JAAOS - 2026-07-07 - Journal Article
Childhood Opportunity Index and Severity at Diagnosis of Developmental Dysplasia of the Hip.
Beber SA, Tracey OC, Ross SJ, Groff KD, Allen AK, Dodwell ER, Scher DM, Doyle SM
Topics
Key Takeaway
At a single tertiary care center, low COI was not associated with later presentation age (29.2 vs 31.2 days, P=0.66), worse Graf alpha angle (54.1° vs 53.6°, P=0.54), or higher surgical intervention rate (10% vs 9%) compared to high COI in 287 DDH patients treated with Pavlik harness.
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Summary
This study examined whether COI 3.0 quintile stratification predicted DDH severity at presentation or Pavlik harness outcomes in patients <9 months at a single tertiary center from 2016–2023. Low-COI (n=93) and high-COI (n=194) groups showed no significant differences in age at harness initiation, bilateral DDH rate, alpha angle, dislocation rate, need for rigid abduction orthosis (18% vs 21%), or surgical intervention rate (10% vs 9%). Despite demographic differences between groups, socioeconomic opportunity did not drive differential outcomes in this cohort.
Key Limitation
Tertiary referral center selection bias excludes low-COI patients who never receive ultrasound screening or specialty referral, making the null result ungeneralizable to population-level DDH disparities.
Original Abstract
BACKGROUND
Socioeconomic disparities are a critical risk factor for poor health outcomes yet remain under investigated in the context of developmental dysplasia of the hip (DDH). Childhood Opportunity Index (COI) 3.0 is a composite index of socioeconomic resources available to a child. Few studies have leveraged COI to investigate social determinants of health and outcomes of DDH.
METHODS
A retrospective review of patients younger than 9 months who presented with ultrasonographic evidence of DDH and treated with a Pavlik harness from January 1, 2016, to July 1, 2023, at a single tertiary care orthopaedic hospital was conducted. Participants were stratified by high and low opportunity using nationally normed COI 3.0 quintiles. Demographic data, clinical presentation, and treatment outcomes were compared.
RESULTS
Two hundred eighty-seven patients with DDH treated with Pavlik harness were included; 194 and 93 patients were included in the high-COI and low-COI groups, respectively. Age at Pavlik harness initiation was not different between the low-COI (29.2 days ± 35.0) and high-COI groups (31.2 days ± 36.0, P = 0.66), nor was the proportion of patients presenting with bilateral DDH (63% versus 57%, respectively, P = 0.37). Per hip analysis demonstrated no difference in alpha angle at presentation between the low-COI (54.1° ± 6.7) and high-COI groups (53.6° ± 8.2, P = 0.54) or the percentage of dislocated hips (8% per group, P = > 0.99). The proportion of patients requiring rigid abduction orthosis after harness treatment was not different between the low-COI (18%) and high-COI groups (21%, P = 0.64) nor was the proportion of patients requiring surgical intervention (10% and 9%, respectively).
CONCLUSION
At a tertiary care, urban orthopaedic hospital, lower childhood opportunity index (COI) was not associated with age or severity of DDH at presentation, nor success in Pavlik harness treatment, aligning with our current understanding of DDH and COI. Despite racial and ethnic differences between high-COI and low-COI groups, individual patient outcomes remained similar.