Incidence and Risk Factors of Developmental Hip Dysplasia in Southeastern Turkey: A Population-Based Screening Study

Abstract

Background: Developmental dysplasia of the hip (DDH) is a leading cause of preventable childhood disability. Early identification through ultrasonography (US) screening enables simple, non-invasive treatment and avoids late surgical interventions, reducing lifetime morbidity and health-system costs. Despite Turkey's national screening program, province-level implementation data from the southeast remain limited. Objectives: This study aims to determine the incidence of DDH in southeastern Turkey and to assess the clinical outcomes of a large-scale, population-based ultrasound screening program conducted in Batman province. Additionally, the study seeks to identify associated risk factors contributing to the development of DDH and to estimate DDH incidence and describe risk factors and management outcomes within a large, province-wide universal screening program. Methods: We retrospectively analyzed 10,639 infants who underwent hip US (Graf method) from 1 January 2022 to 31 December 2023. Associations between DDH and prespecified risk factors were tested using chi-square or Fisher's exact tests; we report Pvalues and odds ratios (ORs) with 95% confidence intervals (CIs). Results: At first ultrasound, 88.8% of hips were Graf type 1 (normal). After follow-up of type 2a hips, 616 infants (5.8%) met criteria for DDH (>= type 2b). Female sex was significantly associated with DDH (OR: 1.59, 95% CI: 135-1.88; P = 3.4 x 10-8). Oligohydramnios (OR: 636, 95% CI: 4.28-9.46; P = 1.6 x 10 25), multiple gestation (OR: 35.29, 95% CI: 17.64-70.59; P = 7.0 x 10 23), and family history (OR: 54.97, 95% CI: 25.90-116.66; P = 6.9 x 10-29) showed strong positive associations. Breech presentation was not significant (OR: 0.76, 95% CI: 0.54-1.07; P = 0.115). Primiparity was less frequent among DDH cases (OR: 0.78, 95% CI: 0.66-0.92; P = 3.5 x 10 3). Conclusions: Province-wide universal screening confirms key associations (notably female sex and oligohydramnios) and provides implementation-level metrics to guide quality improvement.