Developmental dysplasia of the hip: A systematic review of susceptibility genes and epigenetics

Mutation in the COL2A1 gene is associated with acetabular dysplasia

Background

Developmental dysplasia of the hip (DDH) is one of the most common developmental disorders worldwide, caused by a combination of genetic and environmental factors.

Methods

To investigate the genetic etiology of DDH in a proband (a 27-year-old male), we reviewed the patient's clinical data and collected peripheral blood samples from the proband and his parents. Genomic DNA was extracted, and polymerase chain reaction (PCR) amplification was performed. Clinical whole-exome sequencing (WES) using next-generation sequencing (NGS) was conducted to identify potential mutation sites, which were then validated through Sanger sequencing. Bioinformatics analysis was performed to assess the pathogenicity of the identified variant, and 3D protein modeling was conducted to predict its impact on protein structure.

Results

The proband presented with pain in bilateral hips, and based on clinical symptoms, laboratory findings and imaging studies, the final diagnosis was considered to be acetabular dysplasia with overlapping secondary synovial chondromatosis. Family history revealed similar symptoms in the proband's father, while the grandparents and other family members were unaffected. The patient underwent bilateral total hip arthroplasty and synovectomy. NGS and Sanger sequencing identified a heterozygous missense mutation in the COL2A1 gene (ex13, c.823C > T; p.Arg275Cys) in both the proband and his father, while this mutation was absent in the mother. Bioinformatic analysis indicated that the c.823C > T (p.Arg275Cys) variant is pathogenic, and structural modeling demonstrated that the substitution of arginine with cysteine at residue 275 altered the protein structure.

Conclusion

Our findings highlight the diagnostic utility of NGS in identifying precise genetic causes of DDH. The identification of the COL2A1 gene mutation in this present case represents a novel clinical phenotype, expanding the spectrum of disorders associated with COL2A1 mutations.

Is Oxytocin Induction at Labor a Risk Factor for Developmental Hip Dysplasia?

Background: Developmental hip dysplasia is a common condition with preventable causes, and its etiology is still not fully elucidated. In our study, we aimed to examine the use of synthetic oxytocin during childbirth as a potential risk factor for developmental hip dysplasia. Methods: This study involved comprehensive hip examinations on postnatal days 0, 14, 30, and 60, as well as hip ultrasonography results at 6-8 weeks. We specifically focused on healthy girls born with vaginal deliveries, comparing those who were applied with a low-dose oxytocin induction protocol (Group 2) and those who had vaginal deliveries without induction (Group 1). Results: When the examination findings were compared with the hip ultrasonography findings (Type 2a was detected in the left hip of one patient (6.3%) in Group 1 and in the right hip of two patients (11.8%) in Group 2), it was seen that oxytocin induction did not cause a risk for developmental hip dysplasia. The oxytocin induction rate was higher in newborns weighing more than 3400 g (p = 0.04). Conclusions: A low-dose oxytocin protocol applied at birth has not been shown to harm the hip joint in the neonatal period and on ultrasonographic α and β angle measurements applied at 6-8 weeks. However, our study also highlights the need for new studies investigating oxytocin peripheral receptors and their effects, underscoring the importance of our findings in guiding future research in this area.

The diagnostic value of artificial intelligence-assisted imaging for developmental dysplasia of the hip: a systematic review and meta-analysis

OBJECTIVE

To clarify the efficacy of artificial intelligence (AI)-assisted imaging in the diagnosis of developmental dysplasia of the hip (DDH) through a meta-analysis.

METHODS

Relevant literature on AI for early DDH diagnosis was searched in PubMed, Web of Science, Embase, and The Cochrane Library databases until April 4, 2024. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess the quality of included studies. Revman5.4 and StataSE-64 software were used to calculate the combined sensitivity, specificity, AUC value, and DOC value of AI-assisted imaging for DDH diagnosis.

RESULTS

The meta-analysis included 13 studies (6 prospective and 7 retrospective) with 28 AI models and a total of 10,673 samples. The summary sensitivity, specificity, AUC value, and DOC value were 99.0% (95% CI: 97.0-100.0%), 94.0% (95% CI: 89.0-96.0%), 99.0% (95% CI: 98.0-100.0%), and 1342 (95% CI: 469-3842), respectively.

CONCLUSION

AI-assisted imaging demonstrates high diagnostic efficacy for DDH detection, improving the accuracy of early DDH imaging examination. More prospective studies are needed to further confirm the value of AI-assisted imaging for early DDH diagnosis.

The incidence of late-detected developmental dysplasia of the hip and its functional outcomes: a 17-year cohort study using selective ultrasound screening

BACKGROUND AND PURPOSE

We aimed to establish the incidence of late-detected developmental dysplasia of the hip (DDH) with a selective ultrasound (US) examination over 17 years using the femoral head coverage (FHC) as a US measurement. The secondary aim was to establish the everyday function using patient-reported outcome measures (PROMs).

PATIENTS AND METHODS

The incidence of late-detected DDH was based on 60,844 children. Patients diagnosed for the first time after 3 months and before the age of 8 years were included. In the second part of the study, consent to participate was mandatory. PROMIS-25 Pediatric, PROMIS-25 Parent, and EQ-5D-5L were used according to the patient's age to assess everyday function.

RESULTS

The incidence of late-detected DDH was 0.48/1,000. The median age at diagnosis was 8 months (range 4-41 months), with a tendency to require repeated treatment with open surgery if DDH was diagnosed later. Most children reported no or minor health problems with a mean of 18 years' follow-up.

CONCLUSION

We found that selective US examination of the hips by measuring the FHC is a reliable method to examine newborns for DDH resulting in a low incidence of late-detected DDH amounting to 0.48/1,000 newborn children.