Incidence and pattern of congenital dislocation of the hip in Aseer region of Saudi Arabia.

Abstract

OBJECTIVE: The aim of this paper is to determine the incidence, pattern, predisposing risk factors, treatment modalities and outcome of congenital dislocation of the hip (CDH) in the Aseer region of Saudi Arabia. METHODS: A retrospective study of 300 cases of CDH seen during a 4-year period between 1996 to 1999 was carried out at the Aseer Central Hospital, Abha. The relevant data examined included the details on pregnancy, birth, family history, methods of diagnosis and treatment. Data on live births for the same period was also obtained from the Directorate of Health, Aseer Region, Ministry of Health, Saudi Arabia. RESULTS: During the period of study, 300 children were found to have CDH with an incidence rate of 3.5/1000 live births. Only 32.4% of CDH was diagnosed in first 6 months of life. Mean age at diagnosis was 14.5 +/- 19.7 months while the mean age at treatment was 44.50 +/- 36.41 months. Some 235 cases (78.3%) were females (M:F ratio = 1:3.6) and 292 (97.7%) were Saudi nationals. There was a positive family history in 64 cases (21.3%). Both hip joints were involved in 151 cases (50.3%), the left hip joint 82 cases (27.3%) and the right hip joint in 67 cases (22.3%). Delivery was by spontaneous vaginal delivery in 268 cases 89.3%), caesarean section in 28 cases (9.3%) and breech delivery in 29 cases (10%). Limping and waddling gait were the most common clinical presentation seen in 166 cases (55.3%). In 22 children (7.3%), the parents were blood relatives. First born children constituted 56 out of 216 (25.9%). In the present series, 46% of the children were treated surgically, 42% were treated conservatively and 12% were treated by both. Avascular necrosis (AVN) of the femoral head following the treatment was seen in 6 children (2%). CONCLUSION: Incidence rate of CDH in Aseer Central hospital and by inference in Aseer region of Saudi Arabia was found to be 3.5/ 1000 live births. Since the neonatal screening of CDH in this region is poor, awareness programmes, routine neonatal hip joint examination at birth and up to one year of age and plain x-ray of pelvis after the age of 3 months in high-risk babies are strongly recommended.