Journal of Pediatric Orthopaedics - 2026-08-17 - Journal Article
Association Between Idiopathic Clubfoot and Developmental Dysplasia of the Hip: Do We Need Universal Screening for It?
Krespi R, Gigi R, Hemo Y, Danino B, Ovadia D
Topics
Key Takeaway
DDH prevalence in idiopathic clubfoot was 0.78% (4/515 patients), statistically comparable to population norms, arguing against routine hip ultrasound screening based on clubfoot diagnosis alone.
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Summary
This study asked whether idiopathic CTEV constitutes an independent DDH risk factor justifying routine hip ultrasound screening. A retrospective review of prospectively collected data from 515 infants with idiopathic CTEV treated with Ponseti casting at a single tertiary center was performed, with all patients undergoing Graf-classified hip ultrasound at 6 weeks. DDH (Graf 2B or higher) was identified in only 4 patients (0.78%), all mild (Graf 2B or 2C), with no dislocations, and all managed successfully concurrent with clubfoot treatment.
Key Limitation
Syndromic and teratologic clubfoot cases were excluded, so findings cannot be extrapolated to the subset of clubfoot patients at highest theoretical risk for concurrent DDH.
Original Abstract
BACKGROUND
The association between congenital talipes equinovarus (CTEV) and developmental dysplasia of the hip (DDH) remains contested. Some guidelines consider idiopathic clubfoot a DDH risk factor warranting routine hip ultrasonography, while others do not. This study aimed to determine the prevalence of DDH in a large cohort of infants with idiopathic CTEV and assess whether routine screening is justified.
METHODS
A retrospective review of prospectively collected data was conducted at a single tertiary pediatric orthopaedic center. Children treated for idiopathic CTEV between July 2000 and November 2023 with a minimum 2-year follow-up were included. Teratologic and syndromic cases were excluded. All patients underwent routine hip ultrasonography at 6 weeks of age, classified by the Graf method. Hips graded Graf type 2B or higher received treatment.
RESULTS
A total of 515 patients (766 feet; 72% male) were included. Mean age at initiation of Ponseti casting was 14 days (SD: 14.2); mean follow-up was 7.3 years (SD: 4.1). DDH was identified in 4 patients (0.78%): 1 male (0.27%) and 3 females (2.05%). All 4 were classified as Graf type 2B or 2C; no frank dislocations were observed. DDH was successfully managed concurrently with CTEV treatment in all cases, with no recurrence.
CONCLUSIONS
In this largest single-center series to date, the prevalence of DDH in idiopathic CTEV was comparable to population norms, indicating that idiopathic clubfoot is not an independent risk factor for DDH. These findings do not support routine hip ultrasound screening based on a clubfoot diagnosis alone in selective screening systems, though no change is warranted in universal screening systems. This may not apply to syndromic clubfoot, which was not evaluated here.
LEVELS OF EVIDENCE
Level III-retrospective review of a prospective cohort.