Hip Dysplasia in Numbers
Based on selective risk factor screening for DDH:
- 2200-3080 infants should be screened each year in BC
- 20,000-28,000 infants should be screened each year in Canada
- 6-9.2 million infants should be screened each year worldwide
With a DDH diagnosis 15-20/1000 births, dislocation in 1-3/1000 births:
- 660-880 infants likely to be affected each year in BC alone
- 6000-8000 infants likely to be affected each year in Canada
- 2.0-2.6 million infants likely to be affected each year worldwide
Despite being the most common paediatric hip disorder, there is very little strong evidence to inform health care providers, patients and families on the diagnosis, treatment and management of developmental dysplasia of the hip (DDH). This lack of evidence has highlighted the gaps in knowledge related to screening, treatment and management of this disorder, which can have important and long-lasting impacts on children and their families. The impact of screening and detection efforts is significant, both in the number of children and families affected, in cost, time and personnel resources to medical systems.
Every child born is clinically screened for hip instability by a paediatrician, family practitioner or other health care provider, with some countries also routinely performing ultrasound screening an all newborns. In North America, selective ultrasound screening programs are typically used, whereby only infants with specific risk factors for DDH (born breech, family history of DDH or a history of clinical hip instability) receive an ultrasound. There are approximately 44,000 births/year in British Columbia, contributing to 400,000 births/year across Canada. Worldwide, there is an estimated 131.4 million births/year. With a breech birth rate of 4%, and considering the additional risk factors of family history and history of instability, a conservative estimate of 2200-3080 infants/year in BC alone would directly benefit from improvements in DDH screening. Across Canada, screening procedures would be expected to impact 20,000-28,000 infants and their families, while representing a staggering 6.6-9.2 million infants worldwide.
The burden of disease is significant, with a DDH diagnosis in 15-20/1000 live births and a hip dislocation diagnosis in 1-3/1000 live births. Even when treated, DDH is a major cause of early hip replacement or osteoarthritis (OA) in young adults. Reported numbers range from DDH accounting for 10-92% of total hip replacement procedures, which conservatively equates to 30,000 procedures performed due to DDH in Canada and the United States each year. At a cost of $25,000/procedure, the direct financial impact is on the order of $625M/year to the Canadian and US medical systems alone.
In developing and underdeveloped regions, screening systems such as those used in Canada, the US and Europe, are not necessarily in place and/or are limited due to local resource constraints. Consequently, children in these areas may not be diagnosed with DDH until after walking age and thus require complex surgical procedures as the only treatment option. Therefore, even simple improvements to screening procedures with attention to local resources have the potential to impact millions of children and families every year worldwide.