A Novel Scoring System for Early Diagnosis of Pediatric Hip Dysplasia

Abstract

Background: Developmental dysplasia of the hip (DDH) is a common musculoskeletal disorder in infants, where early detection is crucial to prevent long-term complications such as gait abnormalities, chronic pain, and osteoarthritis. Traditional screening methods are often operator-dependent or limited by imaging availability, highlighting the need for a reliable early diagnostic tool.

Objective: To develop and evaluate a novel scoring system integrating demographic risk factors, clinical examination findings, and imaging parameters for early diagnosis of pediatric hip dysplasia.

Methods: A prospective cross-sectional study was conducted at Nishtar Medical university and hospital Multan from April 2024 to April 2025. A total of 85 infants were included in the study. Demographic data, physical examination findings (Ortolani and Barlow signs, hip abduction, leg length discrepancy), and imaging parameters (acetabular index, alpha angle, femoral head coverage, hip laxity) were collected. The scoring system assigned weighted points to these factors, stratifying patients into low, moderate, and high-risk categories.

Results: DDH patients had significantly higher mean scores (9.6 ± 2.8) than controls (6.2 ± 2.5, p<0.001). High-risk scores (≥10) captured 57.1% of DDH patients compared to 7.0% of controls (p<0.001). The scoring system demonstrated sensitivity of 88.1%, specificity of 79.1%, and an AUC of 0.91. Independent predictors of DDH included female sex (aOR 2.45, 95% CI 1.05–5.72), breech presentation (aOR 3.21, 95% CI 1.15–8.96), positive family history (aOR 2.98, 95% CI 1.01–8.77), positive Ortolani sign (aOR 5.76, 95% CI 2.05–16.2), and limited abduction (aOR 2.89, 95% CI 1.03–8.11).

Conclusion: The novel scoring system provides an effective, reliable tool for early DDH detection, allowing identification of high-risk infants, facilitating timely intervention, and potentially reducing delayed diagnosis and unnecessary imaging.