Abstract
BACKGROUND: Developmental dysplasia of the hip (DDH) presents a diagnostic challenge due to varying risk factors (RFs) and ultrasonographic (USG) classifications. This study aimed to identify independent RFs for DDH and evaluate their association with USG hip types in a large pediatric cohort. METHODS: A retrospective review was conducted on infants under six months of age from a tertiary DDH screening program (2008–2022). The study included 227 cases with DDH and 924 controls with normal hips. Univariate and multivariate logistic regression analyses were performed to assess the association of RFs with DDH and USG hip types (stable dysplastic vs. unstable hips). RESULTS: Female sex (OR: 2.518), breech presentation (OR: 1.817), oligohydramnios (OR: 2.762), and foot deformities (OR: 2.262) were identified as independent RFs for DDH. Firstborn girls were significantly more likely to exhibit unstable hips (OR: 1.889, p = 0.027), underscoring their predisposition to severe forms of DDH. CONCLUSION: This study highlights the importance of early USG screening for infants with critical risk factors, including female sex, breech presentation, oligohydramnios, and foot deformities. Notably, firstborn girls with DDH exhibit a significantly higher risk of unstable hips, emphasizing the need for targeted screening in this high-risk subgroup. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12887-025-06426-6.