In a recent meta-analysis, Danish researchers evaluated risk factors for developmental dysplasia of the hip and identified breech presentation and family history as the most significant predictors of the condition in infants younger than 3 months.
The analysis followed PRISMA and MOOSE reporting guidelines and included data from randomized clinical trials and cohort, case-control, and cross-sectional studies published between 1980 and 2023. Inclusion criteria required the use of the Graf ultrasound classification, the gold standard for diagnosing developmental dysplasia of the hip (DDH). The report published in JAMA Network—which reviewed 20 studies involving 64,543 infants—also highlighted oligohydramnios, female sex, and high birth weight as potential additional risk factors for DDH.
Breech presentation had the highest associated risk for DDH, with an odds ratio (OR) of 4.15 (95% confidence interval [CI] = 2.62–6.57), followed by family history (OR = 3.83; 95% CI = 2.05–7.15). Oligohydramnios (OR = 3.76; 95% CI = 1.66–8.53) emerged as a notable risk factor, despite its limited inclusion in existing screening programs. Female infants (OR = 2.50; 95% CI = 1.74–3.59) and those with high birth weight (OR = 2.00; 95% CI = 1.60–2.49) were also at increased risk for developing DDH.
Conversely, cesarean delivery, primiparity, multiple births, low birth weight, and prematurity were not significantly associated with DDH.
Heterogeneity was high (I² > 70%) for most factors, except high birth weight (I² = 0%). Subgroup analyses were conducted to explore sources of variability.
Current screening guidelines emphasize breech presentation and family history as primary criteria for hip ultrasonography referrals.
"A risk increase was detected for oligohydramnios, which had not been included in many screening programs. This finding may be useful in considering oligohydramnios as an additional risk factor for referral criteria for sonography-verified DDH," wrote first study author Maria Tirta, MD, and colleagues from the Department of Orthopaedic Surgery, Aalborg University Hospital, Denmark.
The study reaffirmed the relevance of family history and breech presentation as key risk factors for DDH in young infants, while introducing new evidence that supported the inclusion of oligohydramnios in screening protocols. It also challenged previous findings by indicating a lower risk increase associated with female sex than what had been previously reported.
Further research was recommended to assess the clinical implications of these findings.
Authors disclosed no conflicts of interest.
