Epidemiology of Developmental Dysplasia of Hip in Pakistan: Insights from the Paediatric Orthopaedic Registry Pakistan (PORP).

Objective: 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. Methods: 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. Results: 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. Conclusion: 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.