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Ethnicity as a confounding factor for the incidence of developmental dysplasia of the hip in the UK
  1. Julia Judd,
  2. Aexander Aarvold,
  3. Nicholas M P Clarke
  1. Department of Paediatric Orthopaedics, Southampton Children's Hospital, University Hospital Southampton, Southampton, Hampshire, UK
  1. Correspondence to Alexander Aarvold, Department of Paediatric Orthopaedics, Southampton Children's Hospital, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD, UK; alexander.aarvold{at}

Statistics from

In May 2004, eight new member states (A8) joined the European Union (EU), broadening the free movement of people to include more of Eastern Europe.1 The 2011 census for Southampton city reported a 212% rise in numbers of residents from EU accession countries since 2001. Of 11 370 immigrants, 8391 were Polish-born, making up 3.5% of total city residents. The Polish-born population of the UK increased from 75 000 in 2003 to an estimated 831 000 in 2015. Poland has overtaken India and is the single largest foreign national group resident in the UK2 with 21 156 Polish babies born in 2012, a number larger than any other foreign group.3 The influx has increased the service demands at Southampton Children's Hospital, notably due to the higher rates of developmental dysplasia of the hip (DDH). The incidence of DDH in the UK population is 3–6 per 1000 live births compared with 35.8 in Eastern Europe and remarkably 61.7 in Poland.4

A diagnosis of DDH elicits a 20-week programme of treatment by Pavlik harness, with serial clinical review, harness adjustment and serial ultrasound scans. Successfully treated babies will remain on follow-up for 5 years. Those in whom the harness treatment does not work will require reconstructive hip surgery in their early years. This intensive programme requires an appropriate workforce of specialist surgeons, sonographers and nurses.

Prompted by the increasing referrals to the Southampton Children's Hospital's baby hip screening clinic, the dataset of babies diagnosed with hip dysplasia was reviewed. All surnames of babies treated for hip dysplasia since 2000 were cross-checked through genealogy search engines to identify all those of Eastern European ancestry.

The number of babies diagnosed and treated for DDH in Southampton has increased from 58/year in 2000 to 123/year in 2015, with a disproportionate increase in numbers from Eastern Europe (figure 1). This resembles findings by Graf in Austria, with increased incidence of DDH following the Balkan crisis in the 1990s.

Figure 1

Babies of Eastern European ancestry treated for developmental dysplasia of the hip (DDH), Southampton, 2000–2015.

The increase in treatment for hip dysplasia requires cost and time from National Health Service (NHS) resources. The predisposition of DDH for osteoarthritis and need for future hip replacement4 is a further factor for consideration for future healthcare planning.

The NHS in England is in financial crisis, with hospital trusts disclosing deficits of £2.45 billion in 2015. The impact of immigration as a whole in the UK and for the NHS is contentious and is the remit of health economists.


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  • Contributors JJ did the main data collection and manuscript writing. AA and NMPC edited the manuscript. NMPC conceived the concept.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data collected have been presented in this letter.

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