Reducing burden on future generations of children and adolescents with hip dysplasia

Challenge

Dysplasia of the hip is a congenital condition affecting up to 20% of children and adolescents. People suffering from hip dysplasia are more likely to develop hip osteoarthritis as adults and need hip replacement. Hip dysplasia can cause pain that impairs sleep, and restricts participation in school, sport and exercise, and social activities. Effective and safe treatment options for children and adolescents with hip dysplasia are urgently needed to reduce their immediate disability and prevent them from transitioning to become adults with hip osteoarthritis.

Current strategies for management of hip dysplasia in infants, children and adolescents are designed to diagnose the condition and preserve the hip joint. Milder cases are followed up and may not need any treatment. Infants are mainly treated with a soft brace. With increasing age treatment in more severe case include closed and open procedures. In a proportion of young children, different surgical treatment can be used to achieve better acetabular coverage of the femoral head. After the age of 16 years, periacetabular osteotomy surgery is the most common surgical treatment for hip dysplasia. If current treatments (brace, cast or surgery) do not modify the disease process or progression, they are unlikely to ever change the burden of hip osteoarthritis and eventually hip replacement.

Approach to address the challenge

To solve this problem, we will develop and validate clinical prediction rules for periacetabular osteotomies in adolescents and young adults with hip dysplasia using innovative, cutting edge data linkage and modelling. The risk factors to include in the model are:

1. Data on hip angles obtained by ultrasonography that are retrievable from the PACS system;
2. Clinical data of examination of infant´s hips and other known risk factors that are screened for by midwifes retrievable from the electronic patient record;
3. Identification of treatment with a brace, cast or surgical treatment as a child will be identified in the electronic patient record.

Outcomes: Periacetabular osteotomies will be determined with data from the Danish National Patient Registry

Importance

Our clinical prediction rule can be used to stratify patients into risk groups and allocate resources for x-rays and control visits at the hospital to the children who will need them. Our solution will be first in the world to provide critical knowledge to reduce burden on future generations of children and adolescents with hip dysplasia.

We are looking for a postdoctoral fellow with profound knowledge in data linkage and computer science.

• Dr Inger Mechlenburg, Professor and Expert hip physiotherapy researcher, Department of Orthopaedics at Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Denmark
• Dr Pia Kjær-Kristensen, Associate professor and Expert hip epidemiologist, Department of Orthopaedics at Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Denmark
• Dr Joanne Kemp, Associate professor and Expert sports and exercise physiotherapy clinician, College of Science, Health and Engineering, La Trobe University, Australia
• Dr Martin Gottliebsen, Clinical researcher and expert consultant orthopaedic surgeon at children’s sector, Department of Orthopaedics Aarhus University Hospital, Denmark