplasia of hip among neonates in a tertiary care setting of Odisha. Indian Journal of Orthopaedics Surgery, 13, 346–349.

    Google Scholar 

  55. Jain, R. K., & Patel, S. (2017). Developmental dysplasia of hip—An overview. International Journal of Orthopaedics Science, 3(4), 42–49.

    Google Scholar 

  56. Raj, B., Menon, G., Jeynath, P. V., & Sai, P. M. V. (2016). Developmental dysplasia of hip—Sonographic findings. International Journal of Recent Trends in Science and Technology, 18(2), 354–357.

    Google Scholar 

  57. Ilangovan, G., Kumar, L., Balaganesan, H. 2020. Imaging of Developmental Dysplasia of Hip—Hips don’t lie, but it hurts and then I cry. https://epos.myesr.org/poster/esr/ecr2020/C-029032020

  58. Khan, M. J., Abbas, M., Ali, S. M., Khalid, M., & Mehtab, A. (2018). Role of ultrasound in management of developmental dysplasia of hip with Pavlik harness. Journal of Bone and Joint Diseases, 33(2), 42–46.

    Google Scholar 

  59. Kale, D., Salunkhe, A., Parekh, H., Joshi, S., & Prasanth, A. (2007). Role of Ultrasonography in early diagnosis and management of infant hip dysplasia. Journal of Orthopaedics, 4(2), 33.

    Google Scholar 

  60. Rajput, S. S., & Yadav, R. S. (2016). Observational study to find association between congenital talipes equinovarus and developmental dysplasia of the hip and role of ultrasound screening. Global Journal of Research Analysis, 5(10).

  61. Sherwani, P., Vire, A., Anand, R., & Aggarwal, A. (2016). Utility of MR imaging in developmental dysplasia of hip. Austin Journal of Radiology, 3(3), 1052.

    Google Scholar 

  62. Patel, N., Sharma, A., Patel, M., & Rathod, Y. (2019). Role of ultrasound in developmental dysplasia of the hip in Infants. International Journal of Scientific Research, 8(4), 28–31.

    Google Scholar 

  63. Tej, B. Y., Shetty, B. C., & Hegde, A. H. (2020). Evaluation of avascular necrosis during midterm follow up in DDH cases treated by single stage surgery in the walking age group. Journal of Critical Reviews, 7(14), 4251–4259.

    Google Scholar 

  64. Manimaran, K. P., Sathish, M., & Govardhan, R. H. (2019). Outcome analysis of management of untreated Developmental dysplasia of hip by klisic procedure. IOSR- Journal of Dental and Medical Sciences, 18(2), 38–44.

    Google Scholar 

  65. Bhatnagar, N. (2018). Pediatric musculoskeletal ultrasound. Indian Journal of Rheumatology, 13(5), 57–64.

    Google Scholar 

  66. Kumari, P., & Rani, M. (2018). Developmental dysplasia of the hip. Orthopedics and Rheumatology Open Access, 10(4), 555794.

    Google Scholar 

  67. Uppin, R. B., Saidapur, S. K., Mittal, A. R., & Kumar, U. (2019). Radiological and functional outcome of management of bilateral congenital dislocation of hip in a 1 year old infant: A case report. Journal of Orthopaedic Education. https://doi.org/10.21088/joe.2454.7956.5219.6

    Article  Google Scholar 

  68. Jagadesh, G., Venugopal, S. M., Chaitanya, S. S. R. K., & B, Karthik Gudaru. . (2018). Outcome of surgical management of late presenting developmental dysplasia of hip with pelvic and femoral osteotomies. Indian Journal of Orthopaedic Surgery, 4(1), 53–59.

    Google Scholar 

  69. Priyadarshi, A., & Gupta, K. L. (2018). Role of clinical examination As screening tool for detection of developmental dysplasia of hip in Infants. Indian Journal of Applied Research, 8(2), 52–53.

    Google Scholar 

  70. Kumari, O., & Singh, V. (2018). Prevalence and pattern of congenital musculoskeletal anomalies: A single centre study. Journal of Clinical and Diagnostic Research, 12(1), 16–19.

    CAS  Google Scholar 

  71. Gupta, R. K., Gupta, C. R., & Singh, D. (2003). Incidence of congenital malformations of the musculo-skeletal system in new live borns in Jammu. JK Science, 5(4), 157–160.

    Google Scholar 

  72. Narasimhan, R. (2009). Dega pelvic osteotomy in the management of developmental dislocation of hips in older children. Apollo Medicine, 6(1), 32–39.

    Google Scholar 

  73. Shen, C., & Björk, B.-C. (2015). ‘Predatory’ open access: a longitudinal study of article volumes and market characteristics. BMC Medicine, 13, 230. https://doi.org/10.1186/s12916-015-0469-2

    Article  PubMed  PubMed Central  Google Scholar 

  74. Graf, R. (2017). Hip sonography: background; technique and common mistakes; results; debate and politics; challenges. Hip Int., 27(3), 215–219. https://doi.org/10.5301/hipint.5000514

    Article  PubMed  Google Scholar 

  75. Bialik, V., Bialik, G. M., Blazer, S., Sujov, P., Wiener, F., & Berant, M. (1999). Developmental dysplasia of the hip: a new approach to incidence. Pediatrics, 103(1), 93–9. https://doi.org/10.1542/peds.103.1.93

    Article  CAS  PubMed  Google Scholar 

  76. Suresh, S., Thangavel, G., Sujatha, J., & Indrani, S. (2005). Methodological issues in setting up a surveillance system for birth defects in India. National Medical Journal of India, 18(5), 259–262.

    Google Scholar 

  77. Rashtriya Bal Swasthya Karyakram (RBSK): National Health Mission. Retrieved July 20, 2021, from https://www.nhm.gov.in/index1.php?lang=1&level=4&sublinkid=1190&lid=583

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Authors and Affiliations

  1. Department of Paediatric Orthopaedics, King George’s Medical University, Lucknow, Uttar Pradesh, India

    Suresh Chand

  2. Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra, 400012, India

    Alaric Aroojis

  3. Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India

    Ritesh A. Pandey

  4. Department of Paediatric Orthopaedics, Balabhai Nanavati Super Speciality Hospital, Mumbai, Maharashtra, India

    Ashok N. Johari

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SC and AA conceptualised and designed the study. Data analysis and review was carried out by SC and AA. The first draft of the manuscript was written by SC and edited by AA, RP, and ANJ. All authors read and approved the final manuscript.

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Correspondence to Alaric Aroojis.

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Chand, S., Aroojis, A., Pandey, R.A. et al. The Incidence, Diagnosis, and Treatment practices of Developmental Dysplasia of Hip (DDH) in India: A Scoping Systematic Review. JOIO 55, 1428–1439 (2021). https://doi.org/10.1007/s43465-021-00526-y

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