Abstract
Objective
The objective was to assess whether late presentation of DDH leads to an increase in treatment magnitude and cost.
Methods
This was a retrospective review of prospectively collected data from our hip instability clinic database. All patients presenting to our hip instability clinic that required any form of treatment for DDH between 1990 and 2005 were included. Children were grouped according to age at presentation and then treatment requirements were reviewed. Average costs were calculated based on procedures performed.
Results
84% of children presenting before 6 weeks were treated successfully with abduction bracing, versus none after the age of 10 months. The need for open reduction increased from 8% if presenting before 6 weeks to 86% for those over 10 months. This equates to a 12-fold increase in relative risk of requiring open reduction surgery. Increasing age at presentation was associated with an increase in the number of procedures required, increased magnitude of procedure and increased financial cost per patient.
Conclusions
The loss of repeated screening for DDH will lead to an increase in late presentations. This work has demonstrated that increased age of presentation leads to a concomitant increase in open reduction and other operative procedures. Implementation of an additional opportunistic mandatory screening examination at 3–5 months could help to reduce the unintended effects of the new guidelines.
