Developmental Dysplasia of the Hip: An Examination of Care Practices of Orthopaedic Surgeons in India
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ORIGINAL ARTICLE
Developmental Dysplasia of the Hip: An Examination of Care Practices of Orthopaedic Surgeons in India Nikki Hooper1 · Alaric Aroojis2 · Ramani Narasimhan3 · Emily K. Schaeffer4 · Eva Habib5 · Judy K. Wu5 · Isabel K. Taylor6 · Jessica F. Burlile7 · Aniruddh Agrawal8 · Kevin Shea9 · Kishore Mulpuri4 Received: 4 July 2020 / Accepted: 8 August 2020 © Indian Orthopaedics Association 2020
Abstract Background We evaluated screening, referral and treatment practices for developmental dysplasia of the hip (DDH) in India by surveying Orthopaedic surgeons who treat patients with DDH. The survey assessed the timing of DDH presentation, resource availability, and current state of screening and diagnosis, which would help in the development of a DDH care pathway for India. Methods An online survey was distributed to Orthopaedic surgeons practicing in India via email and administered onsite to those attending the annual conference of the Pediatric Orthopaedic Society of India in 2019. Results 173 completed surveys were received from surgeons practicing in a predominantly urban setting. 68.8% of respondents had performed initial evaluations on children with DDH aged over 1 year in the past 12 months, and 49.1% had assessed children with DDH aged > 2 years on initial presentation. There was no consistent use of established guidelines, with only 30% of respondents stating that a care pathway was in place at their institution. However, 91.9% would support the implementation of a care pathway developed in India, to decrease the incidence of delayed diagnosis and facilitate earlier intervention. 85% of respondents had ready access to ultrasound scans and 95.4% had access to X-rays. Conclusions In India, there is still a large number of late-presenting cases of DDH, which could be improved with effective screening. The development of a care pathway for DDH in India is well-supported by Orthopaedic surgeons and may help decrease the incidence of late presenting cases; potentially improving outcomes, decreasing morbidity, and upskilling local practitioners. Keywords Developmental dysplasia of the hip (DDH) · Screening · Ultrasound · Care pathway · Survey
Introduction Developmental dysplasia of the Hip (DDH) is a common pediatric musculoskeletal condition, affecting 1–2% of all newborns worldwide [1, 2]. The incidence in India is estimated to range from 1.0 to 9.2 per 1000 live births, depending upon the definition used [3–5]. DDH encompasses a wide spectrum; with more severe forms and late presentation being associated with significant morbidity and a higher rate of surgical intervention [6–8]. Untreated DDH may also Electronic supplementary material The online version of this article (https://doi.org/10.1007/s43465-020-00233-0) contains supplementary material, which is available to authorized users. * Alaric Aroojis [email protected] Extended author information available on the last page of the article
cause problems such as limp, limb length inequality and premature degenerative arthritis persisting into
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