Costs of abduction treatment in developmental dysplasia of the hip. Analysis of 900 patients

Vilma Lankinen; Riikka-Liisa Vuorinen; Mika Helminen; Karim Bakti; Jarmo Välipakka; Hannele Laivuori; Anna Hyvärinen

doi:10.1080/07853890.2023.2290694

Costs of abduction treatment in developmental dysplasia of the hip. Analysis of 900 patients

Ann Med. 2023;55(2):2290694. doi: 10.1080/07853890.2023.2290694. Epub 2023 Dec 8.

Authors

Vilma Lankinen^{1

2}, Riikka-Liisa Vuorinen^{2

3}, Mika Helminen^{4

5}, Karim Bakti², Jarmo Välipakka⁶, Hannele Laivuori^{3

7

8

9}, Anna Hyvärinen^{2

5

10

11

12}

Affiliations

¹ Department of Pediatric Surgery, Turku University Hospital, Turku, Finland.
² Faculty of Medicine and Health Technology, Tampere University, Finland.
³ Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
⁴ Faculty of Social Sciences, Health Sciences, Tampere University, Finland.
⁵ Tays Research Services, Tampere University Hospital, Tampere, Finland.
⁶ Pihlajalinna, Tampere, Finland.
⁷ Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampere University, Tampere, Finland.
⁸ Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.
⁹ Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹⁰ Department of Surgery, Mehiläinen Länsi-Pohja Oy, Kemi, Finland.
¹¹ Department of Pediatric Surgery, Oulu University Hospital, Oulu, Finland.
¹² Clinical Medicine Research Unit, Medical Research Center, University of Oulu, Oulu, Finland.

Abstract

Background: Developmental dysplasia of the hip (DDH) is a disorder of hip development that leads to dysplasia, subluxation, or total hip dislocation. Early detection of DDH is important, and early initiation of abduction treatment is key to successful correction of the hip joint. However, mild forms of DDH, including hip instability without complete dislocation, have good spontaneous healing potential, and a watchful waiting strategy in mild DDH has been found to be safe. In this study, we aimed to evaluate the cost differences between different treatment strategies for DDH.

Material and methods: Data were collected retrospectively from the medical records of all children diagnosed with diagnosis and treatment of DDH in Tampere University hospital between 1998 and 2018. In total, 948 patients were included in the study. Patients who underwent casting or operative treatment (n = 48) were excluded from the analysis. All Ortolani positive children were subjected to early abduction treatment. Children with Ortolani negative DDH were subjected to either watchful waiting or early abduction treatment, based on the clinicians' decision. The regression model estimates for the number of clinical visits with and without ultrasound examination were assessed together with cost reports from Tampere University Hospital for the calculation of savings per patient in spontaneous recovery.

Results: Alpha angles at one month of age (p < 0.001) and treatment method (p < 0.001) affected the number of clinical visits and ultrasound examinations during the treatment follow-up. A low alpha angle predicted closer follow-up, and children with spontaneous recovery had lower numbers of clinical visits and ultrasound examinations than children in abduction treatment. Spontaneous recovery was found to result in approximately 375€/patient savings compared to successful abduction treatment.

Conclusion: With correct patient selection, a watchful waiting strategy is cost-effective in treating mild developmental dysplasia of the hip, considering the high percentage of spontaneous recovery.

Keywords: Developmental dysplasia of the hip; Pavlik Harness; abduction treatment; cost analysis.

Plain language summary

Watchful waiting strategy should be implemented to clinical practice when treating mild DDH as it seems safe and cost effective.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Developmental Dysplasia of the Hip*
Early Diagnosis
Hip Dislocation, Congenital* / diagnostic imaging
Hip Dislocation, Congenital* / therapy
Humans
Infant
Orthotic Devices
Retrospective Studies
Ultrasonography

Grants and funding

This study has been supported by The Finnish state grants funding (VTR) to university-level health research, the Finnish Cultural Foundation and the Päivikki and Sakari Sohlberg Foundation for Dr. Anna Hyvärinen and by Vappu Uuspää foundation and by Tampere city research found for M.D. Vilma Lankinen.This work was funded by Vappu Uuspään Säätiö; Tampere city reserach fund; Päivikki ja Sakari Sohlbergin Säätiö; Suomen Kulttuurirahasto.