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Journal of Children's Orthopaedics

Open Access 01-08-2014 | Original Clinical Article

The costs of late detection of developmental dysplasia of the hip

Published in: Journal of Children's Orthopaedics | Issue 4/2014

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Abstract

Purpose

Debate currently exists regarding the economic viability for screening for developmental dysplasia of the hip in infants.

Methods

A prospective study of infant hip dysplasia over the period of 1998–2008 (36,960 live births) was performed to determine treatment complexity and associated costs of disease detection and hospital treatment, related to the age at presentation and treatment modality. The involved screening programme utilised universal clinical screening of all infants and selective ultrasound screening of at-risk infants.

Results

One hundred and seventy-nine infants (4.8/1,000) presented with hip dysplasia. Thirty-four infants presented late (> 3 months of age) and required closed or open reduction. One hundred and forty-five infants presented at < 3 months of age, 14 of whom failed early Pavlik harness treatment. A detailed cost analysis revealed: 131 early presenters with successful management in a Pavlik harness at a cost of £601/child; 34 late presenters who required surgery (36 hips, 19 closed/17 open reductions, one revision procedure) at a cost of £4,352/child; and 14 early presenters with failed management in a Pavlik harness requiring more protracted surgery (18 hips, four closed/14 open reductions, seven revision procedures) at a cost of £7,052/child.

Conclusions

Late detection causes increased treatment complexity and a sevenfold increase in the short-term costs of treatment, compared to early detection and successful management in a Pavlik harness.

Discussion

Improved strategies are needed for the 10 % of early presenting infants who fail Pavlik harness treatment and require the most complex and costly interventions.
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Metadata
Title
The costs of late detection of developmental dysplasia of the hip
Publication date
01-08-2014
Published in
Journal of Children's Orthopaedics / Issue 4/2014
Print ISSN: 1863-2521
Electronic ISSN: 1863-2548
DOI
https://doi.org/10.1007/s11832-014-0599-7