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An Eastern Europe and Middle East multinational expert Delphi consensus study on the prevention, diagnosis, and treatment of developmental dysplasia of the hip before walking age

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Abstract

Purpose

The incidence of developmental dysplasia of the hip (DDH) is higher in Eastern Europeans and Middle Easterners. This study aimed to establish consensus among experts in this geographical area on the management of DDH before walking age.

Methods

Fourteen experienced orthopedic surgeons agreed to participate in a four-round online consensus panel by the Delphi method. The questionnaire included 31 statements concerning the prevention, diagnosis, and treatment of DDH before walking age.

Results

Consensus was established for 26 (84%) of 31 statements. Hip ultrasonography is the proper diagnostic tool under six months in DDH; universal newborn hip screening between three and six weeks is necessary; positive family history, breech presentation, female gender, and postnatal swaddling are the most important risk factors; Ortolani, Barlow tests, and limitation of abduction are the most important clinical findings; Pavlik harness is the first bracing preference; some Graf type IIa hips and all Graf type IIb and worse hips need abduction bracing treatment; the uppermost age limit for closed and open reductions is 12 months and 12–24 months, respectively; anatomic reduction is essential in closed and open reductions, postoperative MRI or CT is not always indicated; anterior approach open reduction is better than medial approach open reduction; forceful reduction and extreme positioning of the hips (> 60° hip abduction) are the two significant risk factors for osteonecrosis of the femoral head.

Conclusion

The findings of the present study may be useful for clinicians because a practical reference, based on the opinions of the multinational expert panel, but may not be applicable to all settings is provided.

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Data Availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon a reasonable request.

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Author information

Authors and Affiliations

  1. Faculty of Medicine, Dr. Ridvan Ege Hospital, Ufuk University, 06520, Ankara, Turkey

    Hakan Ömeroğlu

  2. Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey

    Selcen Yüksel & Pervin Demir

  3. University Orthopaedic Hospital, Sofia Medical University, Sofia, Bulgaria

    Venelin Alexiev

  4. College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Abdulmonem Alsiddiky

  5. Faculty of Dental Medicine and Health, J.J, Strossmayer University of Osijek, Osijek, Croatia

    Darko Anticevic

  6. Clinical Center Mother Teresa Skopje, Skopje, North Macedonia

    Zoran Bozinovski

  7. University Clinical Center of Kosovo, University of Pristina, Pristina, Kosovo

    Cen Bytyqi

  8. Rehabilitation Clinical Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania

    Dan Cosma

  9. Medical Faculty, University Children’s Hospital, University of Belgrade, Belgrade, Serbia

    Siniša Dučić

  10. Sidra Medicine, Doha, Qatar

    Abdelsalam Hegazy

  11. Georgian American University, Tbilisi, Georgia

    Bidzina Kanashvili

  12. Wigmore Hospital for Children, Yerevan State Medical University, Yerevan, Armenia

    Garen Koloyan

  13. Papageorgiou Hospital, Thessaloniki, Greece

    Dimitris Metaxiotis

  14. Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey

    Hakan Şenaran

  15. Shiraz Medical University, Shiraz, Iran

    Gholam-Hossain Shahcheraghi

  16. Assof Harofe-Shamir Medical Center, Tel Aviv University, Tel Aviv, Israel

    Reuven Shitrit

  17. Orthopaedic and Spine Center in Ankara, Ankara, Turkey

    Muharrem Yazici

Authors
  1. Hakan Ömeroğlu
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  2. Selcen Yüksel
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  3. Pervin Demir
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  4. Venelin Alexiev
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  5. Abdulmonem Alsiddiky
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  6. Darko Anticevic
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  7. Zoran Bozinovski
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  8. Cen Bytyqi
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  9. Dan Cosma
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  10. Siniša Dučić
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  11. Abdelsalam Hegazy
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  12. Bidzina Kanashvili
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  13. Garen Koloyan
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  14. Dimitris Metaxiotis
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  15. Hakan Şenaran
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  16. Gholam-Hossain Shahcheraghi
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  17. Reuven Shitrit
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  18. Muharrem Yazici
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Contributions

H. Ömeroğlu: contributed to the study conception and design, wrote the first draft of the manuscript, commented on all versions of the manuscript, read, and approved the final manuscript.

S. Yüksel and P. Demir: contributed to the study conception and design, performed material preparation, data collection and analysis, commented on all versions of the manuscript, read, and approved the final manuscript.

V. Alexiev, A. Alsiddiky, D. Anticevic, Z. Bozinovski, C. Bytyqi, D. Cosma, S. Dučić, A. Hegazy, B. Kanashvili, G. Koloyan, D. Metaxiotis, H. Şenaran, G.H. Shahcheraghi, and R. Shitrit: multinational panel members, responded the four-round questionnaires, attended the final hybrid meeting and contributed to drawing the conclusions from the study, commented on all versions of the manuscript, read, and approved the final manuscript.

M. Yazici: contributed to the study conception and design, commented on all versions of the manuscript, read, and approved the final manuscript.

Corresponding author

Correspondence to Hakan Ömeroğlu.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Institutional Board of Ethics approval was not obtained as this was an online multinational expert survey study based on the theoretical clinical scenarios and any patient data was not used.

Conflict of interest

The authors declare no competing interests.

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Ömeroğlu, H., Yüksel, S., Demir, P. et al. An Eastern Europe and Middle East multinational expert Delphi consensus study on the prevention, diagnosis, and treatment of developmental dysplasia of the hip before walking age. International Orthopaedics (SICOT) (2023). https://doi.org/10.1007/s00264-023-06077-1

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