European Journal of Pediatrics

, Volume 178, Issue 4, pp 559–564 | Cite as

Developmental dysplasia of the hip in children with Down syndrome: comparison of clinical and radiological examinations in a local cohort

  • Anouk F.M. van GijzenEmail author
  • Elsbeth D.M. Rouers
  • Florens Q.M.P. van Douveren
  • Jeanne Dieleman
  • Johannes G.E. Hendriks
  • Feico J.J. Halbertsma
  • Levinus A. Bok
Original Article


Guidelines for children with Down syndrome (DS) suggest to perform an annual hip screening to enable early detection of developmental dysplasia of the hip (DDH). How to perform this screening is not described. Delayed detection can result in disabling osteoarthritis of the hip. Therefore, we determined the association between clinical history, physical, and radiological examination in diagnosing DDH in children with DS. Referral centers for children with DS were interviewed to explore variety of hip examination throughout the Netherlands. Clinical features of 96 outclinic children were retrospectively collected. Clinical history was taken, physical examination was performed, and X-ray of the hip was analyzed. All the referral centers performed physical examination and clinical history; however, 20% performed X-ray. Following physical examination according to Galeazzi test 26.9% and to limited abduction 10.8% of the outclinic-studied children were at risk for DDH. Radiological examination showed moderate or severe abnormal deviating migration rate of 14.6% resp. 11.5% in the right and left hip. However, no association between clinical history, physical examination, and radiological examination was found.

Conclusion: Clinical history and physical examination are insufficient to timely detect DDH in children with Down syndrome. Thereby regular radiological examination of the hip is advised.

What is Known:

• Developmental dysplasia of the hip (DDH) in people with Down syndrome (DS) develops during childhood.

• Guidelines for medical support of children with DS suggest an annual hip screening to enable early detection of hip damaging. How to perform this annual screening is not described.

What is New:

• This study shows no association between clinical history, physical and radiological examination of the hip.

• We recommend regular radiological examination of the hip in children with DS in order to identify DDH early up to 16 years of age.


Developmental dysplasia of the hip Down syndrome Multidisciplinary guidelines Radiological examination 



Developmental dysplasia of the hip


Down Syndrome


Left hip


Máxima Medical Center


Right hip


Standard deviation


Authors’ contributions

AFM van Gijzen has had a substantial contribution to the analysis and interpretation of the study. She added substantial data and results to the paper and rewrote the paper and processed the giving feedback. Agree to be accountable for all aspects of the work.

As a student, EDM Rouers has collected all the data and the analysis and wrote the first draft of the paper. Agree to be accountable for all aspects of the work.

QMP van Douveren has delivered a substantial contribution to the design of the study and acquisition of the data. Agree to be accountable for all aspects of the work.

J Dieleman had a great part in the study design and the data analysis. Agree to be accountable for all aspects of the work.

GE Hendriks has delivered a substantial contribution to the design and analysis of the study and acquisition of the data. Agree to be accountable for all aspects of the work.

F Halbertsma has had a substantial contribution to the design of the study, analysis, and interpretation of the study. Agree to be accountable for all aspects of the work.

LA Bok has had a substantial contribution to the design of the study, the acquisition, analysis, and interpretation. Agree to be accountable for all aspects of the work.

Compliance with ethical standards

This study was approved by the Medical Ethical Commission. All procedures performed in studies were done according to regular yearly medical care for children with Down syndrome, studied in retrospect, and in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Competing interests

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Anouk F.M. van Gijzen
    • 1
    Email author
  • Elsbeth D.M. Rouers
    • 2
    • 3
  • Florens Q.M.P. van Douveren
    • 4
  • Jeanne Dieleman
    • 5
  • Johannes G.E. Hendriks
    • 4
  • Feico J.J. Halbertsma
    • 1
  • Levinus A. Bok
    • 1
  1. 1.Department of Pediatrics and NeonatologyMáxima Medical CenterVeldhovenThe Netherlands
  2. 2.Centre for Infectious Disease ControlNational Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
  3. 3.Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
  4. 4.Department of Orthopedic SurgeryOrthopedie Groot EindhovenEindhovenThe Netherlands
  5. 5.Department of Epidemiology and StatisticsMáxima Medical CenterVeldhovenThe Netherlands

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