174.
A descriptive analysis of reasons for late onset of treatment of
developmental hip dysplasia.
Elisabeth Busk, Stig Sonne-Holm, Jens Krogh Christoffersen, Christian Wong
Department of Orthopaedic Surgery Hvidovre University Hospital ;
Department of Orthopaedic Surgery, Hvidovre University Hospital ; the
Patient Insurance Association, ; Department of Orthopaedic Surgery, Hvidovre
University Hospital
Background:
The prevalence of developmental hip dysplasia (DDH) in DK is
3-5/1000.
Unnoticed the condition can be severely disabling, developing from
restriction in movements in childhood into a painful condition requiring
demanding surgery and potentially arthroplasty.
Purpose / Aim of Study:
A descriptive study combined with a partial root
cause analysis was carried out analysing data from the Danish Patient
Insurance Association (DPIA) to investigate, what caused DDH diagnosis to
be missed or go untreated and subsequently suggest potential solutions to the
problem.
Materials and Methods:
DPIA journals with diagnosis codes for DDH and
related conditions were retrieved (DQ65.0 to DQ65.9). We located twenty
relevant cases (from 103 cases) describing late onsets of treatment for DDH.
Findings / Results:
13
patients were tested negative by Ortolani test (OT)
shortly after birth with subsequent later diagnosis because of DDH symptoms.
In 2 cases OT was not done primarily, and 5 patients had positive OT but
neither ultrasound (US) (4) was done nor treatment initiated (1 even after
positive US). Doctors delay resulted in initiation of treatment between 5 to 48
months of age with a mean age of 18 months. Open reduction was necessary in
two of the cases and one child had pelvis osteotomy performed 2½ years old.
Conclusions:
It is suggested, that early recognition and treatment of DDH
have a significant better clinical outcome and markedly reduce the need of
surgery. The findings of this study suggest that clinical examination alone can
be inadequate and that a lower threshold for US is needed. There are still
widely spread opinions on how to screen and treat DDH. Recent changes in
guidelines from the board of health make the general practitioner responsible
for screening for DDH at 5 weeks of age. An increase in delayed diagnosis
would be expected based on our findings.
