IS CONGENITAL TALIPES EQUINOVARUS A RISK FACTOR FOR PATHOLOGICAL DDH? A 20-YEAR PROSPECTIVE, LONGITUDINAL OBSERVATIONAL STUDY

Aim: An assessment of the relationship between pathological Developmental Dysplasia of the Hip (DDH) and Congenital Talipes Equinovarus (CTEV). Introduction: Traditional UK guidelines consider abnormalities of the foot to be a risk factor for DDH 1,2 . Currently, there is controversy whether congenital foot abnormalities are true risk factors for pathological DDH 3,4 . There is a relationship between CTCV and hip dysplasia though the relationship between CTEV and pathological DDH is less clear 5 . In a previous 11 year prospective longitudinal study no case of Graf Types III, IV or irreducible hip dislocation were associated with CTEV 5 . Subsequent correspondence and case histories have challenged this view 6 Methods: In order to clarify this issue, a 20-year prospective longitudinal observational study was undertaken. All cases of fixed CTEV (Harold & Walker types 1 to 3) referred to the sub-regional Paediatric Orthopaedic clinic at the Royal Blackburn Hospital were evaluated, the feet and hips clinically assessed (Ortolani & Barlow manoeuvres) and the hips ultra-sounded by the senior author (RWP). Modified Graf and Harcke hip ultrasound classification systems were employed. Graf Type III, IV and irreducible hip dislocation were considered pathological. Results: The incidence of CTEV was 1.46 per 1000 live births (nationally quoted incidence of 1 to 2 per 1000 live births 7 ). There was one case of Graf Type III dysplasia with no cases of clinical hip instability. Currently, the clinical significance of this type of dysplasia is uncertain. There were no cases of Graf Type IV dislocations or radiological irreducible hip dislocation. Conclusion: Fixed CTEV should not be considered as a risk factor for pathological DDH and routine sonographic hip screening of CTEV should not be advocated. This is supportive evidence for the current English NIPE guidelines in which the only risk factors screened are family history and breech presentation. Level of evidence: II