A recent study from Cambridge, UK, conducted by Barr and Rehm investigated whether multiple births have a higher incidence of DDH, and if selective ultrasound scanning should be considered for these infants.
There are many known risk factors for hip dysplasia including first-born child, female gender, breech position and family history. Sometimes twins or triplets are considered to be a risk factor for developmental dysplasia of the hip (DDH).
The authors reviewed records of 25 246 single and 990 multiple births. Multiple births did not have a significantly higher incidence of DDH compared with single births. Of the 990 multiple births, 267 had neonatal ultrasound scans and one case of DDH was diagnosed and treated successfully with a Pavlik harness. There were two late-presenting cases at eight and 14 months of age, neither of whom had risk factors for DDH and consequently had not had a neonatal scan.
Whereas selective ultrasound scanning of multiple births would have led to earlier detection and treatment of the late-presenting cases, they did not have a significantly higher incidence of DDH compared with single birth.
Authors concluded that being a twin or triplet in itself is not a risk factor for DDH and that selective ultrasound scanning is not specifically indicated for this population.
Comments: Although ‘packaging problems’ are considered contributory to DDH, there does not seem to be a higher incidence of DDH in ‘twin and triplet’ pregnancies where, more likely than not, there are packing issues.
Based on our current knowledge breech position seems to create a higher risk for DDH than twin/triplet births. We continue to further our knowledge related to known/unknown risk factors and exact causative factor of DDH still remains an enigma.
IHDI and its team remains committed to further studies and research that will improve our understanding related to etiology, early diagnosis and management.
Barr LV, Rehm A. Should all twins and multiple births undergo ultrasound examination for developmental dysplasia of the hip?: A retrospective study of 990 multiple births. Bone Joint J 2013;95-B:132-4.