Association Between Idiopathic Clubfoot and Developmental Dysplasia of the Hip: Do We Need Universal Screening for It?

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.