Incidence of surgery in developmental dysplasia of the hip in taiwan.

BACKGROUND/PURPOSE: Early detection and treatment for developmental dysplasia of the hip (DDH) by screening in nursery has been recommended for several decades. With the recent survey of high prevalence of surgery for DDH in Taiwan, it has raised issues of the effectiveness of baby hip screening.

METHODS

National Health Insurance covers 97% of the 22 million population in Taiwan. From the databank, we retrieved children who were admitted from birth to 5 years of age, with the diagnosis of DDH (International Classification of Disease version 9 [ICD-9] code 754.3x) or had had one of the treatments for DDH (ICD-9 code 77.39, 79.75, 79.85, 88.32) between 1997 and 2004.

RESULTS

There were 1229 children undergoing surgeries for DDH in this study. A total of 1097 of them were female (89%). The mean age at the first surgery was 1.7 years. Major operation, open reduction with or without osteotomy, accounted for 85% of the cases. The number of children who were born between 1997 and 1999 and who had surgery for DDH were 160, 129 and 134, respectively. Incidences of surgery for DDH among these 3 cohort years were 0.49, 0.48 and 0.47 per thousand live births, respectively.

CONCLUSION

The incidence of DDH in Taiwan was reported as 1.2 per thousand, so 40% of the DDH children underwent surgery. However, with 87% of surgeries occurring after walking age, it is reasonable to postulate that the screening program was not performed accurately or universally. The rate of major procedures in surgical cases of DDH is a better indicator for the effectiveness of mass screening.