Bhatti Anisuddin, Soomro Marium Habib, Chinoy Muhammad Amin, Zaman Atiq Uz, Baloch Muhammad Aslam, Ali Pervez, Khan Mansoor Ali, Nadeem Umair, Zafir Muhammad Badaruddin, Jamil Muhammad, Peracha Asif, Pirwani Mehtab Ahmed, Ahmed Zakiuddin
Anisuddin Bhatti, FCPS Consultant Orthopaedic, Trauma & Paediatric Orthopaedic Surgery, Neurospinal Cancer Care Institute, Karachi, Pakistan. Professor, Dr. Ziauddin University Hospital, Clifton Karachi, Pakistan.
Marium Habib Soomro, MSPH General Manager, Health Research, Advisory Board (Health RAB) Karachi, Pakistan.
Pak J Med Sci. 2025 Mar;41(3):668-675. doi: 10.12669/pjms.41.3.10922.
This study aims to determine prevalence, risk factors and geographic distribution of Developmental Dysplasia of the Hip in Pakistan and to assess the cumulative outcomes of various treatments used and propose recommendations to establish preventive strategies and best treatment practices in Pakistan.
This multicentric retrospective study was conducted with analysis of data from DDH section of PORP registry of Pakistan. The data was uploaded by 1,3-11 authors, which were treated during last three decades. The evaluation parameters included 25 variables of basic demographics of patients, geographic prevalence, characteristics of DDH and related risk factors. The data was also analyzed to know methods of treatment used and cumulative outcomes in various age groups and severity of dysplasia.
The study included 755 patients with 1,107 affected hips, aged one day to over eight years. Of these, 86.25% were diagnosed after 18 months, 11.7% were over eight years. Among 104 neonates, 23% had neonatal screening. The female-to-male ratio was 3:1. 21% had history of DDH in family, and 24% were from remote rural areas. 46.6% had bilateral DDH. 48.43% patients had significantly obtuse acetabular index >45°. The acetabular index (AI) found highly associated with age bilaterally (p=0.001). 88% of normal unilateral hips had AI <30°, and 11% have moderate dysplasia of 30°-45°. 129 patients were treated non-operatively with 83.72% success rate at minimum three years follow-up. The failure rate of Pavlik harness was 25%. Six hundred twenty six (626) patients underwent open reduction with 70.42% success rate at minimum one year follow-up. Most failures in conservative and operative treatment were on one side of bilateral cases. Late complications over 10 years follow-up was short femoral neck offset, coxa magna and residual acetabular dysplasia.
This study leverages PORP registry data to identify DDH demographics, risk factors, and treatment outcomes. It highlights the need for establishment of MSK screening protocols, to diagnose DDH at earliest, to prevent development of disability of late treatment and enhance best practices in DDH management.
本研究旨在确定巴基斯坦髋关节发育不良的患病率、危险因素和地理分布，评估所采用的各种治疗方法的累积疗效，并提出建议，以制定巴基斯坦的预防策略和最佳治疗方案。
本多中心回顾性研究通过分析巴基斯坦PORP登记处DDH部分的数据进行。数据由13至11位作者上传，这些患者在过去三十年中接受了治疗。评估参数包括患者基本人口统计学的25个变量、地理患病率、DDH特征及相关危险因素。还对数据进行了分析，以了解所采用的治疗方法以及不同年龄组和发育不良严重程度的累积疗效。
该研究纳入了755例患者，共1107个患髋，年龄从1天至8岁以上。其中，86.25%在18个月后被诊断，11.7%超过8岁。在104例新生儿中，23%进行了新生儿筛查。男女比例为3:1。21%有家族性DDH病史，24%来自偏远农村地区。46.6%为双侧DDH。48.43%的患者髋臼指数明显钝角>45°。发现髋臼指数（AI）与双侧年龄高度相关（p=0.001）。88%的正常单侧髋关节AI<30°，11%有30°-45°的中度发育不良。129例患者接受了非手术治疗，在至少三年的随访中成功率为83.72%。 Pavlik吊带的失败率为25%。626例患者接受了切开复位，在至少一年的随访中成功率为70.42%。保守治疗和手术治疗的大多数失败发生在双侧病例的一侧。超过10年随访的晚期并发症为股骨颈短缩、大转子增大和髋臼发育不良残留。
本研究利用PORP登记处的数据确定DDH的人口统计学特征、危险因素和治疗结果。它强调了建立肌肉骨骼筛查方案的必要性，以便尽早诊断DDH，预防晚期治疗残疾的发生，并加强DDH管理的最佳实践。
