The Epidemiology and Demographics of Hip Dysplasia
Identifieur interne : 000408 ( Pmc/Corpus ); précédent : 000407; suivant : 000409The Epidemiology and Demographics of Hip Dysplasia
Auteurs : Randall T. Loder ; Elaine N. SkopeljaSource :
- ISRN Orthopedics [ 2090-6161 ] ; 2011.
Abstract
The etiology of developmental dysplasia of the hip (DDH) is unknown. There are many insights, however, from epidemiologic/demographic information. A systematic medical literature review regarding DDH was performed. There is a predominance of left-sided (64.0%) and unilateral disease (63.4%). The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans. There is significant variability in incidence within each racial group by geographic location. The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. Predictors of DDH are breech presentation, positive family history, and gender (female). Children born premature, with low birth weights, or to multifetal pregnancies are somewhat protected from DDH. Certain HLA A, B, and D types demonstrate an increase in DDH. Chromosome 17q21 is strongly associated with DDH. Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. Swaddling is strongly associated with DDH. Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. Associated conditions are congenital muscular torticollis and congenital foot deformities. The opposite hip is frequently abnormal when using rigorous radiographic assessments. The role of acetabular dysplasia and adult hip osteoarthritis is complex. Archeological studies demonstrate that the epidemiology of DDH may be changing.
Url:
DOI: 10.5402/2011/238607
PubMed: 24977057
PubMed Central: 4063216
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PMC:4063216Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The Epidemiology and Demographics of Hip Dysplasia</title><author><name sortKey="Loder, Randall T" sort="Loder, Randall T" uniqKey="Loder R" first="Randall T." last="Loder">Randall T. Loder</name><affiliation><nlm:aff id="I1">Section of Orthopedic Surgery, Riley Hospital for Children, ROC 4250, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA</nlm:aff></affiliation><affiliation><nlm:aff id="I2">Department of Orthopaedic Surgery, Indiana University, Indianapolis, IN 46202, USA</nlm:aff></affiliation></author><author><name sortKey="Skopelja, Elaine N" sort="Skopelja, Elaine N" uniqKey="Skopelja E" first="Elaine N." last="Skopelja">Elaine N. Skopelja</name><affiliation><nlm:aff id="I3">Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN 46202, USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24977057</idno><idno type="pmc">4063216</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063216</idno><idno type="RBID">PMC:4063216</idno><idno type="doi">10.5402/2011/238607</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">000408</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000408</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Epidemiology and Demographics of Hip Dysplasia</title><author><name sortKey="Loder, Randall T" sort="Loder, Randall T" uniqKey="Loder R" first="Randall T." last="Loder">Randall T. Loder</name><affiliation><nlm:aff id="I1">Section of Orthopedic Surgery, Riley Hospital for Children, ROC 4250, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA</nlm:aff></affiliation><affiliation><nlm:aff id="I2">Department of Orthopaedic Surgery, Indiana University, Indianapolis, IN 46202, USA</nlm:aff></affiliation></author><author><name sortKey="Skopelja, Elaine N" sort="Skopelja, Elaine N" uniqKey="Skopelja E" first="Elaine N." last="Skopelja">Elaine N. Skopelja</name><affiliation><nlm:aff id="I3">Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN 46202, USA</nlm:aff></affiliation></author></analytic><series><title level="j">ISRN Orthopedics</title><idno type="ISSN">2090-6161</idno><idno type="eISSN">2090-617X</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>The etiology of developmental dysplasia of the hip (DDH) is unknown. There are many insights, however, from epidemiologic/demographic information. A systematic medical literature review regarding DDH was performed. There is a predominance of left-sided (64.0%) and unilateral disease (63.4%). The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans. There is significant variability in incidence within each racial group by geographic location. The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. Predictors of DDH are breech presentation, positive family history, and gender (female). Children born premature, with low birth weights, or to multifetal pregnancies are somewhat protected from DDH. Certain HLA A, B, and D types demonstrate an increase in DDH. Chromosome 17q21 is strongly associated with DDH. Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. Swaddling is strongly associated with DDH. Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. Associated conditions are congenital muscular torticollis and congenital foot deformities. The opposite hip is frequently abnormal when using rigorous radiographic assessments. The role of acetabular dysplasia and adult hip osteoarthritis is complex. Archeological studies demonstrate that the epidemiology of DDH may be changing.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Stedman, Tl" uniqKey="Stedman T">TL Stedman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kocher, Ms" uniqKey="Kocher M">MS Kocher</name></author><author><name sortKey="Zurakowski, D" uniqKey="Zurakowski D">D Zurakowski</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Szabo, Rm" uniqKey="Szabo R">RM Szabo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Macfarlane, A" uniqKey="Macfarlane A">A MacFarlane</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Homer, Cj" uniqKey="Homer C">CJ Homer</name></author><author><name sortKey="Baltz, Rd" uniqKey="Baltz R">RD Baltz</name></author><author><name sortKey="Hickson, Gb" uniqKey="Hickson G">GB 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article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">ISRN Orthop</journal-id><journal-id journal-id-type="iso-abbrev">ISRN Orthop</journal-id><journal-id journal-id-type="publisher-id">ISRN.ORTHOPEDICS</journal-id><journal-title-group><journal-title>ISRN Orthopedics</journal-title></journal-title-group><issn pub-type="ppub">2090-6161</issn><issn pub-type="epub">2090-617X</issn><publisher><publisher-name>International Scholarly Research Network</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24977057</article-id><article-id pub-id-type="pmc">4063216</article-id><article-id pub-id-type="doi">10.5402/2011/238607</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review Article</subject></subj-group></article-categories><title-group><article-title>The Epidemiology and Demographics of Hip Dysplasia</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Loder</surname><given-names>Randall T.</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="aff" rid="I2"><sup>2</sup></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Skopelja</surname><given-names>Elaine N.</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Section of Orthopedic Surgery, Riley Hospital for Children, ROC 4250, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA</aff><aff id="I2"><sup>2</sup>Department of Orthopaedic Surgery, Indiana University, Indianapolis, IN 46202, USA</aff><aff id="I3"><sup>3</sup>Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN 46202, USA</aff><author-notes><corresp id="cor1">*Randall T. Loder: <email>rloder@iupui.edu</email></corresp><fn fn-type="other"><p>Academic Editors: S. Aldrian and T. Matsumoto</p></fn></author-notes><pub-date pub-type="collection"><year>2011</year></pub-date><pub-date pub-type="epub"><day>10</day><month>10</month><year>2011</year></pub-date><volume>2011</volume><elocation-id>238607</elocation-id><history><date date-type="received"><day>15</day><month>5</month><year>2011</year></date><date date-type="accepted"><day>17</day><month>6</month><year>2011</year></date></history><permissions><copyright-statement>Copyright © 2011 R. T. Loder and E. N. Skopelja.</copyright-statement><copyright-year>2011</copyright-year><license license-type="open-access"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>The etiology of developmental dysplasia of the hip (DDH) is unknown. There are many insights, however, from epidemiologic/demographic information. A systematic medical literature review regarding DDH was performed. There is a predominance of left-sided (64.0%) and unilateral disease (63.4%). The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans. There is significant variability in incidence within each racial group by geographic location. The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. Predictors of DDH are breech presentation, positive family history, and gender (female). Children born premature, with low birth weights, or to multifetal pregnancies are somewhat protected from DDH. Certain HLA A, B, and D types demonstrate an increase in DDH. Chromosome 17q21 is strongly associated with DDH. Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. Swaddling is strongly associated with DDH. Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. Associated conditions are congenital muscular torticollis and congenital foot deformities. The opposite hip is frequently abnormal when using rigorous radiographic assessments. The role of acetabular dysplasia and adult hip osteoarthritis is complex. Archeological studies demonstrate that the epidemiology of DDH may be changing.</p></abstract></article-meta></front><body><sec id="sec1"><title>1. Introduction</title><p>Demography is the study of human populations with reference to size, diversity, growth, age, and other characterizing statistics [<xref rid="B1" ref-type="bibr">1</xref>]. Epidemiology is the study of the incidence, distribution, and determinants of disease frequency in groups of individuals who happen to have characteristics in common (e.g., gender, ethnicity, exposure, genetics) [<xref rid="B2" ref-type="bibr">2</xref>, <xref rid="B3" ref-type="bibr">3</xref>]. Incidence is the proportion of new cases in the population at risk during a specified time interval; prevalence is defined as the proportion of individuals with the disease in the study population of interest. Demographic and epidemiologic studies can determine risk factors for a disease/condition of interest, shed light on its etiology, and guide potential prevention programs. </p><p>Developmental dysplasia of the hip (DDH) is an epidemiologic conundrum [<xref rid="B4" ref-type="bibr">4</xref>]. DDH encompasses a wide spectrum of pathology ranging from a complete fixed dislocation at birth to asymptomatic acetabular dysplasia in the adult [<xref rid="B5" ref-type="bibr">5</xref>–<xref rid="B9" ref-type="bibr">9</xref>]. The epidemiologic literature regarding DDH is vast and confusing due to different definitions of hip dysplasia, different methods of diagnosis (e.g., physical exam, plain radiographs, ultrasound), different ages of the population studied (e.g., new born, 1 month old, 3 months old, etc.), clinical experience of the examiner [<xref rid="B10" ref-type="bibr">10</xref>], different ethnicities/races in the examined population, and different geographic locations within similar ethnic populations [<xref rid="B11" ref-type="bibr">11</xref>, <xref rid="B12" ref-type="bibr">12</xref>]. Neonatal hip instability, now even more apparent with hip ultrasonography, must also be addressed [<xref rid="B13" ref-type="bibr">13</xref>, <xref rid="B14" ref-type="bibr">14</xref>]; the clinical challenge is to separate the neonatal hip instability which resolves spontaneously from that which is significant [<xref rid="B15" ref-type="bibr">15</xref>–<xref rid="B21" ref-type="bibr">21</xref>]. </p><p>The last major review of the epidemiology of hip diseases was in 1977 [<xref rid="B22" ref-type="bibr">22</xref>]. The goal of these manuscripts is to update the current knowledge of the epidemiology and demographics of pediatric hip disease which may lead to significant morbidity in later life. </p></sec><sec id="sec2"><title>2. Materials and Methods</title><p>A systematic review was performed for articles on DDH in infants focusing on etiology, epidemiology, and diagnosis. Exclusion criteria were those manuscripts discussing surgery, therapy, rehabilitation and any foreign language articles without an English abstract. There were certain difficulties in searching the literature on this topic because of the many variant names for DDH. The most commonly used modern terms are “developmental dysplasia of the hip” or DDH and “congenital hip dislocation,” CDH. Archaic terms include “congenital dislocation,” “congenital hip,” or “congenital subluxation of the hip” or “congenital dysplasia of the hip.” Even with controlled vocabularies, each database uses a different subject term, for example, Medline's (Medical Subject Headings or MESH) heading is “Hip Dislocation, Congenital,” EMBASE uses “Congenital Hip Dislocation,” Web of Science uses “Congenital Dislocation,” and the historical Index-Catalogue uses “Hip Joint, Dislocation of, Congenital.”</p><p>The databases used in this paper were PubMed Medline (1947–2010) (<ext-link ext-link-type="uri" xlink:href="http://www.ncbi.nlm.nih.gov/pubmed/">http://www.ncbi.nlm.nih.gov/pubmed/</ext-link>), Ovid Medline (1947–2010), EMBASE (1987–2010), WorldCat (1880–2010) (books and theses) (<ext-link ext-link-type="uri" xlink:href="http://firstsearch.oclc.org/">http://firstsearch.oclc.org/</ext-link>), Web of Knowledge (1987–2010), and IndexCat (Index Catalogue of the Library of the Surgeon-General's Office (1880–1961) (<ext-link ext-link-type="uri" xlink:href="http://www.indexcat.nlm.nih.gov/">http://www.indexcat.nlm.nih.gov/</ext-link>). Individual orthopedic journals were also searched for articles published prior to 1966 that predate electronic indexing, including <italic>Journal of Bone and Joint Surgery (American and British), Clinical Orthopaedics and Related Research</italic>, and <italic>Acta Orthopaedica Scandinavica</italic>. Hand searching and citation searching were also performed. Google Scholar (1880–2010) (<ext-link ext-link-type="uri" xlink:href="http://scholar.google.com.eg/">http://scholar.google.com</ext-link>) was searched as a final check but did not find any additional articles. Age groups were limited to those <18 years old; duplicate citations were removed.</p><p>This search resulted in 2277 unique manuscripts which were reviewed to find those that discussed any of the topics regarding DDH and epidemiology, etiology, demographics, incidence, prevalence, race, gender, family history, inheritance, genetics, age, bone age, weight (either birth weight or normal weight), height, growth, maturation, any other anthropometric characteristics, seasonal variation, hormone, endocrine, congenital anomalies, perinatal factors, swaddling, collagen, and opposite hip. Of these 2277 manuscripts, 422 provided ample information and are the contents of this paper.</p></sec><sec id="sec3"><title>3. Results</title><sec sec-type="subsection" id="sec3.1"><title>3.1. Childhood Hip Dysplasia </title><p><statement id="head1"><title>Incidence</title><p>There are three eras in modern medicine when the incidence of hip DDH has been determined [<xref rid="B23" ref-type="bibr">26</xref>]. Period I (1920s to 1950s) was when the incidence was arbitrarily estimated. Period II (1950s to 1980s) was when the incidence was determined based on the detection of unstable hips on neonatal physical exam plus the addition of late-diagnosed patients. Period III (1980s to present) incorporates hip ultrasonography (both diagnostic and screening) (<xref ref-type="fig" rid="fig1">Figure 1</xref>). Generally accepted ranges for the incidence of DDH for Period I range from 0–40% (0% Africans and up to 40% in other racial groups), for Period II 0.04%–16.8% (0% in Africans and up to 33% in Native Americans), and for Period III 4.4%–51.8% (4.4% for Africans and 7.15% the lowest for Caucasians) [<xref rid="B23" ref-type="bibr">26</xref>]. The wide range of DDH incidence in Period III reflects differences in the definition of DDH. Some studies include any hips with ultrasonographic instability, whereas others include only those types ≥ Graf IIb (<xref ref-type="table" rid="tab1">Table 1</xref>, <xref ref-type="fig" rid="fig1">Figure 1</xref>).</p><p>Hip ultrasonography creates confusion due to differences between the neonatal physical exam and ultrasound findings [<xref rid="B15" ref-type="bibr">15</xref>–<xref rid="B17" ref-type="bibr">17</xref>, <xref rid="B24" ref-type="bibr">27</xref>, <xref rid="B25" ref-type="bibr">28</xref>]. The interobserver variability (<italic>κ</italic> 0.4 to 0.5) in determining hip stability is also poor to moderate [<xref rid="B26" ref-type="bibr">29</xref>–<xref rid="B28" ref-type="bibr">31</xref>]. The wide variability in incidence in the ultrasonographic era is better understood when considering two different groups of neonatal instability. The first is neonatal, sonographic DDH which resolves spontaneously. The second is neonatal instability which if left untreated may progress to true DDH, ranging from acetabular dysplasia to complete dislocation. Hadlow [<xref rid="B29" ref-type="bibr">32</xref>] noted that 50% of unstable hips at birth stabilized completely within 5 days; Barlow [<xref rid="B30" ref-type="bibr">33</xref>] noted that 90% of unstable hips at birth become normal by 2 months; Abdinejad et al. [<xref rid="B31" ref-type="bibr">34</xref>] noted that 97% of neonatally unstable hips resolved spontaneously by 6 months. Many of the sonographic DDH hips likely reflect these clinical findings [<xref rid="B20" ref-type="bibr">20</xref>, <xref rid="B29" ref-type="bibr">32</xref>–<xref rid="B31" ref-type="bibr">34</xref>] and are in the first group.</p><p>The incidence/prevalence is quoted as the number per 1000 live births. The data presented here is a best attempt at synthesizing the literature during these different periods; insufficient data was often present making it difficult to calculate demographic variables. Race is classified using the definitions of Eveleth and Tanner: Caucasians, Africans in Africa and of African Ancestry, Asiatics (Amerindians, Hispanics, Indonesian-Malays), Indo-Mediterraneans (inhabitants of the Near East, North Africa, and Indian subcontinent), and Australian Aborigines and Pacific Island peoples [<xref rid="B32" ref-type="bibr">35</xref>].</p></statement></p></sec><sec sec-type="subsection" id="sec3.2"><title>3.2. Clinical Screening Period (1950s–1980s) by Ethnic Groups (<xref ref-type="table" rid="tab2">Table 2</xref>) </title><sec sec-type="subsubsection" id="sec3.2.1"><title>3.2.1. Conventional DDH </title><p><statement id="head2"><title>Indigenous Peoples (<xref ref-type="table" rid="tab2">Table 2(a)</xref>) </title><p><statement id="head3"><title>(i) Native Americans</title><p>The incidence of DDH is high in Native Americans, likely due to a combination of genetics and swaddling. In the Arizona Fort Apache Indians [<xref rid="B33" ref-type="bibr">43</xref>], the incidence was 31, but likely higher, since cases of dysplasia and subluxation were excluded. This particular group of Native Americans represent a very tight gene pool as they have maintained their endogamous marriages (band members only marrying within their own band) after migrating approximately 600 years ago from three different bands in Western Canada. In Navajo children [<xref rid="B34" ref-type="bibr">42</xref>] from Fort Defiance, Arizona and Gallup, New Mexico, the incidence was 67. A positive family history was present in 33% of the dysplasia cases but only 6.1% of the nondysplastic cases. In the Navajo from the Arizona Many Farms District, [<xref rid="B35" ref-type="bibr">41</xref>] the overall prevalence of DDH was 37.9 : 33.3 for adults and 40.1 for children. Complete dislocation was more common in adults and simple acetabular dysplasia/subluxation more common in children. The ratio of childhood dysplasia to dislocation was 4.5 to 1 and in adults 0.3 to 1. </p><p>In an early study of the Cree-Ojibwa, Island Lake, Northern Manitoba, the incidence was 36 [<xref rid="B36" ref-type="bibr">36</xref>]; in a later more detailed study, the incidence of frank dislocation and subluxation was 110 [<xref rid="B37" ref-type="bibr">37</xref>]. The prevalence of DDH for all ages was 336 [<xref rid="B37" ref-type="bibr">37</xref>] (195 for frank hip dislocation or subluxation, 99 for dysplasia, and 54 for other types). In the Cree in Northern Saskatchewan, the overall prevalence was 13.2 [<xref rid="B38" ref-type="bibr">38</xref>]. In Ontario Native Americans [<xref rid="B39" ref-type="bibr">39</xref>], the incidence ranged from 12 to 123. Using weighted averages, the average incidence of DDH in Native Americans is 76.1 for all dysplasia (<xref ref-type="fig" rid="fig2">Figure 2(a)</xref>).</p></statement><statement id="head4"><title>(ii) Sámi and Australian Aboriginals</title><p>The Sámi (previously known as “Lapps” which is a derogatory offensive term) is the indigenous people of Sápmi, the circumpolar areas of Sweden, Norway, Finland, and the Kola Peninsula of Russia [<xref rid="B40" ref-type="bibr">151</xref>]. The Sámi population is 50,000 to 100,000, and ~1/2 live in Norway [<xref rid="B40" ref-type="bibr">151</xref>–<xref rid="B42" ref-type="bibr">153</xref>]. The incidence of DDH in the Sámi was 24.6 [<xref rid="B43" ref-type="bibr">46</xref>] and 40 [<xref rid="B44" ref-type="bibr">45</xref>]. The incidence in Australian Aborigines is ~1/2 that of Caucasians (3.7 versus 6.6) [<xref rid="B45" ref-type="bibr">44</xref>] (<xref ref-type="fig" rid="fig2">Figure 2(a)</xref>).</p></statement><statement id="head5"><title>(iii) Africans</title><p>DDH is extremely rare in Africans (<xref ref-type="table" rid="tab2">Table 2(b)</xref>). In Sub-Saharan Africans, 2 cases of typical DDH were described in the Bantu [<xref rid="B46" ref-type="bibr">48</xref>]. There were no signs of hip dysplasia at 3 months of age in another study of 16678 Bantu children [<xref rid="B47" ref-type="bibr">47</xref>], despite breech presentation in 897 (5.4%). In the Kikuyu Bantu, Kenya, 2 cases of typical DDH are described [<xref rid="B48" ref-type="bibr">154</xref>]. In a review of 284 children with congenital orthopaedic malformations in an African teaching hospital (Ibadan, Nigeria), DDH accounted for only 2.2% of all congenital malformations [<xref rid="B49" ref-type="bibr">155</xref>].</p><p>This immunity of the African infant from DDH may be due to deeper acetabulae [<xref rid="B50" ref-type="bibr">156</xref>], genetic factors [<xref rid="B51" ref-type="bibr">157</xref>], and the absence of swaddling in African cultures. Carrying the infant in an abducted position straddling the iliac crest is postulated as protective against DDH in the African peoples. However, in the United States, the acetabular indices of Caucasian and African infants showed minimal differences at birth but by 6 to 12 months of age were actually slightly higher (or shallower acetabulae) in Africans [<xref rid="B52" ref-type="bibr">158</xref>]. Genetic mixing between Africans and other races with a higher incidence of DDH (e.g., Caucasians in the United States) [<xref rid="B46" ref-type="bibr">48</xref>, <xref rid="B53" ref-type="bibr">159</xref>] results in a higher but still comparatively low incidence of DDH. Quoted incidences in African Americans are 0.21 [<xref rid="B54" ref-type="bibr">51</xref>] and 0.46 [<xref rid="B55" ref-type="bibr">50</xref>] compared to 1.5 in American Caucasian infants [<xref rid="B55" ref-type="bibr">50</xref>]. Using weighted averages, the incidence of DDH is 0.06 in Africans in Africa and 0.40 in the United States.</p></statement><statement id="head6"><title>(iv) Indo-Mediterraneans</title><p>The incidence in India is 0.42 in rural Ballabgarh, Haryana [<xref rid="B56" ref-type="bibr">52</xref>], 1.0 [<xref rid="B57" ref-type="bibr">53</xref>] and 2.65 [<xref rid="B58" ref-type="bibr">55</xref>] in New Delhi, and 9.2 in northern India (Chandigarh) [<xref rid="B59" ref-type="bibr">57</xref>]. For Indians in Malaysia, it is 1.2 [<xref rid="B60" ref-type="bibr">54</xref>] and 4.63 in Singapore [<xref rid="B61" ref-type="bibr">56</xref>]. In Iranians, it is 1.5 in Mashhad City [<xref rid="B62" ref-type="bibr">65</xref>], 3.64 in Shiraz [<xref rid="B31" ref-type="bibr">34</xref>], and 9.1 in Urmia [<xref rid="B63" ref-type="bibr">66</xref>]. In Dubai, UAE, the incidence is 3.17 [<xref rid="B64" ref-type="bibr">62</xref>] and 3.8 in Aseer, Saudi Arabia [<xref rid="B65" ref-type="bibr">63</xref>]. In Western Galilean Arabic's it ranges from 30.0 to 46.7 [<xref rid="B66" ref-type="bibr">61</xref>]. In Ankara, Turkey, it is 1.7 [<xref rid="B67" ref-type="bibr">58</xref>] and 47 [<xref rid="B68" ref-type="bibr">60</xref>], and 3.42 in Konya, Turkey. Using weighted averages, the incidence of DDH in Indo-Mediterraneans is 5.4, 2.4 for those of Indian descent, and 6.2 for those of Arabic descent (<xref ref-type="table" rid="tab2">Table 2(b)</xref>, <xref ref-type="fig" rid="fig2">Figure 2(b)</xref>).</p></statement><statement id="head7"><title>(v) Indo-Malays</title><p>The incidence of DDH in Indo-Malays varies widely (<xref ref-type="table" rid="tab2">Table 2(c)</xref>, <xref ref-type="fig" rid="fig2">Figure 2(c)</xref>). In Japanese the incidence ranges from 1.8 [<xref rid="B69" ref-type="bibr">87</xref>] to 52.9 [<xref rid="B70" ref-type="bibr">85</xref>]; for Chinese 0.07 [<xref rid="B71" ref-type="bibr">74</xref>] to 4.41 [<xref rid="B61" ref-type="bibr">56</xref>]; for Malay 0.71 [<xref rid="B60" ref-type="bibr">54</xref>] to 5.38 [<xref rid="B61" ref-type="bibr">56</xref>]. The one study of Thai note an incidence of 0.51 [<xref rid="B72" ref-type="bibr">75</xref>]. Using weighted averages, the overall incidence of DDH in Indo-Malays is 1.1, 0.1 in Chinese, 1.6 in Malay, and 6.4 in Japanese.</p></statement><statement id="head8"><title>(vi) Caucasians</title><p><statement id="head9"><title>(a) Europe</title><p>The incidence in Scandinavia ranges from 0.9 to 28 [<xref rid="B54" ref-type="bibr">51</xref>, <xref rid="B75" ref-type="bibr">64</xref>, <xref rid="B87" ref-type="bibr">92</xref>, <xref rid="B76" ref-type="bibr">94</xref>–<xref rid="B83" ref-type="bibr">102</xref>, <xref rid="B73" ref-type="bibr">104</xref>–<xref rid="B86" ref-type="bibr">106</xref>, <xref rid="B84" ref-type="bibr">160</xref>]. In the United Kingdom, three studies give a low incidence (0.91 in Birmingham, England [<xref rid="B88" ref-type="bibr">111</xref>], 1.55 in Manchester, England [<xref rid="B30" ref-type="bibr">33</xref>], and 1.7 in Northern Ireland [<xref rid="B89" ref-type="bibr">118</xref>]); most range from 3–6 [<xref rid="B94" ref-type="bibr">107</xref>, <xref rid="B90" ref-type="bibr">109</xref>, <xref rid="B91" ref-type="bibr">112</xref>–<xref rid="B97" ref-type="bibr">115</xref>, <xref rid="B95" ref-type="bibr">161</xref>, <xref rid="B96" ref-type="bibr">162</xref>], with the highest incidence of 30.3 in Aberdeen, Scotland [<xref rid="B98" ref-type="bibr">108</xref>]. In Spain, the incidence was 9.78 in Córdoba [<xref rid="B99" ref-type="bibr">121</xref>] and 43.4 in Madrid [<xref rid="B100" ref-type="bibr">122</xref>] (5.09 for complete dislocation). In the Mediterranean Islands, it was 10.6 in Crete [<xref rid="B101" ref-type="bibr">124</xref>] and 25.5 in Sicily [<xref rid="B102" ref-type="bibr">125</xref>]). The incidence of DDH is higher in Eastern Europe and ranges from 5.2 in Lastovo Island, Croatia [<xref rid="B103" ref-type="bibr">128</xref>] to 113 [<xref rid="B104" ref-type="bibr">133</xref>] in West Bohemia, Czech Republic. The average weighted incidence of DDH in the Scandinavia is 3.8, 3.6 in the United Kingdom, 25.5 in Spain and the Mediterranean Islands, and 35.8 in Eastern Europe (<xref ref-type="table" rid="tab2">Table 2(d)</xref>, <xref ref-type="fig" rid="fig2">Figure 2(e)</xref>).</p></statement><statement id="head10"><title>(b) Australia/New Zealand</title><p>The incidence is 7.7 in Adelaide [<xref rid="B105" ref-type="bibr">144</xref>], 5.5 in South Australia [<xref rid="B106" ref-type="bibr">67</xref>], and 6.6 [<xref rid="B45" ref-type="bibr">44</xref>] and 10.5 [<xref rid="B107" ref-type="bibr">143</xref>] in Western Australia. In New Zealand, it is 2.19 in Southland [<xref rid="B108" ref-type="bibr">147</xref>], 2.65 in Canterbury [<xref rid="B109" ref-type="bibr">146</xref>], 3.54 in Auckland [<xref rid="B110" ref-type="bibr">145</xref>], and 16.0 [<xref rid="B29" ref-type="bibr">32</xref>] in New Plymouth. The averaged weighted incidence of Caucasians in Australia/New Zealand is 6.8.</p></statement><statement id="head11"><title>(c) Americas</title><p>There are few incidence studies in the United States due to its highly mobile population. The incidence is 0.7 in Jefferson County, Alabama [<xref rid="B54" ref-type="bibr">51</xref>], 0.8 in Portland, Oregon [<xref rid="B111" ref-type="bibr">150</xref>], 1.1 in Iowa [<xref rid="B112" ref-type="bibr">163</xref>], and 0.7–6.1 in Utah [<xref rid="B113" ref-type="bibr">164</xref>]. In Llanquihue, Chile [<xref rid="B114" ref-type="bibr">149</xref>], the incidence is 4.6, 2.3 for complete dislocation and 2.2 for dysplasia/subluxation. The incidences for all Caucasians are shown in Figures <xref ref-type="fig" rid="fig2">2(d)</xref> and <xref ref-type="fig" rid="fig2">2(e)</xref>.</p></statement></p></statement><statement id="head12"><title>(vii) Mixed Races</title><p>In a study of 432778 infants born in Birmingham, England between 1960–1984 [<xref rid="B115" ref-type="bibr">165</xref>], the birth prevalence of DDH was 2.77 when both parents were Caucasian, 1.37 when both were South Asian (from India, Pakistan, Bangladesh), and 0.66 when both were Caribbean (primarily African). These numbers are similar to the average weighted incidences in this study (3.6 for the United Kingdom, 2.4 for Indian, and 0.1 for Africans), the value for Caucasians and South Indians slightly lower than ours, while that for the Africans is slightly higher. These values changed with mixed matings; 2.77 to 0.78 when one parent was Caucasian and one South Indian and 0.66 to 1.28 when one parent was Caucasian and one Caribbean/African. This confirms the differences noted in the United States with genetic mixing in Africans. Other incidence figures for mixed or unknown racial groups are shown in <xref ref-type="table" rid="tab2">Table 2(b)</xref>.</p></statement></p></statement></p></sec><sec sec-type="subsubsection" id="sec3.2.2"><title>3.2.2. Clinical Neonatal Hip Instability (<xref ref-type="table" rid="tab3">Table 3</xref>) </title><p><statement id="head13"><title>Indigenous Peoples</title><p>The incidence of neonatal hip instability in the Maori is less than Caucasians [<xref rid="B116" ref-type="bibr">191</xref>], where 16% of the births in one hospital were Maori, but only 7% of the DDH cases were Maori.<statement id="head14"><title>(i) Africans</title><p>In Africans, the incidence was 0 in North African Ethiopian Jews [<xref rid="B117" ref-type="bibr">204</xref>], 0.3 in South Africa [<xref rid="B118" ref-type="bibr">49</xref>], and 2.0 in Uganda [<xref rid="B119" ref-type="bibr">166</xref>]. In Oklahoma City it is 0.4 [<xref rid="B120" ref-type="bibr">167</xref>] and 0.42 in New York City [<xref rid="B121" ref-type="bibr">168</xref>].</p></statement><statement id="head15"><title>(ii) Indo-Mediterraneans</title><p>The incidence of neonatal hip instability is 0.17 in Mumbai [<xref rid="B122" ref-type="bibr">205</xref>] and 18.7 in New Delhi, India [<xref rid="B58" ref-type="bibr">55</xref>], 1.25 in Kuwait (primarily Palestinian) [<xref rid="B123" ref-type="bibr">169</xref>], 4.9 in Dammam, Saudi Arabia [<xref rid="B124" ref-type="bibr">170</xref>], and 36.5 in Abha, Saudi Arabia [<xref rid="B125" ref-type="bibr">171</xref>].</p></statement><statement id="head16"><title>(iii) Amerindians</title><p>The incidence of neonatal hip instability in Guanajuato, México is 1.47 [<xref rid="B126" ref-type="bibr">172</xref>].</p></statement><statement id="head17"><title>(iv) Indo-Malay</title><p>The incidence in Taiwan is 1.2 in Taichung [<xref rid="B127" ref-type="bibr">175</xref>] and 1.8 in Taipei [<xref rid="B128" ref-type="bibr">174</xref>].</p></statement><statement id="head18"><title>(v) Caucasians</title><p>In Europe, the incidence of neonatal hip instability is 4.1 in Uxbridge, England [<xref rid="B95" ref-type="bibr">161</xref>], 5.65 in Falköping, Sweden [<xref rid="B129" ref-type="bibr">178</xref>], 7.7 in Dublin, Ireland [<xref rid="B130" ref-type="bibr">185</xref>], 10.2 in Västerbotten County, Sweden [<xref rid="B85" ref-type="bibr">96</xref>], 10.2 in Uppsala, Sweden [<xref rid="B131" ref-type="bibr">180</xref>], 12.8 in Cork, Ireland [<xref rid="B132" ref-type="bibr">206</xref>], 19 in Bristol, England [<xref rid="B133" ref-type="bibr">187</xref>], 20.4 in Uppsala, Sweden [<xref rid="B134" ref-type="bibr">181</xref>], 32.2 in Leipzig, Germany [<xref rid="B135" ref-type="bibr">189</xref>], 50.0 in Aberdeen, Scotland [<xref rid="B136" ref-type="bibr">188</xref>], and 61.7 in Poland [<xref rid="B137" ref-type="bibr">190</xref>]. In Australia/New Zealand, it is 3.4 and 8.5 in Auckland, New Zealand [<xref rid="B116" ref-type="bibr">191</xref>], 6.6 in Western Australia [<xref rid="B138" ref-type="bibr">192</xref>], 6.7 in Sydney, Australia [<xref rid="B139" ref-type="bibr">193</xref>], and 19.4 in Victoria, Australia [<xref rid="B140" ref-type="bibr">194</xref>]. In North America, it is 1.4 in Iowa City [<xref rid="B141" ref-type="bibr">196</xref>], 5.2 in Oklahoma City [<xref rid="B120" ref-type="bibr">167</xref>], 8.6 in Salt Lake City [<xref rid="B142" ref-type="bibr">195</xref>], 9.2 in Indianapolis, Indiana [<xref rid="B143" ref-type="bibr">198</xref>], 5.7 [<xref rid="B144" ref-type="bibr">207</xref>] and 9.9 in Vancouver, British Columbia [<xref rid="B145" ref-type="bibr">197</xref>], and 15.3 in New York City [<xref rid="B121" ref-type="bibr">168</xref>]. The average weighted incidence for all Caucasians is 10.8 (6.0 in Australia/New Zealand to 23.2 in Western Europe).</p></statement></p></statement></p></sec><sec sec-type="subsubsection" id="sec3.2.3"><title>3.2.3. Ultrasonographic and Clinical Screening Period (1980s to Present) (<xref ref-type="table" rid="tab4">Table 4</xref>)</title><p>For this paper, sonographic DDH is defined as a hip > Graf IIa. North African Black infants (Ethiopian Jews) have a sonographic incidence of 12.4 at birth and 1.5 at 4 to 6 weeks [<xref rid="B51" ref-type="bibr">157</xref>]. In Africans living in London, the incidence of sonographic DDH was 0 (0 of 185) [<xref rid="B146" ref-type="bibr">208</xref>]. Caucasian infants demonstrate a sonographic incidence at birth from 7.6 [<xref rid="B75" ref-type="bibr">64</xref>] to 847 [<xref rid="B147" ref-type="bibr">216</xref>], with a weighted average of 131. At 4 to 6 weeks of age, this drops to 12.8–14.8, with a weighted average of 14.1. In Turkey, the incidence of sonographic DDH at 6 weeks is 47.1 [<xref rid="B68" ref-type="bibr">60</xref>]. </p><p>Composite results (<xref ref-type="table" rid="tab4">Table 4</xref>) denote an average incidence of ultrasonographic DDH in Caucasians at birth of 80.0 (7.6 to 847) and 42.2 (3.8 to 103) for hips > Graf IIa (range). At 4 to 6 weeks of age, these numbers drop to 52.9 (range 3.1–379.4) and to 29.5 for hips > Graf IIa, and by 4 to 6 months of age to 7.5–34.7 for DDH > Graf IIa. This incidence of 7.5–34.7 is similar to that for Caucasians during the clinical screening period from 1950–1980 (3.8 in Scandinavia, 5.5 in Western Europe, 6.8 in Australia/New Zealand, and 35.8 in Eastern Europe) (<xref ref-type="table" rid="tab2">Table 2</xref>).</p></sec></sec><sec sec-type="subsection" id="sec3.3"><title>3.3. Gender, Laterality, Family History, Perinatal Factors (<xref ref-type="table" rid="tab5">Table 5</xref>)</title><p>Typical risk factors for DDH are said to be female, first born, breech position, positive family history, left hip, and unilateral involvement. In 9717 cases (<xref ref-type="table" rid="tab5">Table 5</xref>), 75.5% were female and 63.4% unilateral. When unilateral, 36.0% involved the right and 64.0% the left hip. Left-sided predominance of DDH may reflect the finding that right-sided laterality in birth defects correlates with the proportion of males among a group of infants with any given pathology [<xref rid="B148" ref-type="bibr">232</xref>]. There is minimal gender variability by ethnicity (<xref ref-type="fig" rid="fig3">Figure 3(a)</xref>) but considerable variability in bilaterality (<xref ref-type="fig" rid="fig3">Figure 3(b)</xref>), ranging from 16.7% in Indo-Malay to 69% in South American Caucasians. Although the left hip is typically more involved in those with unilateral dysplasia, there is significant ethnic variability, 44% in Indo-Mediterraneans to 81.4% in Caucasians from Australia/New Zealand (<xref ref-type="fig" rid="fig3">Figure 3(c)</xref>). The prevalence of mild adult acetabular dysplasia in children with documented unilateral DDH is up to 40% [<xref rid="B149" ref-type="bibr">233</xref>]. </p><p>Breech position/presentation increases the incidence of DDH [<xref rid="B29" ref-type="bibr">32</xref>, <xref rid="B31" ref-type="bibr">34</xref>, <xref rid="B45" ref-type="bibr">44</xref>, <xref rid="B60" ref-type="bibr">54</xref>, <xref rid="B61" ref-type="bibr">56</xref>, <xref rid="B65" ref-type="bibr">63</xref>, <xref rid="B62" ref-type="bibr">65</xref>, <xref rid="B106" ref-type="bibr">67</xref>, <xref rid="B81" ref-type="bibr">100</xref>–<xref rid="B83" ref-type="bibr">102</xref>, <xref rid="B74" ref-type="bibr">105</xref>, <xref rid="B86" ref-type="bibr">106</xref>, <xref rid="B92" ref-type="bibr">114</xref>, <xref rid="B89" ref-type="bibr">118</xref>, <xref rid="B151" ref-type="bibr">135</xref>, <xref rid="B157" ref-type="bibr">139</xref>, <xref rid="B96" ref-type="bibr">162</xref>, <xref rid="B121" ref-type="bibr">168</xref>–<xref rid="B125" ref-type="bibr">171</xref>, <xref rid="B116" ref-type="bibr">191</xref>, <xref rid="B150" ref-type="bibr">225</xref>, <xref rid="B166" ref-type="bibr">226</xref>, <xref rid="B162" ref-type="bibr">229</xref>–<xref rid="B152" ref-type="bibr">231</xref>, <xref rid="B153" ref-type="bibr">234</xref>–<xref rid="B165" ref-type="bibr">243</xref>]. Breech position/presentation in children with DDH ranges from 7.1% [<xref rid="B29" ref-type="bibr">32</xref>] to 40% [<xref rid="B62" ref-type="bibr">65</xref>]. In Western Australia [<xref rid="B45" ref-type="bibr">44</xref>], the incidence was 27.7 for breech and 5.5 for vertex presentations; in Denmark [<xref rid="B86" ref-type="bibr">106</xref>], 18.9 for breech and 5.5 for vertex presentation; in Northern Ireland, 6.94 for breech and 1.55 for vertex presentation [<xref rid="B89" ref-type="bibr">118</xref>]. In Singapore, the incidence was 10.7 in breech deliveries, 8.4 in vacuum extraction deliveries, and 0.7 overall [<xref rid="B60" ref-type="bibr">54</xref>]. In Norway [<xref rid="B81" ref-type="bibr">100</xref>–<xref rid="B83" ref-type="bibr">102</xref>], 15.7% of DDH children were breech compared to 3.4% in the normal population; in Helsinki, Finland, these numbers were 19.0% and 3.5% [<xref rid="B74" ref-type="bibr">105</xref>]; in Hungary, 11.4% and 3.1% [<xref rid="B167" ref-type="bibr">142</xref>]. In Riyadh, Saudia Arabia, these same numbers were 38% and 8.8% [<xref rid="B166" ref-type="bibr">226</xref>]; in Kuwait, 7% and 3.7%. In two Finnish hospitals, DDH was present in 2.6 and 6.6% of children with breech presentation [<xref rid="B161" ref-type="bibr">240</xref>], 7.7% in Stockport, England [<xref rid="B162" ref-type="bibr">229</xref>], 18% in Scotland [<xref rid="B96" ref-type="bibr">162</xref>], and 25% in London [<xref rid="B154" ref-type="bibr">235</xref>]. In Southampton, England, 36% of complete dislocations and 83% of subluxations were breech [<xref rid="B91" ref-type="bibr">112</xref>]. In certain Native Americans, there is no correlation with breech presentation/delivery [<xref rid="B37" ref-type="bibr">37</xref>, <xref rid="B45" ref-type="bibr">44</xref>]. </p><p>Breech presentation/presentation also influences neonatal hip instability. In 6571 live births (257 breech) [<xref rid="B168" ref-type="bibr">244</xref>], the odds ratio (OR) of hip instability was 3.42 in all breech babies and 11.1 for those with DDH needing treatment. The incidence of clinical hip instability in breech babies is 44 in Norway [<xref rid="B169" ref-type="bibr">179</xref>] (61 specifically in Trondheim, Norway [<xref rid="B170" ref-type="bibr">245</xref>]), 71 in New York City [<xref rid="B121" ref-type="bibr">168</xref>], 107 in Thailand [<xref rid="B155" ref-type="bibr">236</xref>], 131 in Leipzig, Germany [<xref rid="B135" ref-type="bibr">189</xref>], and 260 in Malmö, Sweden [<xref rid="B171" ref-type="bibr">176</xref>]. In Leipzig [<xref rid="B135" ref-type="bibr">189</xref>], the incidence of neonatal hip instability was 131 in breech and 30 in vertex presentations; in Tiachung, Taiwan, these numbers were 8.9 breech and 0.6 vertex [<xref rid="B127" ref-type="bibr">175</xref>]. In Dammam, Saudi Arabia [<xref rid="B124" ref-type="bibr">170</xref>], breech presentation was present in 13% of newborns with neonatal hip instability and 2.1% without. In Trondheim, Norway, the incidence of ultrasonographic hip instability in breech presentation is 61 [<xref rid="B170" ref-type="bibr">245</xref>]. In Germany, the incidence of ultrasonographic (> Graf IIa) neonatal hip instability in 3739 newborns was 136 in 317 breech children and 64 in nonbreech children [<xref rid="B164" ref-type="bibr">242</xref>]. In another German study; however, there was no correlation between intrauterine presentation and sonographic hip instability [<xref rid="B172" ref-type="bibr">215</xref>]. </p><p>Breech-type (frank breech or bilateral hip flexion/knee extension, nonfrank, or varying amounts of hip and knee flexion) is also important. The incidence of DDH in Hungarian breech children was 340 in nonfrank and 185 in frank breech [<xref rid="B163" ref-type="bibr">241</xref>]. In Norway [<xref rid="B170" ref-type="bibr">245</xref>], the incidence of DDH in frank breech was higher than other breech types. DDH in breech children may be decreased by elective Caesarean section [<xref rid="B173" ref-type="bibr">246</xref>]; of 941 breech presenting infants, the incidence of DDH was 3.69% (19 of 515) when delivered by elective pre-labor Caesarean section, 6.64% (26 of 241) when delivered by intrapartum Caesarean section, and 8.11% (15 of 185) when delivered vaginally. In New York, children born by Caesarean section had a 3.4 times higher chance of DDH when breech compared to vertex presentation, and those born vaginally had a 7.0 times higher chance of DDH when breech compared to vertex presentation [<xref rid="B121" ref-type="bibr">168</xref>]. </p><p>The incidence of DDH is less in premature and low-birth-weight infants [<xref rid="B45" ref-type="bibr">44</xref>]. Children <37 wk gestational age had an incidence of 3.4, 37–42 wks 6.3, and >42 wks 29.9; for those <2500 gms, the incidence was 4.1, 2500–3499 gms 6.7, and >3500 gms 6.4. In another study, all babies with DDH had a gestational age of 39 weeks or more, and 52% were firstborn [<xref rid="B153" ref-type="bibr">234</xref>]. In Northern Ireland, the risk of DDH was less when the birth weight was <3.0 kg [<xref rid="B89" ref-type="bibr">118</xref>]. Children born large for gestational age (LGA) have an increased risk of hip subluxation (OR 1.73) [<xref rid="B174" ref-type="bibr">247</xref>] and twice the incidence of ultrasonographic DDH (<underline>></underline> Graf IIc) compared to normal-birth-weight newborns (6.1% versus 3.5%) [<xref rid="B175" ref-type="bibr">248</xref>]. In breech presentation, DDH is more common in those with higher birth weights (3.49 kg with DDH, 3.06 kg without DDH) [<xref rid="B170" ref-type="bibr">245</xref>]. Very-low-birth-weight infants are not at increased risk of DDH [<xref rid="B176" ref-type="bibr">249</xref>]. </p><p>Primiparity increases the risk of DDH. In Hungary [<xref rid="B167" ref-type="bibr">142</xref>], the average birth order of 1767 children with DDH was 1.37 compared to 1.54 for 108966 control children showing that DDH children are skewed to the first born. In Finland, 63% of DDH children were first born compared to 55% in the normal population [<xref rid="B74" ref-type="bibr">105</xref>], in Southampton, England, 83% of children with subluxation were first born [<xref rid="B91" ref-type="bibr">112</xref>], and in Madrid, Spain, 50% of were firstborn [<xref rid="B100" ref-type="bibr">122</xref>]. In Western Australia [<xref rid="B45" ref-type="bibr">44</xref>], the incidence was 7.6 if first born and 5.9 if multiparous. At Christchurch Women's Hospital, first-borns accounted for 83% of DDH children but only 42% of all births [<xref rid="B109" ref-type="bibr">146</xref>]. In Utah, USA, the primiparity was 46% greater than expected in the 327 cases of DDH. In Singapore [<xref rid="B61" ref-type="bibr">56</xref>], 43.8% to 50% of DDH children were firstborn [<xref rid="B60" ref-type="bibr">54</xref>].</p><p>A positive family history increases the risk of DDH [<xref rid="B38" ref-type="bibr">38</xref>, <xref rid="B34" ref-type="bibr">42</xref>, <xref rid="B68" ref-type="bibr">60</xref>, <xref rid="B65" ref-type="bibr">63</xref>, <xref rid="B62" ref-type="bibr">65</xref>, <xref rid="B74" ref-type="bibr">105</xref>, <xref rid="B96" ref-type="bibr">162</xref>, <xref rid="B150" ref-type="bibr">225</xref>, <xref rid="B158" ref-type="bibr">230</xref>, <xref rid="B177" ref-type="bibr">250</xref>–<xref rid="B180" ref-type="bibr">253</xref>]; it was 14% in Poland [<xref rid="B180" ref-type="bibr">253</xref>], 21% in Saudia Arabia [<xref rid="B65" ref-type="bibr">63</xref>], and 35% in Greece [<xref rid="B101" ref-type="bibr">124</xref>]. In Native Americans, it was 33% in the Navajo [<xref rid="B34" ref-type="bibr">42</xref>]. In northern Saskatchewan Cree, it was 16% in sisters and 14% in mothers [<xref rid="B38" ref-type="bibr">38</xref>] but no correlation in the Manitoba Cree-Ojibwa [<xref rid="B37" ref-type="bibr">37</xref>]. In 589 English children with DDH, 4.01% of 1st degree and 0.33% of 2nd and 3rd degree relatives had DDH [<xref rid="B96" ref-type="bibr">162</xref>]. In 1256 Japanese children with DDH, 6.1% of siblings, 0.7% of parents, and 0.5% of uncles/aunts had DDH [<xref rid="B179" ref-type="bibr">252</xref>]. In 500 Utah children with DDH, 24.5% of 1st degree relatives had DDH [<xref rid="B113" ref-type="bibr">164</xref>]. In two Hungarian families with DDH, DDH occurred in 14% of family members: siblings, 2.1–2.3%, parents, 1.2–1.4% of uncles/aunts, and 4.7% of cousins [<xref rid="B181" ref-type="bibr">254</xref>]; recurrence risks were 8, and 4x increased in brothers and sisters, 4x in parents, 2.5x in uncles/aunts, and 2.0–2.5x in cousins compared to the general population. The risk or liability of inheriting DDH amongst siblings was 49% in Turkey [<xref rid="B182" ref-type="bibr">255</xref>]; the overall heritability was 74% in Norway [<xref rid="B82" ref-type="bibr">101</xref>]. An association between DDH and familial primary acetabular dysplasia [<xref rid="B183" ref-type="bibr">256</xref>] also exists; radiographs of the mothers of DDH children who did not have any known preexisting DDH demonstrated acetabular dysplasia in 8.65% [<xref rid="B179" ref-type="bibr">252</xref>]. One negative study exists regarding the association between ultrasonographic DDH and family history [<xref rid="B172" ref-type="bibr">215</xref>].</p><p>Consanguinity results in a very high incidence of DDH in Japan [<xref rid="B184" ref-type="bibr">81</xref>] and the Middle East where 25% [<xref rid="B123" ref-type="bibr">169</xref>], 40% [<xref rid="B62" ref-type="bibr">65</xref>], and 49% [<xref rid="B150" ref-type="bibr">225</xref>] of DDH cases were from consanguineous parents. In western Galilee, an area with a high incidence of DDH, marriage between 1st cousins is frequent [<xref rid="B66" ref-type="bibr">61</xref>, <xref rid="B185" ref-type="bibr">257</xref>]. Tight gene pools were implicated in the high incidence of DDH in Fort Apache Navajos [<xref rid="B33" ref-type="bibr">43</xref>]. </p><p>To simplify these figures, epidemiologists use decision analysis/meta-analysis or multiple logistic regression to determine DDH risk factors. The clinical practice guidelines of the American Academy of Pediatrics [<xref rid="B5" ref-type="bibr">5</xref>] used a decision analysis model, concluding that the baseline incidence of DDH (not at risk children) was 11.5 (4.1 for boys and 19 for girls). The relative risk with a positive family history is 1.7 times higher (for an absolute incidence of 6.4 for boys and 32 for girls), and the relative risk for a breech presentation compared to vertex is 6.3 times higher (for an incidence of 29 for boys and 133 for girls). </p><p>Logistic regression analysis of 1127 South Australian DDH children (1986–1993) [<xref rid="B7" ref-type="bibr">7</xref>] demonstrated that breech presentation, oligohydramnios, female gender, and primiparity were significant positive risk factors for DDH; low birth weight and prematurity were protective. The ORs were 17.2 for breech deliveries, 10.0 for breech presentation with Caesarean delivery, 4.0 for oligohydramnios, 3.9 for female gender, 2.7 for very high birth weight (>4500 gm), 2.2 for first born, and older maternal age (1.71 for 30–34 years old and 1.72 for ≥35+ years old). Protective ORs were low birth weight (0.3 for <2000 gm, 0.52 for 2000–2499 gms) and prematurity (0.42 for <37 wks gestation, 0.59 for 37 wks gestation, and 0.80 for 38 wks gestation). </p><p>In 51 Israeli DDH children (1994-1995), ORs were 6.0 for breech presentation, 4.3 for female gender, and 2.7 for primiparity [<xref rid="B186" ref-type="bibr">258</xref>]. In 81 Nottingham children with DDH and 323 control subjects [<xref rid="B187" ref-type="bibr">259</xref>], the ORs for those born by Caesarean section or breech delivery were 3.29 and 4.57, respectively, and 0.55 and 0.53 for multigravida and multiparity; maternal age, gestational age, placental weight, race/ethnicity, and birth weight/height were not risk factors [<xref rid="B187" ref-type="bibr">259</xref>].</p><p>In 1,059,479 Norwegian children [<xref rid="B169" ref-type="bibr">179</xref>], predictors of neonatal hip instability (clinical exam) were gestational age, gender, and breech presentation; birth order had no effect. The overall incidence of neonatal hip instability overall was 10.3 with differences by birth weight (2.6–<2500 gms; 10.2–≥2500 gms) and presentation (9.3 vaginal vertex, 10.1 Cesarean section vertex, 45.4 vaginal breech, 42.5 Cesarean breech). With increasing gestational, the incidence of neonatal hip instability increased for each category of gender and presentation (female vertex, female breech, male vertex, male breech).</p></sec><sec sec-type="subsection" id="sec3.4"><title>3.4. Twin Studies and Genetics </title><sec sec-type="subsubsection" id="sec3.4.1"><title>3.4.1. Twin Studies</title><p>In 589 children with DDH, there were five pairs of twins (1.7%): two monozygotic and three dizygotic [<xref rid="B96" ref-type="bibr">162</xref>]. The frequency of concordance (both twins having the same pathology) was ~33% in monozygotic twins and ~8% in dizygotic twins [<xref rid="B188" ref-type="bibr">260</xref>] supporting a polygenic mechanism. Even with this high of a concordance rate, the majority of monozygotic twins are not concordant, demonstrating that the same genetic background and intrauterine environment does not result in DDH most of the time [<xref rid="B188" ref-type="bibr">260</xref>]. The Norwegian Twin Registry found an incidence of 4.3 DDH in twins (38 of 8794). The OR of DDH in a relative of an effected twin was 10.0 : 35.8 for mothers, 12.7 for siblings, 8.1 for fathers, and 3.3 for subsequent offspring [<xref rid="B189" ref-type="bibr">261</xref>]. The increased OR for mothers over fathers suggests a maternal effect. In 4678 opposite sex twins, the relative risk of DDH was 0.13 for males compared to females [<xref rid="B190" ref-type="bibr">262</xref>]. Mirroring has been described in two sets of identical twins [<xref rid="B191" ref-type="bibr">263</xref>, <xref rid="B192" ref-type="bibr">264</xref>] with DDH; one twin had left DDH and the other right DDH. Both sets also had mirrored strabismus, and thumb sucking was mirrored in one set [<xref rid="B191" ref-type="bibr">263</xref>].</p></sec><sec sec-type="subsubsection" id="sec3.4.2"><title>3.4.2. Genetic Patterns</title><p>The prevalence of DDH in France in 1912 was 8 in Paris and 36–41 in Rennes, (Brittany region) [<xref rid="B12" ref-type="bibr">12</xref>, <xref rid="B193" ref-type="bibr">184</xref>] with an epicenter in Pont l'Abbé. DDH did not occur in this geographic area in the 1700s, and it appeared that a genetic mutation occurred in the 19th century [<xref rid="B193" ref-type="bibr">184</xref>]. The genetic mechanism was postulated to be autosomal dominant with incomplete penetrance and penetrance dependent upon gender [<xref rid="B12" ref-type="bibr">12</xref>]. In 16 Turkish family members with DDH, an autosomal dominant inheritance was also noted [<xref rid="B194" ref-type="bibr">265</xref>]. </p><p>Most other investigators propose a two-gene system in DDH. In 589 children with DDH [<xref rid="B96" ref-type="bibr">162</xref>], one gene involved joint laxity (dominant) and the other acetabular dysplasia (polygenic). The risk of subsequent members of a family having DDH when one family member had DDH was 36% when there was one affected parent and child, 12% when there was one affected parent and no affected children, and 6% when both parents were normal and had one affected child with DDH [<xref rid="B195" ref-type="bibr">266</xref>]. A Hungarian study [<xref rid="B196" ref-type="bibr">267</xref>] confirmed the role of polygenic acetabular morphometry and monogenic joint laxity; neonatal and “late-diagnosis” cases did not seem to be different entities. In an Italian study of pedigrees from 171 patients with familial DDH [<xref rid="B197" ref-type="bibr">268</xref>] (1937 individuals in 507 nuclear families with 499 having DDH), segregation analysis demonstrated that a two-locus recessive-recessive model was the most appropriate fit. The major locus demonstrated a penetrance of 5.9% in males and 58.6% in females, and the modifier locus 0.3% in males and 15.6% in females. </p><p>Homozygous recessive conditions (attached earlobes, light eyes, color blindness, inability to roll the tongue, and 3 wrist creases) are increased in children with DDH [<xref rid="B198" ref-type="bibr">269</xref>]; 5.2 ± 0.1 in controls and 7.1 ± 0.2 in DDH.</p></sec><sec sec-type="subsubsection" id="sec3.4.3"><title>3.4.3. HLA and ABO Blood Type Groups</title><p>In Greek children with DDH [<xref rid="B199" ref-type="bibr">270</xref>] there was a significant increase in HLA A<sub>1</sub> in the DDH group (52 versus 26%). In Czechoslovakia, there was a significant decrease in the HLA B<sub>7</sub> type in the DDH group (10% versus 26%) [<xref rid="B200" ref-type="bibr">271</xref>]. In Japanese [<xref rid="B201" ref-type="bibr">272</xref>] the development of DDH and dysplastic osteoarthritis of the hip is associated with genes in the HLA-D regions, especially HLA DR4. No differences in ABO blood types [<xref rid="B121" ref-type="bibr">168</xref>, <xref rid="B187" ref-type="bibr">259</xref>, <xref rid="B198" ref-type="bibr">269</xref>, <xref rid="B202" ref-type="bibr">273</xref>] or Rh blood types [<xref rid="B187" ref-type="bibr">259</xref>] have been found in DDH.</p></sec><sec sec-type="subsubsection" id="sec3.4.4"><title>3.4.4. Associated Genes and Chromosomal Locations</title><p>In Han Chinese, DDH was associated with gene growth differentiate factor 5 (CDF5) (OR 1.40) [<xref rid="B203" ref-type="bibr">274</xref>]. The double von Willebrand factor A gene on chromosome 3p24.3 is strongly associated with osteoarthritis of the knee in Japanese and Chinese [<xref rid="B204" ref-type="bibr">275</xref>] but not DDH [<xref rid="B204" ref-type="bibr">275</xref>]. Estrogen receptor Xba I wild type (XX compared to Xx and xx) is more common in DDH than controls (55.8% versus 37.9%) [<xref rid="B205" ref-type="bibr">276</xref>]. Homozygosity for the mutant Taq1 vitamin D receptor <italic>t</italic> allele is associated with an increased acetabular index, and the Pvu II pp estrogen receptor genotype is associated with a low center-edge angle [<xref rid="B205" ref-type="bibr">276</xref>]. </p><p>Several studies associate DDH with chromosome 17q21. This region contains a cluster of HOX genes that provide specific positional identities to mesenchymal cells in developing joints [<xref rid="B206" ref-type="bibr">277</xref>]. In French Caucasians, there was no increased association between DDH and the HOXB9 gene [<xref rid="B199" ref-type="bibr">270</xref>] while in the Chinese there is an association with the HOXB9 as well as the <italic>COL1A1</italic> genes in DDH [<xref rid="B207" ref-type="bibr">278</xref>]. In Italian Caucasians, the <italic>COLL2A1</italic> and vitamin D receptor genes are associated with nonsyndromic DDH [<xref rid="B208" ref-type="bibr">279</xref>] but not confirmed by others [<xref rid="B209" ref-type="bibr">280</xref>]. In an 18 member multigenerational family affected by DDH, a 4 Mb region on chromosome 17q21.32 was linked to DDH [<xref rid="B206" ref-type="bibr">277</xref>].</p></sec></sec><sec sec-type="subsection" id="sec3.5"><title>3.5. Ligamentous Laxity</title><p>Joint laxity is increased in DDH [<xref rid="B154" ref-type="bibr">235</xref>, <xref rid="B195" ref-type="bibr">266</xref>, <xref rid="B196" ref-type="bibr">267</xref>, <xref rid="B210" ref-type="bibr">281</xref>–<xref rid="B212" ref-type="bibr">283</xref>]: 75% of boys and 33% of girls with DDH demonstrate joint laxity [<xref rid="B154" ref-type="bibr">235</xref>]. The prevalence of joint laxity (≥3 joints) in normal children ages 6–11 years was 10.5% and 47% in DDH children [<xref rid="B211" ref-type="bibr">282</xref>]. Increased joint laxity likely explains the increase in inguinal hernias in DDH children and their fathers and brothers [<xref rid="B167" ref-type="bibr">142</xref>, <xref rid="B195" ref-type="bibr">266</xref>, <xref rid="B212" ref-type="bibr">283</xref>]. Girls with DDH have a 5-fold increase and boys with DDH a 3-fold increase in inguinal hernias; the hernia also develops earlier in life than normal [<xref rid="B213" ref-type="bibr">284</xref>]. Relaxin, which stimulates collagenase, alters the connective tissue and may lead to the development of both DDH and inguinal hernias. </p><p>Collagen metabolism is altered in DDH. In newborns with DDH, the amount of umbilical cord collagen was decreased (~26%) [<xref rid="B214" ref-type="bibr">285</xref>] but not total protein [<xref rid="B215" ref-type="bibr">286</xref>]; this was not found in another study [<xref rid="B216" ref-type="bibr">173</xref>]. Umbilical cord type III/I collagen ratio is increased in DDH [<xref rid="B215" ref-type="bibr">286</xref>]. Hip capsule and skin biopsies in older DDH children (1 to 4 years old) show a decreased type III/I collagen ratio in the hip capsule but not the skin [<xref rid="B217" ref-type="bibr">287</xref>]. Opposite results were found in Japanese children with DDH [<xref rid="B218" ref-type="bibr">288</xref>] where the type III/I collagen ratio was increased in the hip capsule and ligamentum teres. The ligamentum teres in DDH children demonstrates thicker collagen fiber bundles and increased hyalinization in those with complete dislocation compared to subluxation [<xref rid="B219" ref-type="bibr">289</xref>]. In patients with hypermobility syndrome (including several cases of DDH) [<xref rid="B220" ref-type="bibr">290</xref>], growth hormone, insulin, and IGF-1 levels were elevated, leading us to endocrine abnormalities in DDH.</p></sec><sec sec-type="subsection" id="sec3.6"><title>3.6. Hormonal/Endocrine and Metabolic Associations</title><p>DDH occurs predominantly in females, and a hormonal/endocrine relationship has long been suspected. In newborns with DDH, there is an increase in urinary excretion of conjugated estrogen and 17 <italic>β</italic>-estradiol [<xref rid="B221" ref-type="bibr">291</xref>–<xref rid="B223" ref-type="bibr">293</xref>], suggesting that DDH may be due to abnormal estrogen metabolism. Abnormal fetoplacental estrogen metabolism in a mother and child with DDH has been described [<xref rid="B224" ref-type="bibr">294</xref>]. </p><p>Others found no estrogen metabolism abnormalities. Urinary estrogen excretion in the first 3 days of life in 7 newborns with bilateral Ortolani instability and 4 normal newborns was not different [<xref rid="B225" ref-type="bibr">295</xref>]. Urinary excretion of oestradiol, oestrone, and oestriol in 16 neonatal hip instability, and 19-matched-control newborns [<xref rid="B226" ref-type="bibr">296</xref>] showed no differences. Similar conclusions were reached by Borglin [<xref rid="B227" ref-type="bibr">297</xref>]. Umbilical cord blood measurements of 17 <italic>β</italic>-estradiol levels in 2185 consecutive newborns [<xref rid="B228" ref-type="bibr">298</xref>] with neonatal hip instability showed conflicting data; in boys low levels (<10 nmol/L) increased the risk of neonatal hip instability (OR 54) while in girls high levels (>15 nmol/L) increased the risk (OR 2.2). </p><p>Women who develop pelvic joint instability and pain in pregnancy have an increased risk of a child with DDH [<xref rid="B229" ref-type="bibr">299</xref>]: incidence of 7–9 compared to the normal 2-3. In another study of Norwegian women with pregnancy-initiated pelvic pain, the incidence of DDH in the children was 45 [<xref rid="B230" ref-type="bibr">300</xref>], 7 times normal [<xref rid="B169" ref-type="bibr">179</xref>]. Women with pelvic joint instability and pain have higher serum relaxin levels compared to those without pelvic pain [<xref rid="B231" ref-type="bibr">301</xref>] in the third trimester which may explain these associations; others refute this [<xref rid="B232" ref-type="bibr">302</xref>, <xref rid="B233" ref-type="bibr">303</xref>]. There is no correlation between serum relaxin in umbilical cord blood and neonatal hip instability [<xref rid="B234" ref-type="bibr">304</xref>, <xref rid="B235" ref-type="bibr">305</xref>].</p><p>In adults previously treated for DDH without surgery, bone mineral density at the hip but not the spine is decreased with a concomitant increase in osteocalcin [<xref rid="B236" ref-type="bibr">306</xref>]. The OR of decreased bone mineral density at the hip was 6.3 for those with DDH. Some children with DDH demonstrate lower serum calcium and alkaline phosphatase but not serum phosphorus [<xref rid="B237" ref-type="bibr">307</xref>].</p></sec><sec sec-type="subsection" id="sec3.7"><title>3.7. Seasonal Variation</title><p>Most studies note an increase in the number of DDH births in the winter. In Tokyo, 549 of 1276 (43%) DDH children were born on November–January [<xref rid="B238" ref-type="bibr">308</xref>]; in Kochi, Japan, 55 of 106 (52%) were born on December–February [<xref rid="B184" ref-type="bibr">81</xref>]. Other Japanese studies confirm this winter predominance [<xref rid="B240" ref-type="bibr">83</xref>, <xref rid="B241" ref-type="bibr">90</xref>, <xref rid="B239" ref-type="bibr">309</xref>], likely due to the increase of extension diapering/swaddling in the colder months. In Navajo boys, a slight increase was noted in the midwinter [<xref rid="B37" ref-type="bibr">37</xref>] but no seasonal variation was noted in other Navajos [<xref rid="B242" ref-type="bibr">40</xref>]. </p><p>In Caucasians many studies also note a predominance of DDH births in the fall/winter months: September–December in Scandinavia [<xref rid="B78" ref-type="bibr">97</xref>–<xref rid="B83" ref-type="bibr">102</xref>]; September–November throughout Sweden [<xref rid="B171" ref-type="bibr">176</xref>, <xref rid="B243" ref-type="bibr">310</xref>]; October–January in Israel [<xref rid="B244" ref-type="bibr">70</xref>]; November in Alicante, Spain [<xref rid="B165" ref-type="bibr">243</xref>]; September–January [<xref rid="B245" ref-type="bibr">311</xref>] and November–March in Leipzig [<xref rid="B246" ref-type="bibr">312</xref>]; December–February in Berlin [<xref rid="B247" ref-type="bibr">313</xref>], Northern Ireland [<xref rid="B89" ref-type="bibr">118</xref>], and Scotland [<xref rid="B96" ref-type="bibr">162</xref>]; December in all of the United States [<xref rid="B152" ref-type="bibr">231</xref>]; September–February in Utah [<xref rid="B113" ref-type="bibr">164</xref>]; September–March in England [<xref rid="B250" ref-type="bibr">110</xref>, <xref rid="B248" ref-type="bibr">314</xref>, <xref rid="B249" ref-type="bibr">315</xref>]; December-January in Debrecen, Hungary [<xref rid="B251" ref-type="bibr">141</xref>]; October–February in Budapest, Hungary [<xref rid="B167" ref-type="bibr">142</xref>]; November–February in Dêčín and Česká Lípa, Czechoslovakia [<xref rid="B252" ref-type="bibr">134</xref>]; December–March in Tel Aviv, Israel [<xref rid="B254" ref-type="bibr">201</xref>, <xref rid="B253" ref-type="bibr">316</xref>]; and January–April in East Anglia, England [<xref rid="B255" ref-type="bibr">317</xref>]. In the southern hemisphere, the same was also noted: July-August in Southland, New Zealand [<xref rid="B108" ref-type="bibr">147</xref>], and in Australia, April–June in Victoria [<xref rid="B256" ref-type="bibr">318</xref>], June in Adelaide, and July in Brisbane [<xref rid="B257" ref-type="bibr">319</xref>]. Infants born in colder winter months demonstrate poorer acetabular development compared to those born in the warmer months [<xref rid="B258" ref-type="bibr">320</xref>] as measured by acetabular depth and acetabular angles; this may explain the increase in DDH in children born in the winter or may represent an effect of increased swaddling or tight clothing to protect the baby from the colder weather. Pelvic insufficiency also shows a seasonal variation [<xref rid="B259" ref-type="bibr">321</xref>] with a peak in November-December. </p><p>Bimodal peaks were seen in Bardejov, Slovakia (July and February) [<xref rid="B260" ref-type="bibr">138</xref>]. Peaks were noted in the spring in Córdoba, Spain [<xref rid="B99" ref-type="bibr">121</xref>]; in the summer in Southampton, England [<xref rid="B91" ref-type="bibr">112</xref>], Helsinki, Finland [<xref rid="B74" ref-type="bibr">105</xref>], and Israel [<xref rid="B261" ref-type="bibr">202</xref>]. </p><p>No seasonal variation was noted in Atlanta [<xref rid="B262" ref-type="bibr">322</xref>], Manchester and Newcastle-upon-Tyne, England [<xref rid="B30" ref-type="bibr">33</xref>, <xref rid="B92" ref-type="bibr">114</xref>], Liberec, Czech Republic [<xref rid="B263" ref-type="bibr">136</xref>], Western Australia [<xref rid="B45" ref-type="bibr">44</xref>], Auckland, New Zealand [<xref rid="B116" ref-type="bibr">191</xref>], Christchurch and North Canterbury, New Zealand [<xref rid="B109" ref-type="bibr">146</xref>], and New York City [<xref rid="B121" ref-type="bibr">168</xref>].</p></sec><sec sec-type="subsection" id="sec3.8"><title>3.8. Swaddling</title><p>Swaddling theoretically maintains the hip in an extended and adducted position; radiographs of hips in cradled infants demonstrate that they are not in true adduction, and up to 15–20° of abduction is possible [<xref rid="B242" ref-type="bibr">40</xref>]. Newborn swaddling used in many cultures [<xref rid="B264" ref-type="bibr">323</xref>] is considered by many to be a significant factor in the development of DDH. In ~2300 Navajos [<xref rid="B242" ref-type="bibr">40</xref>], hip dislocation was more prevalent in adults than children. It was postulated that this decrease in dislocation was due to the transition from exclusive use of the Navajo cradleboard to a more frequent use of diapers.</p><p>Swaddling/cradle boards in a few studies are not associated with DDH. In the Navajo, 9 of 13 cases of DDH which spontaneously improved showed improvement while on the cradleboard, and 2 cases with complete dislocation were never kept on the cradleboard [<xref rid="B242" ref-type="bibr">40</xref>]. Nearly all the Cree-Ojibwa swaddle their children (tihkinākan cradleboard) [<xref rid="B38" ref-type="bibr">38</xref>], yet in 427 untreated Cree-Ojibwa infants with hip dysplasia, frank improvement was seen in 113 with ≥1 year of followup. Most interestingly, 21 of the 113 had an initial diagnosis of complete dislocation [<xref rid="B37" ref-type="bibr">37</xref>]. Swaddling is also used in Saudia Arabia (mehad) [<xref rid="B265" ref-type="bibr">326</xref>] and Iran (ghondagh) [<xref rid="B31" ref-type="bibr">34</xref>] with no differences in the use of mehad/ghondagh for those with or without DDH. These studies question the role of swaddling. </p><p>Most other studies demonstrate a strong correlation between swaddling and DDH. There was a 10-fold increase in DDH (123.0 versus 12.6) in Canadian Native Americans from Ontario who used the cradleboard [<xref rid="B39" ref-type="bibr">39</xref>]. Similar concerns were noted in the Cree from northern Quebec [<xref rid="B266" ref-type="bibr">327</xref>]. In Turkey [<xref rid="B267" ref-type="bibr">59</xref>], 98% of DDH cases were swaddled as infants compared to 87.1% not swaddled; the OR of DDH in swaddled children was 6.1 [<xref rid="B268" ref-type="bibr">223</xref>]. In a sonographic Turkish study [<xref rid="B68" ref-type="bibr">60</xref>], swaddling was used in 21.2% of those children with DDH ≥ Graf IIb (<italic>P</italic> < 0.001), which was the highest risk factor associated with DDH, greater than breech delivery (9.0%), positive family history (6.6%), and female gender (6.2%). The incidence of ultrasonographic dysplasia in children at high risk for DDH in Qatar [<xref rid="B269" ref-type="bibr">328</xref>] dropped from 20% to 6% after a community awareness program demonstrating the harmful effects of swaddling and discouraging its use; swaddling alone did not cause the hip dysplasia but had an unfavorable effect on the future course of a dysplastic hip. Another study from Saudi Arabia concluded that swaddling was an important factor in the etiology of DDH [<xref rid="B270" ref-type="bibr">329</xref>]. Swaddling is also believed to be responsible for the high incidence of DDH in the Arabic peoples in Western Galilee [<xref rid="B66" ref-type="bibr">61</xref>] and Iraqi immigrants in Israel [<xref rid="B271" ref-type="bibr">330</xref>].</p><p>In Europe, Békés County, Hungary [<xref rid="B157" ref-type="bibr">139</xref>], swaddling was believed to account for the high incidence (28.7) of DDH and supported by others [<xref rid="B252" ref-type="bibr">134</xref>]. In the Swedish Sámi, the cradleboard (gietka or komse) was also believed to account for the high incidence (24.6) of DDH [<xref rid="B43" ref-type="bibr">46</xref>]. The gietka is a cradle hollowed from a log tightly swaddling the lower extremities and allowing for minimal movement. This cradle was very practical in the Sámi nomadic culture and lifestyle and allowed mothers to carry the cradle across their shoulders onto a reindeer's pack saddle; as their nomadic reindeer herding culture and lifestyle decreases and health nurses forbid the use of the geitka/komse [<xref rid="B272" ref-type="bibr">324</xref>, <xref rid="B273" ref-type="bibr">331</xref>], the prevalence of DDH in the Sámi has fallen (<xref ref-type="fig" rid="fig4">Figure 4(a)</xref>). </p><p>DDH is very rare in cultures where swaddling is not used (Southern Chinese, African Bantu, Thailand, North Korea, Sri Lanka [<xref rid="B274" ref-type="bibr">332</xref>]); the absence of swaddling is believed to be responsible for this [<xref rid="B275" ref-type="bibr">333</xref>]. Two different northern circumpolar peoples (Sámi and Inuit/Eskimos) have markedly different incidences of DDH [<xref rid="B272" ref-type="bibr">324</xref>, <xref rid="B276" ref-type="bibr">334</xref>]; the Sámi, who swaddled their young in the past, had a very high incidence, while the Inuit/Eskimo's, whose mothers carried their young inside their parkas in a hood (amauti) abducting the hips around their backs have an incidence of DDH similar to Caucasians. </p><p>In Japan, swaddling/diapering in extension was strongly associated with DDH [<xref rid="B70" ref-type="bibr">85</xref>]. This is especially so for children born in the winter months, being more tightly wrapped to protect against the cold [<xref rid="B277" ref-type="bibr">335</xref>]. This effect of swaddling/diapering with the hips in extension was initially noted in a small series of 5 normal newborn children; no hip instability was noted within the 1st 24 hours on physical examination, but after diapering in extension, 4 of 5 children developed Ortolani-positive hip instability [<xref rid="B278" ref-type="bibr">84</xref>]. This resulted in a larger study, and the creation of an educational campaign regarding the problems associated with extension diapering/swaddling in Kyoto, Japan [<xref rid="B70" ref-type="bibr">85</xref>]. The incidence of DDH dropped from 52.9 in 1971–97 to 5.6 in 1974–1976 after the educational campaign [<xref rid="B70" ref-type="bibr">85</xref>]. These results in Kyoto led to a national Japanese education and prevention campaign [<xref rid="B277" ref-type="bibr">335</xref>] with similarly striking results (<xref ref-type="table" rid="tab2">Table 2(c)</xref>, <xref ref-type="fig" rid="fig4">Figure 4(b)</xref>). This demonstrates the impact of epidemiological/demographic studies in reducing the occurrence of a particular condition.</p><p>Swaddling thus influences the development of DDH [<xref rid="B279" ref-type="bibr">336</xref>, <xref rid="B280" ref-type="bibr">337</xref>]. This is particularly relevant since there is a strong resurgence to return to swaddling to reduce crying and promote uninterrupted sleep in the baby [<xref rid="B279" ref-type="bibr">336</xref>, <xref rid="B281" ref-type="bibr">338</xref>, <xref rid="B282" ref-type="bibr">339</xref>]. Swaddled infants arouse less and sleep longer; preterm infants show improved neuromuscular development, self-regulatory ability, and less physiologic distress when swaddled [<xref rid="B281" ref-type="bibr">338</xref>]. Infants that are at an increased risk of DDH should probably not be swaddled unless imaging studies are absolutely normal [<xref rid="B279" ref-type="bibr">336</xref>]; appropriate swaddling also must be used [<xref rid="B283" ref-type="bibr">340</xref>].</p></sec><sec sec-type="subsection" id="sec3.9"><title>3.9. “Late Diagnosis” of DDH</title><p>When the hip actually dislocates [<xref rid="B284" ref-type="bibr">341</xref>–<xref rid="B286" ref-type="bibr">343</xref>] has been debated for some time [<xref rid="B287" ref-type="bibr">344</xref>]. The studies of “late” diagnosis reveal several findings. In one study, all the children were female, and 40% (8 of 20) had recognized risk factors [<xref rid="B288" ref-type="bibr">345</xref>]. Canadian children [<xref rid="B289" ref-type="bibr">346</xref>] diagnosed with DDH at an older age (20 months) have more right hip involvement (31% versus 15% right hips) compared to those diagnosed younger (<20 months) who have more left hip involvement (57% versus 15% left hips); bilateral dislocations are also more common when diagnosed at an older age (44 versus 28%) [<xref rid="B289" ref-type="bibr">346</xref>]. In Norway the incidence of “late” diagnosis was 2.4; of these 197 Norwegian children diagnosed “late” [<xref rid="B290" ref-type="bibr">347</xref>], all hips were stable at birth; 86% were female, the left hip was involved in 48%, right hip in 31%, and both in 21%. Breech delivery occurred in only 6.5%. The incidence of late DDH in all of Norway was 2.4 [<xref rid="B290" ref-type="bibr">347</xref>]: 1.7 in Oslo and 0.76 in southern Finland [<xref rid="B291" ref-type="bibr">348</xref>]. In Glasgow it was 0.84 before and 0.57 after institution of a selective ultrasound screening program [<xref rid="B292" ref-type="bibr">349</xref>]. A positive family history was associated with an increased risk of “late” DDH [<xref rid="B293" ref-type="bibr">350</xref>]. Avascular necrosis of the opposite normal hip in children with “late” diagnosis was described (9 of 103 cases) and associated with high, free-riding dislocations [<xref rid="B294" ref-type="bibr">351</xref>].</p></sec><sec sec-type="subsection" id="sec3.10"><title>3.10. Miscellaneous Demographic and Epidemiologic Findings </title><sec sec-type="subsubsection" id="sec3.10.1"><title>3.10.1. In Utero Environment </title><p><statement id="head19"><title>Exposures to Agents</title><p>Administration of progesterone in the 1st trimester for threatened or habitual abortion [<xref rid="B295" ref-type="bibr">352</xref>] increases the risk of DDH as does maternal hypothyroidism [<xref rid="B296" ref-type="bibr">353</xref>] and maternal phenylketonuria [<xref rid="B297" ref-type="bibr">354</xref>]. Maternal smoking during pregnancy reduces the risk of sonographic DDH ≥ Graf IIa in female but not male neonates [<xref rid="B298" ref-type="bibr">355</xref>], most likely due to the effects of maternal smoke on estrogen physiology. The incidence of DDH in children whose mothers were exposed to radiation at Hiroshima or Nagasaki, Japan (0.31 and 0.23) is higher than those not exposed to radiation in Kure, Japan (0.13) [<xref rid="B299" ref-type="bibr">356</xref>]. In Seveso, Italy, no increase in DDH was seen after exposure of a densely populated area to TCDD (2,3,7,8-tetracholorobenzo-<italic>p</italic>-dioxin) [<xref rid="B300" ref-type="bibr">357</xref>]. Intrauterine toxoplasmosis [<xref rid="B301" ref-type="bibr">358</xref>] or viral infection [<xref rid="B302" ref-type="bibr">132</xref>] does not increase the risk of DDH. Iron deficiency anemia in fetal life may been associated with DDH [<xref rid="B303" ref-type="bibr">359</xref>].</p></statement></p><p><statement id="head20"><title>Mechanical and/or Physical Exposures</title><p>Multifetal pregnancies (e.g., twins, triplets) are not at increased risk of DDH [<xref rid="B167" ref-type="bibr">142</xref>, <xref rid="B304" ref-type="bibr">360</xref>–<xref rid="B312" ref-type="bibr">368</xref>]. There were no cases of DDH in 968 sets of twins and 18 sets of triplets in Tokyo [<xref rid="B313" ref-type="bibr">369</xref>]. Two studies noted less DDH in children born to multifetal pregnancies (relative risk 0.57 [<xref rid="B314" ref-type="bibr">370</xref>], 0.46 [<xref rid="B315" ref-type="bibr">371</xref>]). Although extrauterine pregnancy is rare (1 in 1100 to 1 in 50000 pregnancies) [<xref rid="B316" ref-type="bibr">372</xref>], it is often associated with DDH [<xref rid="B317" ref-type="bibr">373</xref>, <xref rid="B318" ref-type="bibr">374</xref>], suggesting DDH is associated with molding forces in those circumstances rather than a teratological abnormality [<xref rid="B316" ref-type="bibr">372</xref>]. </p><p>Mid-trimester amniocentesis does not increase the risk of DDH [<xref rid="B319" ref-type="bibr">375</xref>] whereas 1st trimester likely does [<xref rid="B320" ref-type="bibr">376</xref>] (OR 1.22). Premature labor and/or threatened abortion increases the risk of DDH [<xref rid="B302" ref-type="bibr">132</xref>, <xref rid="B321" ref-type="bibr">377</xref>]. Prior miscarriage increases the risk of a subsequent child having DDH (OR 1.4) [<xref rid="B322" ref-type="bibr">378</xref>]. Preterm infants demonstrate a decrease in neonatal hip instability on physical examination compared to term infants [<xref rid="B323" ref-type="bibr">379</xref>] and do not demonstrate an increase in ≥Graf IIb DDH even though many are immature (Graf IIa) [<xref rid="B324" ref-type="bibr">380</xref>]. Preterm infants demonstrate no increase in DDH even after reaching normal development and gestational age [<xref rid="B325" ref-type="bibr">381</xref>].</p></statement></p></sec><sec sec-type="subsubsection" id="sec3.10.2"><title>3.10.2. Parental Associations</title><p>DDH was more common in higher socioeconomic groups in Scotland [<xref rid="B96" ref-type="bibr">162</xref>] but more common in lower groups in Martin, Slovakia [<xref rid="B326" ref-type="bibr">137</xref>]; no differences in New York City [<xref rid="B121" ref-type="bibr">168</xref>] or England [<xref rid="B250" ref-type="bibr">110</xref>] were noted by socioeconomic class. Paternal plywood mill workers had an increased risk (OR 2.71) of DDH in 14415 British Columbian children [<xref rid="B327" ref-type="bibr">399</xref>].</p><p>Older paternal age has been associated with DDH [<xref rid="B328" ref-type="bibr">400</xref>]. Younger maternal age is a function of birth order and primiparity [<xref rid="B113" ref-type="bibr">164</xref>]. In one study, DDH and maternal age demonstrated a bell-shaped curve with a peak at 30 years of age [<xref rid="B329" ref-type="bibr">401</xref>]. Short maternal stature is associated with DDH in Canada [<xref rid="B330" ref-type="bibr">402</xref>] and Ireland [<xref rid="B331" ref-type="bibr">403</xref>] but not in Britain [<xref rid="B331" ref-type="bibr">403</xref>]. Early abduction treatment in children with neonatal instability is associated with increased maternal anxiety, while the use of ultrasound to manage infants with DDH is not [<xref rid="B332" ref-type="bibr">404</xref>].</p></sec><sec sec-type="subsubsection" id="sec3.10.3"><title>3.10.3. Child Development</title><p>The median walking age in 86 DDH children diagnosed at an average age of 16 months was not statistically different from a control group of 100 normal children with fractures (13.8 months—DDH; 12.5 months—control) [<xref rid="B333" ref-type="bibr">405</xref>]. Menarche in girls with DDH was decreased by 6 months compared to others [<xref rid="B334" ref-type="bibr">406</xref>]. DDH children have lower skin temperature on the affected lower limb [<xref rid="B335" ref-type="bibr">407</xref>].</p></sec></sec><sec sec-type="subsection" id="sec3.11"><title>3.11. Associated Conditions </title><sec sec-type="subsubsection" id="sec3.11.1"><title>3.11.1. Congenital Muscular Torticollis</title><p>DDH is associated with congenital muscular torticollis (CMT) [<xref rid="B336" ref-type="bibr">433</xref>–<xref rid="B344" ref-type="bibr">441</xref>]. The proportion of DDH in CMT children is 2.4% [<xref rid="B344" ref-type="bibr">441</xref>], 3.7% [<xref rid="B337" ref-type="bibr">434</xref>], 4.1% [<xref rid="B340" ref-type="bibr">437</xref>], 4.5% [<xref rid="B343" ref-type="bibr">440</xref>], 8% [<xref rid="B338" ref-type="bibr">435</xref>], 12% [<xref rid="B341" ref-type="bibr">438</xref>], 13% [<xref rid="B342" ref-type="bibr">439</xref>], 14.1% [<xref rid="B345" ref-type="bibr">442</xref>], 17% [<xref rid="B346" ref-type="bibr">443</xref>], and 20% [<xref rid="B336" ref-type="bibr">433</xref>]. Boys are particularly at risk [<xref rid="B337" ref-type="bibr">434</xref>]. CMT also has a higher incidence of breech presentation (19.5%) [<xref rid="B340" ref-type="bibr">437</xref>]. DDH risk is directly related to the severity of CMT [<xref rid="B344" ref-type="bibr">441</xref>]. The incidence of DDH in Hong Kong children with CMT is 48.1 compared to 0.1 in the general population [<xref rid="B71" ref-type="bibr">74</xref>].</p></sec><sec sec-type="subsubsection" id="sec3.11.2"><title>3.11.2. Congenital Foot Deformity</title><p>There is some association between DDH and metatarsus adductus [<xref rid="B347" ref-type="bibr">444</xref>–<xref rid="B349" ref-type="bibr">446</xref>]; the proportion of DDH in children with metatarsus adductus is 1.53% [<xref rid="B347" ref-type="bibr">444</xref>] and 10% [<xref rid="B348" ref-type="bibr">445</xref>]. The proportion of DDH children with congenital clubfoot is 0.3% (1 of 349) [<xref rid="B350" ref-type="bibr">447</xref>], 1% (16 of 1509) [<xref rid="B349" ref-type="bibr">446</xref>], and 5.9% (9 of 119) [<xref rid="B351" ref-type="bibr">448</xref>]. There is a slight association between positional clubfeet and DDH [<xref rid="B350" ref-type="bibr">447</xref>]. Acetabular dysplasia (acetabular index >28° at ≥4 months of age) occurred in 16% of children with congenital clubfoot [<xref rid="B352" ref-type="bibr">449</xref>]. Sonographic Graf type IV (irreducible DDH) occurred in 6.5% of children with congenital vertical talus and 4% with metatarsus adductus [<xref rid="B353" ref-type="bibr">450</xref>].</p></sec><sec sec-type="subsubsection" id="sec3.11.3"><title>3.11.3. Spinal and Neuromuscular Associations</title><p>Abnormal sensory evoked potentials in DDH children 10–13 months of age were present in 31% without spinal dysraphism and 56% with spina bifida occulta [<xref rid="B354" ref-type="bibr">451</xref>]. The incidence of DDH is 10 times greater in children with infantile scoliosis [<xref rid="B355" ref-type="bibr">452</xref>]. One study found no free nerve endings in either the ligamentum teres or hip capsule of DDH children [<xref rid="B356" ref-type="bibr">453</xref>] while the ligamentum teres had a higher frequency (66.6%) of type IVa free nerve endings [<xref rid="B219" ref-type="bibr">289</xref>] in DDH children, suggesting a role of abnormal nocioception/proprioception [<xref rid="B357" ref-type="bibr">454</xref>]. Vibration arthrometry demonstrates low-frequency vibrations in unstable (Ortolani- or Barlow-positive) neonatal hips [<xref rid="B358" ref-type="bibr">455</xref>, <xref rid="B359" ref-type="bibr">456</xref>]. </p><p>Electrophysiological and histological examinations of the hip muscles in DDH demonstrate muscle degeneration which is more severe in younger children [<xref rid="B360" ref-type="bibr">457</xref>]; the iliopsoas, gluteus medius, and vastus lateralis muscles demonstrated hyaline granulous degenerative changes [<xref rid="B361" ref-type="bibr">458</xref>]. Others note minimal histological changes [<xref rid="B362" ref-type="bibr">459</xref>].</p></sec><sec sec-type="subsubsection" id="sec3.11.4"><title>3.11.4. The Opposite Hip in Unilateral DDH</title><p>The opposite hip in “unilateral DDH” children often develops abnormally: 14% [<xref rid="B363" ref-type="bibr">460</xref>], 31% [<xref rid="B364" ref-type="bibr">461</xref>], 34% [<xref rid="B365" ref-type="bibr">462</xref>], and 43% [<xref rid="B149" ref-type="bibr">233</xref>]. The center-edge angle is the most predictive single measurement of delayed acetabular development while the overall best predictor is the hip ratio (CE angle + 100(acetabular depth/acetabular diameter))/2 [<xref rid="B364" ref-type="bibr">461</xref>]. A low ratio indicates a more abnormal hip; <22 is abnormal for those <2 years old and <23 for those ≥2 years old. This makes it possible to predict if the opposite hip is “at risk” [<xref rid="B364" ref-type="bibr">461</xref>]. Contralateral abduction hip contracture occurs in children with unilateral DDH [<xref rid="B366" ref-type="bibr">463</xref>, <xref rid="B367" ref-type="bibr">464</xref>] as well as diffuse pelvic asymmetry if diagnosed after 4 months of age [<xref rid="B368" ref-type="bibr">465</xref>].</p></sec></sec><sec sec-type="subsection" id="sec3.12"><title>3.12. Transition from Childhood to Adult Hip Dysplasia</title><p>Persistent childhood dysplasia [<xref rid="B369" ref-type="bibr">466</xref>] and neonatal hip instability predisposes to adult hip disease. The Norwegian Medical Birth Registry was correlated with the Arthroplasty Registry [<xref rid="B370" ref-type="bibr">467</xref>]; when adjusting for gender and year of birth, there was a 2.6 times increased risk (95% CI 30–105) for children with neonatal hip instability to undergo total hip replacement. Of the 442 patients undergoing hip replacement, 95 had the surgery due to degenerative joint disease from residual hip dysplasia, yet only 8 had neonatal hip instability. This underscores the need for continued vigilance in the screening of neonatal hip instability and long-term followup. It also confirms that there is a significant amount of hip dysplasia, with no physical findings in childhood, that later becomes symptomatic in adult life (e.g., asymptomatic radiographic dysplasia). Underlying joint laxity may also predispose to the development of adult hip osteoarthritis [<xref rid="B371" ref-type="bibr">468</xref>, <xref rid="B372" ref-type="bibr">469</xref>].</p></sec><sec sec-type="subsection" id="sec3.13"><title>3.13. Adult Hip Dysplasia</title><p>The incidence and demographics/epidemiology of adult hip dysplasia is easier to study yet there are fewer and less detailed studies. The diagnosis of dysplasia, aside from complete dislocation, involves relatively simple radiographic measurements [<xref rid="B373" ref-type="bibr">470</xref>]. The center-edge (CE) angle of Wiberg is most commonly used to determine hip dysplasia [<xref rid="B374" ref-type="bibr">398</xref>] but only quantifies lateral coverage, ignoring other methods such as anterior coverage assessment with the false-profile radiograph [<xref rid="B373" ref-type="bibr">470</xref>]. The literature defining acetabular dysplasia is confusing; some studies use a CE angle <20°, while others use 22.5°, 25°, and 30° as the cutoff (<xref ref-type="table" rid="tab6">Table 6</xref>). Also, intra- and interobserver agreement in CE angle measurement is ~±3% [<xref rid="B375" ref-type="bibr">471</xref>]. Considering these caveats, the prevalence of acetabular dysplasia ranges from 5.9% in Caucasians to ~19% in the Sámi.</p><p>Adult hip osteoarthritis (OA) is either primary or secondary. Primary OA is a diagnosis of exclusion and defined as when neither an anatomic abnormality nor any specific disease is identified as the cause [<xref rid="B376" ref-type="bibr">475</xref>]. Secondary OA is due to preexisting conditions, such as DDH, Perthes', and SCFE. Hoaglund [<xref rid="B376" ref-type="bibr">475</xref>] noted that normal hip anatomy was present in >80% of degenerative hip arthritis patients and that an underlying defect in articular cartilage or bone leads to the eventual development of OA in most Caucasians.</p><p>For the other 20%, what relations exist between mild dysplasia, ethnicity, and hip OA? The magnitude of adult acetabular dysplasia does not always correlate with degenerative hip disease in adults [<xref rid="B379" ref-type="bibr">385</xref>–<xref rid="B378" ref-type="bibr">387</xref>, <xref rid="B380" ref-type="bibr">474</xref>, <xref rid="B376" ref-type="bibr">475</xref>]. We must first know the prevalence of hip OA, and there are two ways to determine this number. One is the radiographic prevalence of hip OA. When using this method, the prevalence of radiographic hip OA is greater in men than in women and greater in Caucasians, intermediate in Blacks, and rare in Indo-Malays [<xref rid="B381" ref-type="bibr">472</xref>] (<xref ref-type="fig" rid="fig5">Figure 5(a)</xref>). The second is to determine total hip replacement rates, since truly symptomatic hip OA will likely come to THR. THR rates in San Francisco [<xref rid="B382" ref-type="bibr">473</xref>], in a population-based study, showed significant variation by ethnicity (<xref ref-type="fig" rid="fig5">Figure 5(b)</xref>), with Caucasians having a rate of THR ~10 times that of Indo-Malay peoples (Chinese, Japanese, Filipino), ~1.5 to 2 times that of Blacks, and ~3 to 4 times that of Hispanics. </p><p>Variations in the frequency of hip OA are not necessarily caused by differences in the occurrence of hip dysplasia. There are marked differences in the etiology of hip osteoarthritis between Japanese Indo-Malays and American Caucasians [<xref rid="B380" ref-type="bibr">474</xref>]. In patients with osteoarthritis of the hip, secondary osteoarthritis was present in ~82% of the Japanese patients but only 10.1% of Caucasian Americans (<xref ref-type="fig" rid="fig5">Figure 5(c)</xref>). There is more acetabular dysplasia in Japanese adults but more hip OA in British Caucasians [<xref rid="B379" ref-type="bibr">385</xref>]. The prevalence of acetabular dysplasia (defined as a CE < 25°) was 0.5% in British Caucasians and 17.3% in Japanese, yet the prevalence of hip OA was lower in Japan (0% men, 2% women) compared to Britain (11% men, 4.8% women). In a random effects' statistical model, a negative relationship was actually discovered between acetabular dysplasia and joint space [<xref rid="B379" ref-type="bibr">385</xref>]; as acetabular depth increased (CE angle), joint space decreased. This was confirmed in Hong Kong where there is a lower prevalence of radiographic OA in Hong Kong men compared to British men, yet acetabular dysplasia was equal in prevalence in both groups [<xref rid="B383" ref-type="bibr">391</xref>]. It was also confirmed in France with a negative correlation between acetabular dysplasia and the risk of hip OA [<xref rid="B384" ref-type="bibr">390</xref>]. The highest prevalence of OA was in French men (5.8%) who had a low prevalence of hip dysplasia (1.8%), while the highest prevalence of acetabular dysplasia was in Japanese women (11.6%) who had a low prevalence of OA (3.5%). In Turkish adults [<xref rid="B385" ref-type="bibr">395</xref>] there is no direct correlation between acetabular dysplasia and hip OA. The prevalence of acetabular dysplasia is similar between British Caucasian men and Nigerian Black men, yet the prevalence of hip OA was less in the Nigerian men [<xref rid="B386" ref-type="bibr">382</xref>]. In the Sámi, there is no evidence that acetabular dysplasia is associated with OA [<xref rid="B387" ref-type="bibr">476</xref>].</p><p>In other populations; however, there is a definite correlation between acetabular dysplasia/residual childhood DDH and secondary hip OA [<xref rid="B380" ref-type="bibr">474</xref>, <xref rid="B388" ref-type="bibr">477</xref>]. This is especially true in Asian populations [<xref rid="B389" ref-type="bibr">478</xref>], where the development of OA is nearly guaranteed if there is preexisting acetabular dysplasia or subluxation. In Japan, 97% of hip OA cases were secondary, with 88% due to DDH [<xref rid="B390" ref-type="bibr">479</xref>]. In elderly United States Caucasian women, mild acetabular dysplasia is associated with an increased risk of hip osteoarthritis [<xref rid="B391" ref-type="bibr">388</xref>]. The exceedingly low prevalence of acetabular dysplasia in Saudi people has been suggested as a contributing factor to their very low prevalence of OA [<xref rid="B392" ref-type="bibr">394</xref>].</p></sec><sec sec-type="subsection" id="sec3.14"><title>3.14. Both Child and Adult Hip Dysplasia—Archeological Evidence</title><p>There has been significant interest in hip dysplasia and archeological remains (<xref ref-type="table" rid="tab7">Table 7</xref>). A systematic review in this domain is quite difficult due to the many detailed, but hard to identify and access, theses and monographs. Thus, the papers discussed here are not included in the 422 of 2277 manuscripts reviewed. We attempted to review the literature as best as possible, well recognizing that some studies have been missed. Many archeological studies are not applicable being solely a case description of a skeleton with DDH with no data from which a prevalence can be calculated. In archeological studies, prevalence rather than incidence is calculated. As DDH begins some time in infancy, and since there were no diagnostic/treatment methods for children with DDH in the eras of these archeological studies, prevalence and incidence become identical. With anthropological materials, the exact diagnosis may be questioned due to many different types of hip dislocation. However, a critical review was performed, and all attempts were made to exclude posttraumatic, neuromuscular, or infectious dislocations.</p><sec sec-type="subsubsection" id="sec3.14.1"><title>3.14.1. Europeans</title><p>In 700 skeletons buried in six medieval (4th to 13th century) sites from Northern and Eastern France [<xref rid="B393" ref-type="bibr">408</xref>], six had DDH. In 900 skeletons from the Notre-Dame-du-Borg cathedral gravesite (8th to 17th century) in Southern France (Digne) [<xref rid="B394" ref-type="bibr">409</xref>], nine had DDH. In the Spitalfields cemetery in London, used between 1150 and 1530 AD [<xref rid="B395" ref-type="bibr">410</xref>], 3290 pairs of hips were sufficiently preserved for study; nine had DDH. In 100 skeletons (all affluent citizens) from a Minorite monastery churchyard cemetery in Dordrecht, Netherlands, one had DDH [<xref rid="B396" ref-type="bibr">414</xref>]. In 70 skeletons from post-medieval (1550 to 1700) Bobald, Transylvania, Romania [<xref rid="B397" ref-type="bibr">412</xref>], two had DDH. In327 skeletons at Devín, Slovakia (9th–12th century AD) [<xref rid="B398" ref-type="bibr">413</xref>], DDH was noted in one. In 271 skeletons from the Southern East Siberian area of Cis-Baikal (6800–1000 BC) one had DDH [<xref rid="B399" ref-type="bibr">415</xref>]. </p><p>In the Mediterranean areas, a study of 139 Herculaneum people buried by the Mt. Vesuvius volcano in 79 AD demonstrated one DDH [<xref rid="B400" ref-type="bibr">418</xref>]. In Padua, Italy, a study of 213 skeletons (Tedeschi Osteological Collection) from the late 19th and early 20th centuries demonstrated one DDH [<xref rid="B401" ref-type="bibr">417</xref>]. In a study of 225 skeletons from Southern Greece in the 6th-7th centuries AD there were no cases of DDH [<xref rid="B402" ref-type="bibr">416</xref>].</p></sec><sec sec-type="subsubsection" id="sec3.14.2"><title>3.14.2. Mid-Eastern/Egyptians</title><p>In the early Bronze Age (3150–2200 BC) people of Bâb edh-Dhrâ, Jordan, there was one case of DDH in 92 skeletons [<xref rid="B403" ref-type="bibr">420</xref>]. None of 73 Bedouin skeletons (200 BC) from Tel Sheva, Israel, demonstrated DDH [<xref rid="B404" ref-type="bibr">419</xref>]. In 24 skeletons from Gisr el-Mudir, Saqqara, Egypt during the 2nd Dynasty (2890–2650 BC), there was one case of DDH [<xref rid="B405" ref-type="bibr">421</xref>].</p></sec><sec sec-type="subsubsection" id="sec3.14.3"><title>3.14.3. Native Americans</title><p>The first natives encountered by Christopher Columbus were the Taino people [<xref rid="B406" ref-type="bibr">480</xref>]. In 102 Taino skeletons dated from the late 15th century found at Juan Dolio, Maguana, Santo Domingo, Dominican Republic [<xref rid="B407" ref-type="bibr">432</xref>], 5 cases of DDH were noted. In 100 Mound Builder peoples' skeletons along the Mississippi River in eastern Arkansas [<xref rid="B408" ref-type="bibr">425</xref>], (precolonization era, before 1500), there was one unilateral case of DDH. In 75 Caddo-Indian peoples who lived in what is now the Red River county, Eastern Texas (1100–1800 AD) [<xref rid="B409" ref-type="bibr">429</xref>], there was one DDH. In the Ontario Uxbridge Iroquoian ossuary (~1490 AD), one DDH was seen in 312 skeletons [<xref rid="B410" ref-type="bibr">423</xref>]. In 286 skeletons from the Fort Erie, Niagara River, Ontario (precolonization era), two cases of DDH were noted [<xref rid="B411" ref-type="bibr">424</xref>]. In 486 Native American Crow Creek villagers massacred in the 14th century on the east bank of the Missouri River in South Dakota [<xref rid="B412" ref-type="bibr">426</xref>], one DDH was found (a 6–10 years old child). In 54 skeletons from the Kechipawan Pueblo, New Mexico (1300–1600 AD), no DDH was seen [<xref rid="B413" ref-type="bibr">422</xref>]. In two small series of 26 skeletons each from El Morro Valley, New Mexico (13th century) [<xref rid="B414" ref-type="bibr">430</xref>] and Sundown, Prescott, Arizona (1100–1200 AD) [<xref rid="B415" ref-type="bibr">431</xref>], there were no cases of DDH.</p><p>The overall gender and laterality mix in the archeological samples is very similar to the composite results in this paper (<xref ref-type="table" rid="tab7">Table 7</xref>). In those skeletons with DDH where the data was known, 74% were female and 35% demonstrated bilateral involvement, similar to the figures of 76% female and 27% bilateral in this paper. The prevalence of DDH in these archeological samples, even though most are small in size except for that from the Spitalfields cemetery, demonstrates differences compared to the incidence of DDH in this paper. Those for Western Europe are similar (4.9 archeological, 3.6 present United Kingdom). All others were different: Eastern Europe (6.0 archeological, 35.8 present), Mediterranean (3.5 archeological, 25.5 present), Middle East (10.6 archeological, 6.2 present), and indigenous Native Americans (6.1 archeological, 76.1 present). If the sampling of the archeological data set was adequate, then statistical analysis should determine if such differences were real. We subjected the data to the Fisher two-tailed exact test, analyzing for differences between the archeological data and the present data. These data (DDH <italic>n</italic>/total <italic>n</italic>) and (archeological versus present) were 25/5089 and 3232/906428 for Western Europe; 4/668 and 12452/348031 for Eastern Europe; 2/577 and 2240/87581 for Mediterranean; 2/189 and 732/118225 for Arabic Middle East; 44/8321 and 1108/14553 for indigenous Native Americans. There were no differences for Western Europe (<italic>P</italic> = 0.12) and the Middle East Arabic (<italic>P</italic> = 0.33), while there were differences for Eastern Europe and indigenous Native Americans (<italic>P</italic> < 0.001). These differences may represent changing epidemiology, changes in natural selection processes in the archeological era, or inadequate sampling of the archeological materials. Further inquiry will be needed in this subject area.</p></sec></sec></sec><sec id="sec4"><title>4. Conclusion</title><p>DDH demonstrates a predominance of left-sided (64.0%) and unilateral involvement (63.4%). The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans with significant variability between and within racial groups and geographic location. The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. Predictors of DDH are breech presentation, positive family history, and gender (female). Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. Many studies demonstrate an increase of DDH in the winter, both in the Northern and Southern hemispheres. Swaddling is strongly associated with DDH. Associated conditions are congenital muscular torticollis and congenital foot deformities. The opposite hip is frequently abnormal when using rigorous radiographic assessments. Archeological studies demonstrate that the epidemiology of DDH may be changing.</p></sec></body><back><ack><title>Acknowledgments</title><p>This study was supported in part by the Garceau Professorship Endowment, Department of Orthopaedic Surgery, Indiana University School of Medicine, and the George Rapp Pediatric Orthopaedic Research Endowment, Riley Children's Foundation, Riley Children's Hospital, Indianapolis, Indiana. </p></ack><ack><title>Disclosure</title><p>The authors otherwise have no financial interests with any other organizations or bodies. As a systematic literature review, Institutional Review Board approval is not applicable. 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(a) A representative longitudinal ultrasound image of a normal neonatal hip. The ilium is marked by the asterisk, the bony acetabular roof by the large arrowhead, and the abductor muscles seen by the longitudinal white/gray alternating structures. (b) Measurement of the alpha (<italic>α</italic>) and beta (<italic>β</italic>) angles on ultrasound establish the Graf class. The baseline is first drawn and is the line along the ilium as it intersects the bony and cartilaginous portions of the acetabulum (solid black line). The <italic>α</italic> angle is the angle between the baseline and the roof of the bony acetabulum; the <italic>β</italic> angle is the angle between the baseline and the cartilaginous roof. (c) An example of a Graf IIc hip, with an <italic>α</italic> angle of 43° and a <italic>β</italic> angle of 49°. (d) An example of a Graf IV hip, irreducible dislocated hip, with an <italic>α</italic> angle of 42°. Typically <italic>β</italic> angles are not measured on dislocated hips, but in this example it would measure 99°.</p></caption><graphic xlink:href="ISRN.ORTHOPEDICS2011-238607.001"></graphic></fig><fig id="fig2" position="float"><label>Figure 2</label><caption><p>The incidence of DDH in various ethnic groups. (a) The incidence of DDH in indigenous populations. (b) DDH incidence in Indo-Mediterraneans. (c) DDH incidence in Indo-Malay peoples. (d) DDH incidence in all Caucasians. (e) DDH incidence in Eastern European Caucasians. (f) Incidence of DDH amongst all ethnic groups; note the <italic>y</italic>-axis is logarithmic<sub>10</sub>.</p></caption><graphic xlink:href="ISRN.ORTHOPEDICS2011-238607.002"></graphic></fig><fig id="fig3" position="float"><label>Figure 3</label><caption><p>Variability in DDH demographics amongst ethnic groups. (a) Variability in gender amongst ethnic groups. (b) Variability in unilateral/bilateral involvement amongst ethnic groups. (c) Variability in right and left hip involvement amongst ethnic groups.</p></caption><graphic xlink:href="ISRN.ORTHOPEDICS2011-238607.003"></graphic></fig><fig id="fig4" position="float"><label>Figure 4</label><caption><p>(a) The prevalence of DDH in the late 1970's by age group in the Sámi living in northern Finland, Lake Inari region. The overall prevalence was 16.3; for those ≥60 years of age it was 60.2, and dropped to 3.5 for those 0–19 years of age. This has been attributed to a decrease in the practice of newborn swaddling using the gietka or komse. Data from Eriksson et al. [<xref rid="B272" ref-type="bibr">324</xref>]. (b) The marked decrease in DDH incidence in Japan after introduction of a nationwide educational program for both neonatal hip instability and hip dislocation after 3 months of age. For neonatal hip instability the data was taken from [<xref rid="B278" ref-type="bibr">84</xref>, <xref rid="B416" ref-type="bibr">325</xref>] and for hip dislocation from [<xref rid="B240" ref-type="bibr">83</xref>–<xref rid="B241" ref-type="bibr">90</xref>].</p></caption><graphic xlink:href="ISRN.ORTHOPEDICS2011-238607.004"></graphic></fig><fig id="fig5" position="float"><label>Figure 5</label><caption><p>The demographics of hip osteoarthritis in adults. (a) Radiographic prevalence of hip osteoarthritis by ethnicity and geographic location. Data from Lau et al. [<xref rid="B381" ref-type="bibr">472</xref>]. (b1) Estimated rates of total hip replacements for primary coxarthrosis in San Francisco, 1984–1988, for men. Data from Hoaglund et al. [<xref rid="B382" ref-type="bibr">473</xref>]. (b2) Estimated rates of total hip replacements for primary coxarthrosis in San Francisco, 1984–1988, for women. Data from Hoaglund et al. [<xref rid="B382" ref-type="bibr">473</xref>]. (c) Differences in the etiology of adult hip arthritis between Japanese and Caucasian patients. Note the rarity of SCFE and Perthes' as a cause of adult hip arthritis. Data from Hoaglund et al. [<xref rid="B380" ref-type="bibr">474</xref>].</p></caption><graphic xlink:href="ISRN.ORTHOPEDICS2011-238607.005"></graphic></fig><table-wrap id="tab1" position="float"><label>Table 1</label><caption><p>Graf's classification of hip dysplasia using ultrasound.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Graf's hip type</th><th align="center" rowspan="1" colspan="1">Description</th><th align="center" rowspan="1" colspan="1"><italic>α</italic> angle (°)</th><th align="center" rowspan="1" colspan="1"><italic>β</italic> angle (°)</th><th align="center" rowspan="1" colspan="1">Age</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">I</td><td align="center" rowspan="1" colspan="1">Normal</td><td align="center" rowspan="1" colspan="1">>60</td><td align="center" rowspan="1" colspan="1"><55</td><td align="center" rowspan="1" colspan="1">Any</td></tr><tr><td align="left" rowspan="1" colspan="1">IIa</td><td align="center" rowspan="1" colspan="1">Physiologically immature</td><td align="center" rowspan="1" colspan="1">50–60</td><td align="center" rowspan="1" colspan="1">55–77</td><td align="center" rowspan="1" colspan="1">0–12 wks</td></tr><tr><td align="left" rowspan="1" colspan="1">IIb</td><td align="center" rowspan="1" colspan="1">Immature</td><td align="center" rowspan="1" colspan="1">50–59</td><td align="center" rowspan="1" colspan="1">55–77</td><td align="center" rowspan="1" colspan="1">>12 wks</td></tr><tr><td align="left" rowspan="1" colspan="1">IIc</td><td align="center" rowspan="1" colspan="1">Acetabular deficiency</td><td align="center" rowspan="1" colspan="1">43–49</td><td align="center" rowspan="1" colspan="1">>77</td><td align="center" rowspan="1" colspan="1">Any</td></tr><tr><td align="left" rowspan="1" colspan="1">IId</td><td align="center" rowspan="1" colspan="1">Everted labrum with subluxation</td><td align="center" rowspan="1" colspan="1">43–49</td><td align="center" rowspan="1" colspan="1">>77</td><td align="center" rowspan="1" colspan="1">Any</td></tr><tr><td align="left" rowspan="1" colspan="1">III</td><td align="center" rowspan="1" colspan="1">Everted labrum with dislocation</td><td align="center" rowspan="1" colspan="1"><43</td><td align="center" rowspan="1" colspan="1">>77</td><td align="center" rowspan="1" colspan="1">Any</td></tr><tr><td align="left" rowspan="1" colspan="1">IV</td><td align="center" rowspan="1" colspan="1">Dislocation</td><td align="center" rowspan="1" colspan="1"><43</td><td align="center" rowspan="1" colspan="1">>77</td><td align="center" rowspan="1" colspan="1">Any</td></tr></tbody></table><table-wrap-foot><fn><p>As described by Graf [<xref rid="B420" ref-type="bibr">23</xref>], Roposch et al. [<xref rid="B421" ref-type="bibr">24</xref>], and Herring [<xref rid="B422" ref-type="bibr">25</xref>].</p></fn></table-wrap-foot></table-wrap><table-wrap-group id="tab2" position="float"><label>Table 2</label><caption><p>Incidence of DDH in the clinical screening period era (1950s–1980s).</p></caption><table-wrap id="tab2a" position="anchor"><caption><p>(a) Indigenous peoples</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Study</th><th align="center" rowspan="1" colspan="1">Year</th><th align="center" rowspan="1" colspan="1">Location</th><th align="center" rowspan="1" colspan="1">Ethnicity</th><th align="left" rowspan="1" colspan="1">Dx</th><th align="center" rowspan="1" colspan="1">No. Pts</th><th align="center" rowspan="1" colspan="1">No. DDH</th><th align="center" rowspan="1" colspan="1">Incidence (per 1000)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Native Americans</italic></bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Corrigan and Segal [<xref rid="B36" ref-type="bibr">36</xref>]</td><td align="center" rowspan="1" colspan="1">1950</td><td align="center" rowspan="1" colspan="1">Island Lake, Manitoba</td><td align="center" rowspan="1" colspan="1">Cree-Ojibwa</td><td align="left" rowspan="1" colspan="1">Documented DDH</td><td align="center" rowspan="1" colspan="1">1253</td><td align="center" rowspan="1" colspan="1">45</td><td align="center" rowspan="1" colspan="1">35.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Walker [<xref rid="B37" ref-type="bibr">37</xref>]</td><td align="center" rowspan="1" colspan="1">1977</td><td align="center" rowspan="1" colspan="1">Island Lake, Manitoba</td><td align="center" rowspan="1" colspan="1">Cree-Ojibwa</td><td align="left" rowspan="1" colspan="1">All DDH</td><td align="center" rowspan="1" colspan="1">1248</td><td align="center" rowspan="1" colspan="1">420</td><td align="center" rowspan="1" colspan="1">336.5</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dislocation</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">243</td><td align="center" rowspan="1" colspan="1">194.7</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dysplasia</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">123</td><td align="center" rowspan="1" colspan="1">98.6</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Other</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">54</td><td align="center" rowspan="1" colspan="1">43.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Houston and Buhr [<xref rid="B38" ref-type="bibr">38</xref>]</td><td align="center" rowspan="1" colspan="1">1966</td><td align="center" rowspan="1" colspan="1">Northern Saskatchewan</td><td align="center" rowspan="1" colspan="1">Cree</td><td align="left" rowspan="1" colspan="1">All DDH</td><td align="center" rowspan="1" colspan="1">4453</td><td align="center" rowspan="1" colspan="1">59</td><td align="center" rowspan="1" colspan="1">13.2</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Likely DDH</td><td align="center" rowspan="1" colspan="1">1253</td><td align="center" rowspan="1" colspan="1">71</td><td align="center" rowspan="1" colspan="1">56.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Salter [<xref rid="B39" ref-type="bibr">39</xref>]</td><td align="center" rowspan="1" colspan="1">1968</td><td align="center" rowspan="1" colspan="1">Ontario, Canada</td><td align="center" rowspan="1" colspan="1">—</td><td align="left" rowspan="1" colspan="1">All DDH</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Used cradleboard</td><td align="center" rowspan="1" colspan="1">2032</td><td align="center" rowspan="1" colspan="1">250</td><td align="center" rowspan="1" colspan="1">123.0</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">No cradleboard</td><td align="center" rowspan="1" colspan="1">1347</td><td align="center" rowspan="1" colspan="1">17</td><td align="center" rowspan="1" colspan="1">12.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Rabin et al. [<xref rid="B242" ref-type="bibr">40</xref>]</td><td align="center" rowspan="1" colspan="1">1965</td><td align="center" rowspan="1" colspan="1">Many Farms District, AZ</td><td align="center" rowspan="1" colspan="1">Navajo</td><td align="left" rowspan="1" colspan="1"><italic>Adults—All</italic></td><td align="center" rowspan="1" colspan="1">270</td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">33.3</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dislocation</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">25.9</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dysplasia</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">7.4</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>Children—All</italic></td><td align="center" rowspan="1" colspan="1">548</td><td align="center" rowspan="1" colspan="1">22</td><td align="center" rowspan="1" colspan="1">40.1</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dislocation</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">7.3</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dysplasia</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">18</td><td align="center" rowspan="1" colspan="1">32.8</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>Adults and Children—All</italic></td><td align="center" rowspan="1" colspan="1">818</td><td align="center" rowspan="1" colspan="1">31</td><td align="center" rowspan="1" colspan="1">37.9</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dislocation</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">11</td><td align="center" rowspan="1" colspan="1">13.4</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dysplasia</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">24.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Pratt et al. [<xref rid="B35" ref-type="bibr">41</xref>]</td><td align="center" rowspan="1" colspan="1">1982</td><td align="center" rowspan="1" colspan="1">Many Farms District, AZ</td><td align="center" rowspan="1" colspan="1">Navajo</td><td align="left" rowspan="1" colspan="1"><italic>Children</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">All DDH</td><td align="center" rowspan="1" colspan="1">548</td><td align="center" rowspan="1" colspan="1">18</td><td align="center" rowspan="1" colspan="1">32.8</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dislocation</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">14</td><td align="center" rowspan="1" colspan="1">25.5</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dysplasia</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">7.3</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>Adults</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">All DDH</td><td align="center" rowspan="1" colspan="1">270</td><td align="center" rowspan="1" colspan="1">89</td><td align="center" rowspan="1" colspan="1">330</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dislocation</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">70</td><td align="center" rowspan="1" colspan="1">259</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dysplasia</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">19</td><td align="center" rowspan="1" colspan="1">70</td></tr><tr><td align="left" rowspan="1" colspan="1">Coleman [<xref rid="B34" ref-type="bibr">42</xref>]</td><td align="center" rowspan="1" colspan="1">1968</td><td align="center" rowspan="1" colspan="1">Fort Defiance, Ship Rock, Gallup</td><td align="center" rowspan="1" colspan="1">Navajo</td><td align="left" rowspan="1" colspan="1">All DDH ≤ 3 months old</td><td align="center" rowspan="1" colspan="1">1155</td><td align="center" rowspan="1" colspan="1">77</td><td align="center" rowspan="1" colspan="1">66.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Kraus and Schwartzman [<xref rid="B33" ref-type="bibr">43</xref>]</td><td align="center" rowspan="1" colspan="1">1957</td><td align="center" rowspan="1" colspan="1">Fort Apache</td><td align="center" rowspan="1" colspan="1">Apache</td><td align="left" rowspan="1" colspan="1">Dislocation</td><td align="center" rowspan="1" colspan="1">3500</td><td align="center" rowspan="1" colspan="1">107</td><td align="center" rowspan="1" colspan="1">30.6</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Weighted avg.</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">All DDH</td><td align="center" rowspan="1" colspan="1">14553</td><td align="center" rowspan="1" colspan="1">1108</td><td align="center" rowspan="1" colspan="1">76.1</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Sámi and Australian Aboriginals</italic></bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Bower et al. [<xref rid="B45" ref-type="bibr">44</xref>]</td><td align="center" rowspan="1" colspan="1">1987</td><td align="center" rowspan="1" colspan="1">Western Australia</td><td align="center" rowspan="1" colspan="1">Australian Aboriginals</td><td align="left" rowspan="1" colspan="1">All DDH</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1">22</td><td align="center" rowspan="1" colspan="1">37 </td></tr><tr><td align="left" rowspan="1" colspan="1">Getz [<xref rid="B44" ref-type="bibr">45</xref>]</td><td align="center" rowspan="1" colspan="1">1955</td><td align="center" rowspan="1" colspan="1">Sámpi (Circumpolar Europe)</td><td align="center" rowspan="1" colspan="1">Sámi</td><td align="left" rowspan="1" colspan="1">All DDH</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">40</td></tr><tr><td align="left" rowspan="1" colspan="1">Mellbin [<xref rid="B43" ref-type="bibr">46</xref>]</td><td align="center" rowspan="1" colspan="1">1962</td><td align="center" rowspan="1" colspan="1">Sweden</td><td align="center" rowspan="1" colspan="1">Sámi</td><td align="left" rowspan="1" colspan="1">All DDH</td><td align="center" rowspan="1" colspan="1">813</td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">24.6</td></tr></tbody></table></table-wrap><table-wrap id="tab2b" position="anchor"><caption><p>(b) Africans, Indo-Mediterranean, and mixed peoples</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Study</th><th align="center" rowspan="1" colspan="1">Year</th><th align="left" rowspan="1" colspan="1">Location</th><th align="left" rowspan="1" colspan="1">Ethnicity</th><th align="center" rowspan="1" colspan="1">No. Pts</th><th align="center" rowspan="1" colspan="1">No. DDH</th><th align="center" rowspan="1" colspan="1">Incidence (per 1000)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Africans—Blacks</italic></bold></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Edelsetin [<xref rid="B47" ref-type="bibr">47</xref>]</td><td align="center" rowspan="1" colspan="1">1966</td><td align="left" rowspan="1" colspan="1">South Africa</td><td align="left" rowspan="1" colspan="1">Bantu</td><td align="center" rowspan="1" colspan="1">16678</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">0</td></tr><tr><td align="left" rowspan="1" colspan="1">Roper [<xref rid="B46" ref-type="bibr">48</xref>]</td><td align="center" rowspan="1" colspan="1">1976</td><td align="left" rowspan="1" colspan="1">Rhodesia (Zimbabwe)</td><td align="left" rowspan="1" colspan="1">Bantu</td><td align="center" rowspan="1" colspan="1">40000</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">0.025</td></tr><tr><td align="left" rowspan="1" colspan="1">Pompe van Meerdervoort [<xref rid="B118" ref-type="bibr">49</xref>]</td><td align="center" rowspan="1" colspan="1">1977</td><td align="left" rowspan="1" colspan="1">South Africa</td><td align="left" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">10000</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">0.3</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Weighted avg.</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">66678</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">0.06</td></tr><tr><td align="left" rowspan="1" colspan="1">Burke et al. [<xref rid="B55" ref-type="bibr">50</xref>]</td><td align="center" rowspan="1" colspan="1">1985</td><td align="left" rowspan="1" colspan="1">United States</td><td align="left" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">28261*</td><td align="center" rowspan="1" colspan="1">13</td><td align="center" rowspan="1" colspan="1">0.46</td></tr><tr><td align="left" rowspan="1" colspan="1">Finley et al. [<xref rid="B54" ref-type="bibr">51</xref>]</td><td align="center" rowspan="1" colspan="1">1994</td><td align="left" rowspan="1" colspan="1">Jefferson County, Alabama, USA</td><td align="left" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">9654</td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">0.2</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Weighted avg.</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">37915</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">0.40</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Indo- Mediterranean</italic></bold></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> Kulshrestha et al. [<xref rid="B56" ref-type="bibr">52</xref>]</td><td align="center" rowspan="1" colspan="1">1983</td><td align="left" rowspan="1" colspan="1">Ballabhgarh, India</td><td align="left" rowspan="1" colspan="1">Indian</td><td align="center" rowspan="1" colspan="1">2409</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">0.42</td></tr><tr><td align="left" rowspan="1" colspan="1">Singh and Sharma [<xref rid="B57" ref-type="bibr">53</xref>]</td><td align="center" rowspan="1" colspan="1">1980</td><td align="left" rowspan="1" colspan="1">New Delhi, India</td><td align="left" rowspan="1" colspan="1">Indian</td><td align="center" rowspan="1" colspan="1">7274</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">1.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Boo and Rajaram [<xref rid="B60" ref-type="bibr">54</xref>]</td><td align="center" rowspan="1" colspan="1">1984</td><td align="left" rowspan="1" colspan="1">Kuala Lumpur</td><td align="left" rowspan="1" colspan="1">Indian</td><td align="center" rowspan="1" colspan="1">8109</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">1.23</td></tr><tr><td align="left" rowspan="1" colspan="1">Gupta et al. [<xref rid="B58" ref-type="bibr">55</xref>]</td><td align="center" rowspan="1" colspan="1">1992</td><td align="left" rowspan="1" colspan="1">New Delhi, India</td><td align="left" rowspan="1" colspan="1">Indian</td><td align="center" rowspan="1" colspan="1">6209</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">2.65</td></tr><tr><td align="left" rowspan="1" colspan="1">Ang et al. [<xref rid="B61" ref-type="bibr">56</xref>]</td><td align="center" rowspan="1" colspan="1">1997</td><td align="left" rowspan="1" colspan="1">Singapore</td><td align="left" rowspan="1" colspan="1">Indian</td><td align="center" rowspan="1" colspan="1">2810</td><td align="center" rowspan="1" colspan="1">13</td><td align="center" rowspan="1" colspan="1">4.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Kaushal et al. [<xref rid="B59" ref-type="bibr">57</xref>]</td><td align="center" rowspan="1" colspan="1">1976</td><td align="left" rowspan="1" colspan="1">Chandigarh, Northern India</td><td align="left" rowspan="1" colspan="1">Indian</td><td align="center" rowspan="1" colspan="1">2500</td><td align="center" rowspan="1" colspan="1">23</td><td align="center" rowspan="1" colspan="1">9.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Şahin et al. [<xref rid="B67" ref-type="bibr">58</xref>]</td><td align="center" rowspan="1" colspan="1">2004</td><td align="left" rowspan="1" colspan="1">Ankara, Turkey</td><td align="left" rowspan="1" colspan="1">Turkish</td><td align="center" rowspan="1" colspan="1">5798</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">1.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Kutlu et al. [<xref rid="B267" ref-type="bibr">59</xref>]</td><td align="center" rowspan="1" colspan="1">1992</td><td align="left" rowspan="1" colspan="1">Konya, Turkey</td><td align="left" rowspan="1" colspan="1">Turkish</td><td align="center" rowspan="1" colspan="1">4173</td><td align="center" rowspan="1" colspan="1">56</td><td align="center" rowspan="1" colspan="1">13.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Doğruel [<xref rid="B68" ref-type="bibr">60</xref>]</td><td align="center" rowspan="1" colspan="1">2008</td><td align="left" rowspan="1" colspan="1">Ankara, Turkey</td><td align="left" rowspan="1" colspan="1">Turkish</td><td align="center" rowspan="1" colspan="1">3541</td><td align="center" rowspan="1" colspan="1">167</td><td align="center" rowspan="1" colspan="1">47.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Alkalay [<xref rid="B66" ref-type="bibr">61</xref>]</td><td align="center" rowspan="1" colspan="1">1972</td><td align="left" rowspan="1" colspan="1">Tamra, Galilee, Israel</td><td align="left" rowspan="1" colspan="1">Arabic</td><td align="center" rowspan="1" colspan="1">450</td><td align="center" rowspan="1" colspan="1">21</td><td align="center" rowspan="1" colspan="1">46.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Alkalay [<xref rid="B66" ref-type="bibr">61</xref>]</td><td align="center" rowspan="1" colspan="1">1972</td><td align="left" rowspan="1" colspan="1">Western Galilee, Israel</td><td align="left" rowspan="1" colspan="1">Arabic/Druze</td><td align="center" rowspan="1" colspan="1">3625</td><td align="center" rowspan="1" colspan="1">109</td><td align="center" rowspan="1" colspan="1">30.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Moosa et al. [<xref rid="B64" ref-type="bibr">62</xref>]</td><td align="center" rowspan="1" colspan="1">2009</td><td align="left" rowspan="1" colspan="1">Dubai, UAE</td><td align="left" rowspan="1" colspan="1">Arabic</td><td align="center" rowspan="1" colspan="1">3786</td><td align="center" rowspan="1" colspan="1">12</td><td align="center" rowspan="1" colspan="1">3.17</td></tr><tr><td align="left" rowspan="1" colspan="1">Mirdad [<xref rid="B65" ref-type="bibr">63</xref>]</td><td align="center" rowspan="1" colspan="1">2002</td><td align="left" rowspan="1" colspan="1">Aseer, Saudi Arabia</td><td align="left" rowspan="1" colspan="1">Saudi</td><td align="center" rowspan="1" colspan="1">79548</td><td align="center" rowspan="1" colspan="1">300</td><td align="center" rowspan="1" colspan="1">3.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Danielsson [<xref rid="B75" ref-type="bibr">64</xref>]</td><td align="center" rowspan="1" colspan="1">2000</td><td align="left" rowspan="1" colspan="1">Malmö, Sweden</td><td align="left" rowspan="1" colspan="1">Iraqi/Iranian</td><td align="center" rowspan="1" colspan="1">1604</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">4.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Mamouri et al. [<xref rid="B62" ref-type="bibr">65</xref>]</td><td align="center" rowspan="1" colspan="1">2004</td><td align="left" rowspan="1" colspan="1">Mashhad, Iran</td><td align="left" rowspan="1" colspan="1">Iranian</td><td align="center" rowspan="1" colspan="1">6576</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">1.5</td></tr><tr><td align="left" rowspan="1" colspan="1">Abdinejad et al. [<xref rid="B31" ref-type="bibr">34</xref>]</td><td align="center" rowspan="1" colspan="1">1996</td><td align="left" rowspan="1" colspan="1">Shiraz, Iran</td><td align="left" rowspan="1" colspan="1">Iranian</td><td align="center" rowspan="1" colspan="1">8024</td><td align="center" rowspan="1" colspan="1">30</td><td align="center" rowspan="1" colspan="1">3.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Pashapour and Golmaham- madlou [<xref rid="B63" ref-type="bibr">66</xref>]</td><td align="center" rowspan="1" colspan="1">2007</td><td align="left" rowspan="1" colspan="1">Urmia, Iran</td><td align="left" rowspan="1" colspan="1">Iranian</td><td align="center" rowspan="1" colspan="1">1100</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">9.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Paterson [<xref rid="B106" ref-type="bibr">67</xref>]</td><td align="center" rowspan="1" colspan="1">1976</td><td align="left" rowspan="1" colspan="1">Western Australia</td><td align="left" rowspan="1" colspan="1">Indo-Mediterra- nean, not otherwise specified</td><td align="center" rowspan="1" colspan="1">2964</td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">3.0</td></tr><tr><td align="left" rowspan="3" colspan="1"><italic>Weighted avg.</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>All</italic></td><td align="center" rowspan="1" colspan="1">150500</td><td align="center" rowspan="1" colspan="1">811</td><td align="center" rowspan="1" colspan="1">5.4</td></tr><tr><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"><italic>Indian</italic></td><td align="left" rowspan="1" colspan="1">29311</td><td align="left" rowspan="1" colspan="1">70</td><td align="center" rowspan="1" colspan="1">2.4</td></tr><tr><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"><italic>Arabic</italic></td><td align="left" rowspan="1" colspan="1">118225</td><td align="left" rowspan="1" colspan="1">732</td><td align="center" rowspan="1" colspan="1">6.2</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Mixed/ Unknown—All Geographic Locations</italic></bold></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Rao and Thurston [<xref rid="B423" ref-type="bibr">68</xref>]</td><td align="center" rowspan="1" colspan="1">1986</td><td align="left" rowspan="1" colspan="1">Wellington, New Zealand</td><td align="left" rowspan="1" colspan="1">Not specified</td><td align="center" rowspan="1" colspan="1">15174</td><td align="center" rowspan="1" colspan="1">60</td><td align="center" rowspan="1" colspan="1">4.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Lowry et al. [<xref rid="B424" ref-type="bibr">69</xref>]</td><td align="center" rowspan="1" colspan="1">1989</td><td align="left" rowspan="1" colspan="1">Alberta, Canada</td><td align="left" rowspan="1" colspan="1">North America</td><td align="center" rowspan="1" colspan="1">813<sup>@</sup></td><td align="center" rowspan="1" colspan="1">30347</td><td align="center" rowspan="1" colspan="1">2.68</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Not specified</td><td align="center" rowspan="1" colspan="1">34956</td><td align="center" rowspan="1" colspan="1">342</td><td align="center" rowspan="1" colspan="1">9.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Medalie et al. [<xref rid="B244" ref-type="bibr">70</xref>]</td><td align="center" rowspan="1" colspan="1">1966</td><td align="left" rowspan="1" colspan="1">Jerusalem, Israel</td><td align="left" rowspan="1" colspan="1"> Dislocation</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">107</td><td align="center" rowspan="1" colspan="1">3.1</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"> Subluxation</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">235</td><td align="center" rowspan="1" colspan="1">6.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Harlap et al. [<xref rid="B425" ref-type="bibr">71</xref>]</td><td align="center" rowspan="1" colspan="1">1971</td><td align="left" rowspan="1" colspan="1">Jerusalem, Israel</td><td align="left" rowspan="1" colspan="1">Jewish/Arabic</td><td align="center" rowspan="1" colspan="1">18017</td><td align="center" rowspan="1" colspan="1">104</td><td align="center" rowspan="1" colspan="1">5.7</td></tr></tbody></table><table-wrap-foot><fn><p><sup>@</sup>calculated from the given incidence and total number of births.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab2c" position="anchor"><caption><p>(c) Indo-Malay peoples</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Study</th><th align="center" rowspan="1" colspan="1">Year</th><th align="left" rowspan="1" colspan="1">Location</th><th align="left" rowspan="1" colspan="1">Ethnicity</th><th align="center" rowspan="1" colspan="1">No. Pts</th><th align="center" rowspan="1" colspan="1">No. DDH</th><th align="center" rowspan="1" colspan="1">Incidence (per 1000)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Huang et al. [<xref rid="B426" ref-type="bibr">72</xref>]</td><td align="center" rowspan="1" colspan="1">1988</td><td align="left" rowspan="1" colspan="1">Taiwan</td><td align="left" rowspan="1" colspan="1">Chinese</td><td align="center" rowspan="1" colspan="1">9884</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">1.01</td></tr><tr><td align="left" rowspan="1" colspan="1">Chang et al. [<xref rid="B427" ref-type="bibr">73</xref>]</td><td align="center" rowspan="1" colspan="1">2007</td><td align="left" rowspan="1" colspan="1">Taiwan</td><td align="left" rowspan="1" colspan="1">Chinese</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1">2.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Hoaglund et al. [<xref rid="B71" ref-type="bibr">74</xref>]</td><td align="center" rowspan="1" colspan="1">1981</td><td align="left" rowspan="1" colspan="1">Hong Kong</td><td align="left" rowspan="1" colspan="1">Chinese</td><td align="center" rowspan="1" colspan="1">557683</td><td align="center" rowspan="1" colspan="1">38</td><td align="center" rowspan="1" colspan="1">0.07</td></tr><tr><td align="left" rowspan="1" colspan="1">Boo and Rajaram [<xref rid="B60" ref-type="bibr">54</xref>]</td><td align="center" rowspan="1" colspan="1">1984</td><td align="left" rowspan="1" colspan="1">Kuala Lumpur</td><td align="left" rowspan="1" colspan="1">Chinese</td><td align="center" rowspan="1" colspan="1">12115</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">0.33</td></tr><tr><td align="left" rowspan="1" colspan="1">Limpaphayom [<xref rid="B72" ref-type="bibr">75</xref>, <xref rid="B428" ref-type="bibr">76</xref>]</td><td align="center" rowspan="1" colspan="1">1975</td><td align="left" rowspan="1" colspan="1">Thailand</td><td align="left" rowspan="1" colspan="1">Thai</td><td align="center" rowspan="1" colspan="1">33433</td><td align="center" rowspan="1" colspan="1">17</td><td align="center" rowspan="1" colspan="1">0.5</td></tr><tr><td align="left" rowspan="1" colspan="1">Ang et al. [<xref rid="B61" ref-type="bibr">56</xref>]</td><td align="center" rowspan="1" colspan="1">1997</td><td align="left" rowspan="1" colspan="1">Singapore</td><td align="left" rowspan="1" colspan="1">Malay</td><td align="center" rowspan="1" colspan="1">7439</td><td align="center" rowspan="1" colspan="1">40</td><td align="center" rowspan="1" colspan="1">5.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Boo and Rajaram [<xref rid="B60" ref-type="bibr">54</xref>]</td><td align="center" rowspan="1" colspan="1">1984</td><td align="left" rowspan="1" colspan="1">Kuala Lumpur</td><td align="left" rowspan="1" colspan="1">Malay</td><td align="center" rowspan="1" colspan="1">29695</td><td align="center" rowspan="1" colspan="1">21</td><td align="center" rowspan="1" colspan="1">0.71</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Japanese—before Educational/ Prevention Campaigns</italic></bold></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Naito [<xref rid="B429" ref-type="bibr">77</xref>]</td><td align="center" rowspan="1" colspan="1">1958</td><td align="left" rowspan="1" colspan="1">Japan</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1">*</td><td align="center" rowspan="1" colspan="1">56.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Akabayashi [<xref rid="B430" ref-type="bibr">78</xref>]</td><td align="center" rowspan="1" colspan="1">1958</td><td align="left" rowspan="1" colspan="1">Miyagi, Japan</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">33.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Tsuji [<xref rid="B431" ref-type="bibr">79</xref>]</td><td align="center" rowspan="1" colspan="1">1964</td><td align="left" rowspan="1" colspan="1">Tokyo, Japan</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">11.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Kashiwagi and Kagawa [<xref rid="B432" ref-type="bibr">80</xref>]</td><td align="center" rowspan="1" colspan="1">1965</td><td align="left" rowspan="1" colspan="1">Kobe, Japan</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1">929</td><td align="center" rowspan="1" colspan="1">41</td><td align="center" rowspan="1" colspan="1">44.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Haginomori [<xref rid="B184" ref-type="bibr">81</xref>]</td><td align="center" rowspan="1" colspan="1">1966</td><td align="left" rowspan="1" colspan="1">Kochi, Japan</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1">3323</td><td align="center" rowspan="1" colspan="1">106</td><td align="center" rowspan="1" colspan="1">31.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Tanabe et al. [<xref rid="B433" ref-type="bibr">82</xref>]</td><td align="center" rowspan="1" colspan="1">1972</td><td align="left" rowspan="1" colspan="1">Okayama, Japan</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">All</td><td align="center" rowspan="1" colspan="1">2756</td><td align="center" rowspan="1" colspan="1">73</td><td align="center" rowspan="1" colspan="1">26.5</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dislocation</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">32</td><td align="center" rowspan="1" colspan="1">11.6</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Subluxation</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">41</td><td align="center" rowspan="1" colspan="1">14.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Wada et al. [<xref rid="B240" ref-type="bibr">83</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Tokushima Prefecture,</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">22*</td></tr><tr><td align="left" rowspan="1" colspan="1">Ishida [<xref rid="B278" ref-type="bibr">84</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Aichi</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">11.2*</td></tr><tr><td align="left" rowspan="1" colspan="1">Ishida [<xref rid="B278" ref-type="bibr">84</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Fukushima</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">18*</td></tr><tr><td align="left" rowspan="1" colspan="1">Ishida [<xref rid="B278" ref-type="bibr">84</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Osaka</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">8*</td></tr><tr><td align="left" rowspan="1" colspan="1">Ishida [<xref rid="B70" ref-type="bibr">85</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Kyoto</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">28*</td></tr><tr><td align="left" rowspan="1" colspan="1">Kikuike et al. [<xref rid="B418" ref-type="bibr">86</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Takayama/Gifu</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1">2289</td><td align="center" rowspan="1" colspan="1">25</td><td align="center" rowspan="1" colspan="1">10.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Gotoh et al. [<xref rid="B69" ref-type="bibr">87</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Asahikawa</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1">15944</td><td align="center" rowspan="1" colspan="1">95</td><td align="center" rowspan="1" colspan="1">6</td></tr><tr><td align="left" rowspan="1" colspan="1">Saito [<xref rid="B417" ref-type="bibr">88</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Sapporo</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">12*</td></tr><tr><td align="left" rowspan="1" colspan="1">Shinohara [<xref rid="B419" ref-type="bibr">89</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Matsudo</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">5.1*</td></tr><tr><td align="left" rowspan="1" colspan="1">Iwasaki and Takahashi [<xref rid="B241" ref-type="bibr">90</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Nagasaki</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">6.3*</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Japanese—Seminal Study on Effects of Extension Diapering/Swaddling</italic></bold></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Ishida [<xref rid="B70" ref-type="bibr">85</xref>]</td><td align="center" rowspan="1" colspan="1">1977</td><td align="left" rowspan="1" colspan="1">Kyoto, Japan</td><td align="left" rowspan="1" colspan="1">Swaddled</td><td align="center" rowspan="1" colspan="1">3778</td><td align="center" rowspan="1" colspan="1">200</td><td align="center" rowspan="1" colspan="1">52.9</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Not swaddled</td><td align="center" rowspan="1" colspan="1">3047</td><td align="center" rowspan="1" colspan="1">17</td><td align="center" rowspan="1" colspan="1">5.6</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Japanese— after Educational/Prevention Campaigns</italic></bold></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Higuchi [<xref rid="B434" ref-type="bibr">91</xref>]</td><td align="center" rowspan="1" colspan="1">1984</td><td align="left" rowspan="1" colspan="1">Tokyo and Ibaragi Prefecture</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1">13379</td><td align="center" rowspan="1" colspan="1">45</td><td align="center" rowspan="1" colspan="1">3.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Wada et al. [<xref rid="B240" ref-type="bibr">83</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Tokushima Prefecture,</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1">17224</td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">1.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Ishida [<xref rid="B278" ref-type="bibr">84</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Aichi</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1.1*</td></tr><tr><td align="left" rowspan="1" colspan="1">Ishida [<xref rid="B278" ref-type="bibr">84</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Fukushima</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">5*</td></tr><tr><td align="left" rowspan="1" colspan="1">Ishida [<xref rid="B278" ref-type="bibr">84</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Osaka</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">3*</td></tr><tr><td align="left" rowspan="1" colspan="1">Ishida [<xref rid="B70" ref-type="bibr">85</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Kyoto</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">3*</td></tr><tr><td align="left" rowspan="1" colspan="1">Kikuike et al. [<xref rid="B418" ref-type="bibr">86</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Takayama/Gifu</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1">1749</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">5.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Gotoh et al. [<xref rid="B69" ref-type="bibr">87</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Asahikawa</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1">9471</td><td align="center" rowspan="1" colspan="1">17</td><td align="center" rowspan="1" colspan="1">1.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Saito [<xref rid="B417" ref-type="bibr">88</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Sapporo</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">5.0*</td></tr><tr><td align="left" rowspan="1" colspan="1">Shinohara [<xref rid="B419" ref-type="bibr">89</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Matsudo</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1.8*</td></tr><tr><td align="left" rowspan="1" colspan="1">Iwasaki and Takahashi [<xref rid="B241" ref-type="bibr">90</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Nagasaki</td><td align="left" rowspan="1" colspan="1">Japanese</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">2.0*</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>All</italic></td><td align="center" rowspan="1" colspan="1">714254</td><td align="center" rowspan="1" colspan="1">769</td><td align="center" rowspan="1" colspan="1">1.08</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>Chinese</italic></td><td align="center" rowspan="1" colspan="1">57962</td><td align="center" rowspan="1" colspan="1">52</td><td align="center" rowspan="1" colspan="1">0.1</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Weighted avg.</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>Malay</italic></td><td align="center" rowspan="1" colspan="1">37134</td><td align="center" rowspan="1" colspan="1">61</td><td align="center" rowspan="1" colspan="1">1.6</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>Japanese</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic> Before</italic></td><td align="center" rowspan="1" colspan="1">25241</td><td align="center" rowspan="1" colspan="1">340</td><td align="center" rowspan="1" colspan="1">13.5</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic> After</italic></td><td align="center" rowspan="1" colspan="1">41823</td><td align="center" rowspan="1" colspan="1">92</td><td align="center" rowspan="1" colspan="1">2.2</td></tr></tbody></table><table-wrap-foot><fn><p><sup>∧</sup>Incidence from [<xref rid="B433" ref-type="bibr">82</xref>]. </p></fn><fn><p>*Only the incidence was given and could not be included in the weighted averages.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab2d" position="anchor"><caption><p>(d) Caucasians</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Study</th><th align="center" rowspan="1" colspan="1">Year</th><th align="left" rowspan="1" colspan="1">Location</th><th align="center" rowspan="1" colspan="1">No. Pts</th><th align="left" rowspan="1" colspan="1">No. DDH</th><th align="left" rowspan="1" colspan="1">Incidence (per 1000)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Scandinavia</italic></bold></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Severin [<xref rid="B87" ref-type="bibr">92</xref>]</td><td align="center" rowspan="1" colspan="1">1956</td><td align="left" rowspan="1" colspan="1">All Sweden</td><td align="center" rowspan="1" colspan="1">566142</td><td align="left" rowspan="1" colspan="1">497</td><td align="left" rowspan="1" colspan="1">0.88</td></tr><tr><td align="left" rowspan="1" colspan="1">von Rosen [<xref rid="B435" ref-type="bibr">93</xref>]</td><td align="center" rowspan="1" colspan="1">1962</td><td align="left" rowspan="1" colspan="1">Malmö, Sweden</td><td align="center" rowspan="1" colspan="1">24000</td><td align="left" rowspan="1" colspan="1">40</td><td align="left" rowspan="1" colspan="1">1.7</td></tr><tr><td align="left" rowspan="1" colspan="1">von Rosen [<xref rid="B76" ref-type="bibr">94</xref>]</td><td align="center" rowspan="1" colspan="1">1968</td><td align="left" rowspan="1" colspan="1">Malmö, Sweden</td><td align="center" rowspan="1" colspan="1">31304</td><td align="left" rowspan="1" colspan="1">171</td><td align="left" rowspan="1" colspan="1">5.46</td></tr><tr><td align="left" rowspan="1" colspan="1">Fredensborg [<xref rid="B77" ref-type="bibr">95</xref>]</td><td align="center" rowspan="1" colspan="1">1976</td><td align="left" rowspan="1" colspan="1">Malmö, Sweden</td><td align="center" rowspan="1" colspan="1">58579</td><td align="left" rowspan="1" colspan="1">548</td><td align="left" rowspan="1" colspan="1">9.33</td></tr><tr><td align="left" rowspan="1" colspan="1">Danielsson [<xref rid="B75" ref-type="bibr">64</xref>]</td><td align="center" rowspan="1" colspan="1">2000</td><td align="left" rowspan="1" colspan="1">Malmö, Sweden</td><td align="center" rowspan="1" colspan="1">15189</td><td align="left" rowspan="1" colspan="1">115</td><td align="left" rowspan="1" colspan="1">7.57</td></tr><tr><td align="left" rowspan="1" colspan="1">Beckman et al. [<xref rid="B85" ref-type="bibr">96</xref>]</td><td align="center" rowspan="1" colspan="1">1977</td><td align="left" rowspan="1" colspan="1">Northern Sweden</td><td align="center" rowspan="1" colspan="1">40419</td><td align="left" rowspan="1" colspan="1">295</td><td align="left" rowspan="1" colspan="1">7.30</td></tr><tr><td align="left" rowspan="1" colspan="1">Finley et al. [<xref rid="B54" ref-type="bibr">51</xref>]</td><td align="center" rowspan="1" colspan="1">1984</td><td align="left" rowspan="1" colspan="1">Uppsala, Sweden</td><td align="center" rowspan="1" colspan="1">62879*</td><td align="left" rowspan="1" colspan="1">193</td><td align="left" rowspan="1" colspan="1">28.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Bjerkeim [<xref rid="B78" ref-type="bibr">97</xref>–<xref rid="B83" ref-type="bibr">102</xref>]</td><td align="center" rowspan="1" colspan="1">1974, 1976</td><td align="left" rowspan="1" colspan="1">Southeastern Norway</td><td align="center" rowspan="1" colspan="1">*</td><td align="left" rowspan="1" colspan="1">*</td><td align="left" rowspan="1" colspan="1">10.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Finne et al. [<xref rid="B436" ref-type="bibr">103</xref>]</td><td align="center" rowspan="1" colspan="1">2008</td><td align="left" rowspan="1" colspan="1">Oslo, Norway</td><td align="center" rowspan="1" colspan="1">19820</td><td align="left" rowspan="1" colspan="1">34</td><td align="left" rowspan="1" colspan="1">1.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Melve and Skjaerven [<xref rid="B73" ref-type="bibr">104</xref>]</td><td align="center" rowspan="1" colspan="1">2008</td><td align="left" rowspan="1" colspan="1">All Norway</td><td align="center" rowspan="1" colspan="1">519266</td><td align="left" rowspan="1" colspan="1">2509</td><td align="left" rowspan="1" colspan="1">4.83</td></tr><tr><td align="left" rowspan="1" colspan="1">Heikkilä [<xref rid="B74" ref-type="bibr">105</xref>]</td><td align="center" rowspan="1" colspan="1">1984</td><td align="left" rowspan="1" colspan="1">Southern Finland</td><td align="center" rowspan="1" colspan="1">151924</td><td align="left" rowspan="1" colspan="1">1035</td><td align="left" rowspan="1" colspan="1">6.81</td></tr><tr><td align="left" rowspan="1" colspan="1">Clausen and Nielsen [<xref rid="B86" ref-type="bibr">106</xref>]</td><td align="center" rowspan="1" colspan="1">1988</td><td align="left" rowspan="1" colspan="1">Randers, Denmark</td><td align="center" rowspan="1" colspan="1">13589</td><td align="left" rowspan="1" colspan="1">83</td><td align="left" rowspan="1" colspan="1">6.1</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Weighted avg.</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1510007</td><td align="left" rowspan="1" colspan="1">5713</td><td align="left" rowspan="1" colspan="1">3.8</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Western Europe</italic></bold></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Mitchell [<xref rid="B94" ref-type="bibr">107</xref>]</td><td align="center" rowspan="1" colspan="1">1972</td><td align="left" rowspan="1" colspan="1">Edinburgh, Scotland</td><td align="center" rowspan="1" colspan="1">31961</td><td align="left" rowspan="1" colspan="1">100</td><td align="left" rowspan="1" colspan="1">3.1</td></tr><tr><td align="left" rowspan="1" colspan="1">MacKenzie and Wilson [<xref rid="B98" ref-type="bibr">108</xref>]</td><td align="center" rowspan="1" colspan="1">1981</td><td align="left" rowspan="1" colspan="1">Aberdeen, Scotland</td><td align="center" rowspan="1" colspan="1">53033</td><td align="left" rowspan="1" colspan="1">1606</td><td align="left" rowspan="1" colspan="1">30.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Bertol et al. [<xref rid="B90" ref-type="bibr">109</xref>]</td><td align="center" rowspan="1" colspan="1">1982</td><td align="left" rowspan="1" colspan="1">Edinburgh, Scotland</td><td align="center" rowspan="1" colspan="1">44953</td><td align="left" rowspan="1" colspan="1">299</td><td align="left" rowspan="1" colspan="1">6.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Record and Edwards [<xref rid="B250" ref-type="bibr">110</xref>]</td><td align="center" rowspan="1" colspan="1">1958</td><td align="left" rowspan="1" colspan="1">Birmingham, England</td><td align="center" rowspan="1" colspan="1">226038</td><td align="left" rowspan="1" colspan="1">148</td><td align="left" rowspan="1" colspan="1">0.66</td></tr><tr><td align="left" rowspan="1" colspan="1">Leck et al. [<xref rid="B88" ref-type="bibr">111</xref>]</td><td align="center" rowspan="1" colspan="1">1968</td><td align="left" rowspan="1" colspan="1">Birmingham, England</td><td align="center" rowspan="1" colspan="1">94474</td><td align="left" rowspan="1" colspan="1">86</td><td align="left" rowspan="1" colspan="1">0.91</td></tr><tr><td align="left" rowspan="1" colspan="1">Wilkinson [<xref rid="B91" ref-type="bibr">112</xref>]</td><td align="center" rowspan="1" colspan="1">1972</td><td align="left" rowspan="1" colspan="1">Southampton, England</td><td align="center" rowspan="1" colspan="1">6272</td><td align="left" rowspan="1" colspan="1">37</td><td align="left" rowspan="1" colspan="1">5.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Jones [<xref rid="B93" ref-type="bibr">113</xref>]</td><td align="center" rowspan="1" colspan="1">1977</td><td align="left" rowspan="1" colspan="1">Hertfordshire, England</td><td align="center" rowspan="1" colspan="1">29366</td><td align="left" rowspan="1" colspan="1">76</td><td align="left" rowspan="1" colspan="1">2.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Noble et al. [<xref rid="B92" ref-type="bibr">114</xref>]</td><td align="center" rowspan="1" colspan="1">1978</td><td align="left" rowspan="1" colspan="1">Newcastle upon Tyne, England</td><td align="center" rowspan="1" colspan="1">25921</td><td align="left" rowspan="1" colspan="1">271</td><td align="left" rowspan="1" colspan="1">10.5</td></tr><tr><td align="left" rowspan="1" colspan="1">Catford et al. [<xref rid="B97" ref-type="bibr">115</xref>]</td><td align="center" rowspan="1" colspan="1">1982</td><td align="left" rowspan="1" colspan="1">Southampton, England</td><td align="center" rowspan="1" colspan="1">76724</td><td align="left" rowspan="1" colspan="1">178</td><td align="left" rowspan="1" colspan="1">2.32</td></tr><tr><td align="left" rowspan="1" colspan="1">Knox et al. [<xref rid="B437" ref-type="bibr">116</xref>]</td><td align="center" rowspan="1" colspan="1">1987</td><td align="left" rowspan="1" colspan="1">Birmingham, England</td><td align="center" rowspan="1" colspan="1">144246</td><td align="left" rowspan="1" colspan="1">96</td><td align="left" rowspan="1" colspan="1">0.67</td></tr><tr><td align="left" rowspan="1" colspan="1">Williamson [<xref rid="B438" ref-type="bibr">117</xref>]</td><td align="center" rowspan="1" colspan="1">1972</td><td align="left" rowspan="1" colspan="1">Northern Ireland</td><td align="center" rowspan="1" colspan="1">34840</td><td align="left" rowspan="1" colspan="1">97</td><td align="left" rowspan="1" colspan="1">2.78</td></tr><tr><td align="left" rowspan="1" colspan="1">Patterson et al. [<xref rid="B89" ref-type="bibr">118</xref>]</td><td align="center" rowspan="1" colspan="1">1995</td><td align="left" rowspan="1" colspan="1">Belfast, Northern Ireland</td><td align="center" rowspan="1" colspan="1">138600</td><td align="left" rowspan="1" colspan="1">243</td><td align="left" rowspan="1" colspan="1">1.75</td></tr><tr><td align="left" rowspan="1" colspan="1">Reerink [<xref rid="B439" ref-type="bibr">119</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Leiden, Netherlands</td><td align="center" rowspan="1" colspan="1">2092</td><td align="left" rowspan="1" colspan="1">32</td><td align="left" rowspan="1" colspan="1">15.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Judet and Tanzy [<xref rid="B440" ref-type="bibr">120</xref>]</td><td align="center" rowspan="1" colspan="1">1966</td><td align="left" rowspan="1" colspan="1">Creuse, France (only girls)</td><td align="center" rowspan="1" colspan="1">1326</td><td align="left" rowspan="1" colspan="1">48</td><td align="left" rowspan="1" colspan="1">3.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Valdivieso Garcia et al. [<xref rid="B99" ref-type="bibr">121</xref>]</td><td align="center" rowspan="1" colspan="1">1989</td><td align="left" rowspan="1" colspan="1">Córdoba, Spain</td><td align="center" rowspan="1" colspan="1">33000</td><td align="left" rowspan="1" colspan="1">323</td><td align="left" rowspan="1" colspan="1">9.79</td></tr><tr><td align="left" rowspan="1" colspan="1">Padilla-Esteban et al. [<xref rid="B100" ref-type="bibr">122</xref>]</td><td align="center" rowspan="1" colspan="1">1990</td><td align="left" rowspan="1" colspan="1">Madrid, Spain</td><td align="center" rowspan="1" colspan="1">40243</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">All</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1747</td><td align="left" rowspan="1" colspan="1">43.4</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dislocation</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">89</td><td align="left" rowspan="1" colspan="1">2.21</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Subluxation</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">80</td><td align="left" rowspan="1" colspan="1">1.99</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Dysplasia</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1587</td><td align="left" rowspan="1" colspan="1">39.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Sanz et al. [<xref rid="B441" ref-type="bibr">123</xref>]</td><td align="center" rowspan="1" colspan="1">1991</td><td align="left" rowspan="1" colspan="1">Salamanca, Spain</td><td align="center" rowspan="1" colspan="1">6135</td><td align="left" rowspan="1" colspan="1">54</td><td align="left" rowspan="1" colspan="1">8.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Giannakopoulou et al. [<xref rid="B101" ref-type="bibr">124</xref>]</td><td align="center" rowspan="1" colspan="1">2002</td><td align="left" rowspan="1" colspan="1">Crete</td><td align="center" rowspan="1" colspan="1">6140</td><td align="left" rowspan="1" colspan="1">65</td><td align="left" rowspan="1" colspan="1">10.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Di Bella et al. [<xref rid="B102" ref-type="bibr">125</xref>]</td><td align="center" rowspan="1" colspan="1">1997</td><td align="left" rowspan="1" colspan="1">Sicily</td><td align="center" rowspan="1" colspan="1">2000</td><td align="left" rowspan="1" colspan="1">51</td><td align="left" rowspan="1" colspan="1">25.5</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>All</italic></td><td align="center" rowspan="1" colspan="1">996038</td><td align="left" rowspan="1" colspan="1">5509</td><td align="left" rowspan="1" colspan="1">5.5</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Weighted avg.</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>United Kingdom</italic></td><td align="center" rowspan="1" colspan="1">906428</td><td align="left" rowspan="1" colspan="1">3232</td><td align="left" rowspan="1" colspan="1">3.6</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>Mediterranean/ Spain</italic></td><td align="center" rowspan="1" colspan="1">87518</td><td align="left" rowspan="1" colspan="1">2240</td><td align="left" rowspan="1" colspan="1">25.5</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Eastern Europe</italic></bold></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Srakar [<xref rid="B442" ref-type="bibr">126</xref>]</td><td align="center" rowspan="1" colspan="1">1986</td><td align="left" rowspan="1" colspan="1">Ljubljana, Yugoslavia</td><td align="center" rowspan="1" colspan="1">5000</td><td align="left" rowspan="1" colspan="1">50<sup>@</sup></td><td align="left" rowspan="1" colspan="1">10.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Kepeski et al. [<xref rid="B443" ref-type="bibr">127</xref>]</td><td align="center" rowspan="1" colspan="1">1969</td><td align="left" rowspan="1" colspan="1">Skoplje, Macedonia</td><td align="center" rowspan="1" colspan="1">9149</td><td align="left" rowspan="1" colspan="1">302<sup>@</sup></td><td align="left" rowspan="1" colspan="1">33.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Maričević [<xref rid="B103" ref-type="bibr">128</xref>]</td><td align="center" rowspan="1" colspan="1">1885–1993</td><td align="left" rowspan="1" colspan="1">Lastovo Island, Croatia</td><td align="center" rowspan="1" colspan="1">3676</td><td align="left" rowspan="1" colspan="1">19</td><td align="left" rowspan="1" colspan="1">5.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Krolo et al. [<xref rid="B444" ref-type="bibr">129</xref>]</td><td align="center" rowspan="1" colspan="1">1968–88</td><td align="left" rowspan="1" colspan="1">Zagreb, Croatia</td><td align="center" rowspan="1" colspan="1">7168</td><td align="left" rowspan="1" colspan="1">120</td><td align="left" rowspan="1" colspan="1">16.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Stipanicev [<xref rid="B445" ref-type="bibr">130</xref>]</td><td align="center" rowspan="1" colspan="1">1985</td><td align="left" rowspan="1" colspan="1">Šibenik, Croatia</td><td align="center" rowspan="1" colspan="1">26227</td><td align="left" rowspan="1" colspan="1">2203<sup>@</sup></td><td align="left" rowspan="1" colspan="1">84.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Darmonov [<xref rid="B446" ref-type="bibr">131</xref>]</td><td align="center" rowspan="1" colspan="1">1996</td><td align="left" rowspan="1" colspan="1">Stara Zagora, Bulgaria</td><td align="center" rowspan="1" colspan="1">20417</td><td align="left" rowspan="1" colspan="1">124</td><td align="left" rowspan="1" colspan="1">6.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Samborska and Lembrych [<xref rid="B302" ref-type="bibr">132</xref>]</td><td align="center" rowspan="1" colspan="1">1973</td><td align="left" rowspan="1" colspan="1">Opole, Poland</td><td align="center" rowspan="1" colspan="1">14500</td><td align="left" rowspan="1" colspan="1">159</td><td align="left" rowspan="1" colspan="1">11.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Polívka [<xref rid="B104" ref-type="bibr">133</xref>]</td><td align="center" rowspan="1" colspan="1">1973</td><td align="left" rowspan="1" colspan="1">West Bohemia, Czech Republic</td><td align="center" rowspan="1" colspan="1">28471</td><td align="left" rowspan="1" colspan="1">3223</td><td align="left" rowspan="1" colspan="1">113.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Košek [<xref rid="B252" ref-type="bibr">134</xref>]</td><td align="center" rowspan="1" colspan="1">1973</td><td align="left" rowspan="1" colspan="1">Dêčín and Česká Lípa, Czech Republic</td><td align="center" rowspan="1" colspan="1">23580</td><td align="left" rowspan="1" colspan="1">1048</td><td align="left" rowspan="1" colspan="1">44.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Poul et al. [<xref rid="B151" ref-type="bibr">135</xref>]</td><td align="center" rowspan="1" colspan="1">1992</td><td align="left" rowspan="1" colspan="1">Brno, Czechoslovakia</td><td align="center" rowspan="1" colspan="1">35550</td><td align="left" rowspan="1" colspan="1">656</td><td align="left" rowspan="1" colspan="1">18.5</td></tr><tr><td align="left" rowspan="1" colspan="1">Vencálková and Janata [<xref rid="B263" ref-type="bibr">136</xref>]</td><td align="center" rowspan="1" colspan="1">2009</td><td align="left" rowspan="1" colspan="1">Liberec, Czech Republic</td><td align="center" rowspan="1" colspan="1">12944</td><td align="left" rowspan="1" colspan="1">335</td><td align="left" rowspan="1" colspan="1">25.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Drimal [<xref rid="B326" ref-type="bibr">137</xref>]</td><td align="center" rowspan="1" colspan="1">1959</td><td align="left" rowspan="1" colspan="1">Martin, Slovakia</td><td align="center" rowspan="1" colspan="1">9510</td><td align="left" rowspan="1" colspan="1">120</td><td align="left" rowspan="1" colspan="1">12.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Tomáš [<xref rid="B260" ref-type="bibr">138</xref>]</td><td align="center" rowspan="1" colspan="1">1989</td><td align="left" rowspan="1" colspan="1">Bardejov, Slovakia</td><td align="center" rowspan="1" colspan="1">7208</td><td align="left" rowspan="1" colspan="1">323</td><td align="left" rowspan="1" colspan="1">44.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Czéizel et al. [<xref rid="B157" ref-type="bibr">139</xref>]</td><td align="center" rowspan="1" colspan="1">1974</td><td align="left" rowspan="1" colspan="1">Békéscsaba, Hungary</td><td align="center" rowspan="1" colspan="1">18219</td><td align="left" rowspan="1" colspan="1">523</td><td align="left" rowspan="1" colspan="1">28.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Csató and Benkó[<xref rid="B447" ref-type="bibr">140</xref>]</td><td align="center" rowspan="1" colspan="1">1963</td><td align="left" rowspan="1" colspan="1">Miskole, Hungary</td><td align="center" rowspan="1" colspan="1">5513</td><td align="left" rowspan="1" colspan="1">30</td><td align="left" rowspan="1" colspan="1">5.44</td></tr><tr><td align="left" rowspan="1" colspan="1">Pap [<xref rid="B251" ref-type="bibr">141</xref>]</td><td align="center" rowspan="1" colspan="1">1956</td><td align="left" rowspan="1" colspan="1">Debrecen, Hungary</td><td align="center" rowspan="1" colspan="1">11933</td><td align="left" rowspan="1" colspan="1">217</td><td align="left" rowspan="1" colspan="1">18.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Czeizel et al. [<xref rid="B167" ref-type="bibr">142</xref>]</td><td align="center" rowspan="1" colspan="1">1972</td><td align="left" rowspan="1" colspan="1">Budapest, Hungary</td><td align="center" rowspan="1" colspan="1">108966</td><td align="left" rowspan="1" colspan="1">3000</td><td align="left" rowspan="1" colspan="1">27.5</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Weighted avg.</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">348031</td><td align="left" rowspan="1" colspan="1">12452</td><td align="left" rowspan="1" colspan="1">35.8</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Australia and New Zealand</italic></bold></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Paterson [<xref rid="B106" ref-type="bibr">67</xref>]</td><td align="center" rowspan="1" colspan="1">1976</td><td align="left" rowspan="1" colspan="1">South Australia</td><td align="center" rowspan="1" colspan="1">4445</td><td align="left" rowspan="1" colspan="1">31</td><td align="left" rowspan="1" colspan="1">7.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Yiv et al. [<xref rid="B107" ref-type="bibr">143</xref>]</td><td align="center" rowspan="1" colspan="1">1977</td><td align="left" rowspan="1" colspan="1">South Australia</td><td align="center" rowspan="1" colspan="1">19622</td><td align="left" rowspan="1" colspan="1">206</td><td align="left" rowspan="1" colspan="1">10.5</td></tr><tr><td align="left" rowspan="1" colspan="1">Bower et al. [<xref rid="B45" ref-type="bibr">44</xref>]</td><td align="center" rowspan="1" colspan="1">1987</td><td align="left" rowspan="1" colspan="1">Western Australia</td><td align="center" rowspan="1" colspan="1">62879<sup>∧</sup></td><td align="left" rowspan="1" colspan="1">415</td><td align="left" rowspan="1" colspan="1">6.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Chan et al. [<xref rid="B105" ref-type="bibr">144</xref>]</td><td align="center" rowspan="1" colspan="1">1999</td><td align="left" rowspan="1" colspan="1">Adelaide, Australia</td><td align="center" rowspan="1" colspan="1">118379</td><td align="left" rowspan="1" colspan="1">916</td><td align="left" rowspan="1" colspan="1">7.74</td></tr><tr><td align="left" rowspan="1" colspan="1">Howie and Phillips [<xref rid="B110" ref-type="bibr">145</xref>]</td><td align="center" rowspan="1" colspan="1">1970</td><td align="left" rowspan="1" colspan="1">Auckland, New Zealand</td><td align="center" rowspan="1" colspan="1">16103</td><td align="left" rowspan="1" colspan="1">57</td><td align="left" rowspan="1" colspan="1">3.54</td></tr><tr><td align="left" rowspan="1" colspan="1">Doig and Shannon [<xref rid="B109" ref-type="bibr">146</xref>]</td><td align="center" rowspan="1" colspan="1">1975</td><td align="left" rowspan="1" colspan="1">Canterbury, New Zealand</td><td align="center" rowspan="1" colspan="1">23443</td><td align="left" rowspan="1" colspan="1">62</td><td align="left" rowspan="1" colspan="1">2.65</td></tr><tr><td align="left" rowspan="1" colspan="1">Dykes [<xref rid="B108" ref-type="bibr">147</xref>]</td><td align="center" rowspan="1" colspan="1">1975</td><td align="left" rowspan="1" colspan="1">Southland, New Zealand</td><td align="center" rowspan="1" colspan="1">47064</td><td align="left" rowspan="1" colspan="1">103</td><td align="left" rowspan="1" colspan="1">2.19</td></tr><tr><td align="left" rowspan="1" colspan="1">Hadlow [<xref rid="B29" ref-type="bibr">32</xref>]</td><td align="center" rowspan="1" colspan="1">1988</td><td align="left" rowspan="1" colspan="1">New Plymouth, New Zealand</td><td align="center" rowspan="1" colspan="1">20657</td><td align="left" rowspan="1" colspan="1">331</td><td align="left" rowspan="1" colspan="1">16.0</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Weighted avg.</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">312592</td><td align="left" rowspan="1" colspan="1">2121</td><td align="left" rowspan="1" colspan="1">6.8</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Americas</italic></bold></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Lehmann and Street [<xref rid="B448" ref-type="bibr">148</xref>]</td><td align="center" rowspan="1" colspan="1">1981</td><td align="left" rowspan="1" colspan="1">Vancouver, British, Columbia, Canada</td><td align="center" rowspan="1" colspan="1">116808</td><td align="left" rowspan="1" colspan="1">142</td><td align="left" rowspan="1" colspan="1">1.2*</td></tr><tr><td align="left" rowspan="1" colspan="1">Tijmes et al. [<xref rid="B114" ref-type="bibr">149</xref>]</td><td align="center" rowspan="1" colspan="1">1971</td><td align="left" rowspan="1" colspan="1">Llanquihue, Chile</td><td align="center" rowspan="1" colspan="1">30000</td><td align="left" rowspan="1" colspan="1">137</td><td align="left" rowspan="1" colspan="1">4.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Hazel and Beals [<xref rid="B111" ref-type="bibr">150</xref>]</td><td align="center" rowspan="1" colspan="1">1989</td><td align="left" rowspan="1" colspan="1">Portland, Oregon</td><td align="center" rowspan="1" colspan="1">39429</td><td align="left" rowspan="1" colspan="1">32</td><td align="left" rowspan="1" colspan="1">0.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Finley et al. [<xref rid="B54" ref-type="bibr">51</xref>]</td><td align="center" rowspan="1" colspan="1">1994</td><td align="left" rowspan="1" colspan="1">Jefferson County, Alabama</td><td align="center" rowspan="1" colspan="1">17907</td><td align="left" rowspan="1" colspan="1">12</td><td align="left" rowspan="1" colspan="1">0.7</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Weighted avg.</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">174144</td><td align="left" rowspan="1" colspan="1">186</td><td align="left" rowspan="1" colspan="1">1.07</td></tr></tbody></table><table-wrap-foot><fn><p>*The incidence and either the numerator/denominator were given; appropriate values calculated when possible. </p></fn><fn><p><sup>@</sup>calculated from the given incidence and total number of births.</p></fn></table-wrap-foot></table-wrap></table-wrap-group><table-wrap id="tab3" position="float"><label>Table 3</label><caption><p>Incidence of neonatal hip instability by screening physical examination.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Study</th><th align="center" rowspan="1" colspan="1">Year</th><th align="left" rowspan="1" colspan="1">Location</th><th align="center" rowspan="1" colspan="1">No. Pts</th><th align="center" rowspan="1" colspan="1">No. DDH</th><th align="center" rowspan="1" colspan="1">Incidence (per 1000)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1"><italic>Africans</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Robinson and Buse [<xref rid="B119" ref-type="bibr">166</xref>]</td><td align="center" rowspan="1" colspan="1">1979</td><td align="left" rowspan="1" colspan="1">Kampala, Uganda</td><td align="center" rowspan="1" colspan="1">2000</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">2.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Gross et al. [<xref rid="B120" ref-type="bibr">167</xref>]</td><td align="center" rowspan="1" colspan="1">1982</td><td align="left" rowspan="1" colspan="1">Oklahoma City, Oklahoma</td><td align="center" rowspan="1" colspan="1">2686</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">0.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Artz et al. [<xref rid="B121" ref-type="bibr">168</xref>]</td><td align="center" rowspan="1" colspan="1">1975</td><td align="left" rowspan="1" colspan="1">New York City</td><td align="center" rowspan="1" colspan="1">4286</td><td align="center" rowspan="1" colspan="1">18</td><td align="center" rowspan="1" colspan="1">0.42</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Indo-Mediterranean</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Abdel-Kader and Booz [<xref rid="B123" ref-type="bibr">169</xref>]</td><td align="center" rowspan="1" colspan="1">1968</td><td align="left" rowspan="1" colspan="1">Kuwait</td><td align="center" rowspan="1" colspan="1">4000</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">1.25</td></tr><tr><td align="left" rowspan="1" colspan="1">Al-Umran et al. [<xref rid="B124" ref-type="bibr">170</xref>]</td><td align="center" rowspan="1" colspan="1">1988</td><td align="left" rowspan="1" colspan="1">Dammam, Saudi Arabia</td><td align="center" rowspan="1" colspan="1">12733</td><td align="center" rowspan="1" colspan="1">62</td><td align="center" rowspan="1" colspan="1">4.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Khan and Benjamin [<xref rid="B125" ref-type="bibr">171</xref>]</td><td align="center" rowspan="1" colspan="1">1992</td><td align="left" rowspan="1" colspan="1">Abha, Saudi Arabia</td><td align="center" rowspan="1" colspan="1">2222</td><td align="center" rowspan="1" colspan="1">81</td><td align="center" rowspan="1" colspan="1">36.5</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Amerindian</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Hernández-Arriaga et al. [<xref rid="B126" ref-type="bibr">172</xref>]</td><td align="center" rowspan="1" colspan="1">1991</td><td align="left" rowspan="1" colspan="1">Guanajuato, México</td><td align="center" rowspan="1" colspan="1">16987</td><td align="center" rowspan="1" colspan="1">25</td><td align="center" rowspan="1" colspan="1">1.47</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Indo-Malay</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Morito [<xref rid="B216" ref-type="bibr">173</xref>]</td><td align="center" rowspan="1" colspan="1">1983</td><td align="left" rowspan="1" colspan="1">Okayama, Japan</td><td align="center" rowspan="1" colspan="1">4824*</td><td align="center" rowspan="1" colspan="1">51*</td><td align="center" rowspan="1" colspan="1">10.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Chen [<xref rid="B128" ref-type="bibr">174</xref>]</td><td align="center" rowspan="1" colspan="1">1967</td><td align="left" rowspan="1" colspan="1">Taipei, Taiwan</td><td align="center" rowspan="1" colspan="1">2257</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">1.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Hsieh et al. [<xref rid="B127" ref-type="bibr">175</xref>]</td><td align="center" rowspan="1" colspan="1">2000</td><td align="left" rowspan="1" colspan="1">Taichung, Taiwan</td><td align="center" rowspan="1" colspan="1">3345</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">1.2</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Caucasians—Scandinavia</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Andrén [<xref rid="B171" ref-type="bibr">176</xref>]</td><td align="center" rowspan="1" colspan="1">1962</td><td align="left" rowspan="1" colspan="1">Malmö, Sweden</td><td align="center" rowspan="1" colspan="1">28292</td><td align="center" rowspan="1" colspan="1">64</td><td align="center" rowspan="1" colspan="1">2.26</td></tr><tr><td align="left" rowspan="1" colspan="1">von Rosen [<xref rid="B449" ref-type="bibr">177</xref>]</td><td align="center" rowspan="1" colspan="1">1970</td><td align="left" rowspan="1" colspan="1">Malmö, Sweden</td><td align="center" rowspan="1" colspan="1">34520</td><td align="center" rowspan="1" colspan="1">171</td><td align="center" rowspan="1" colspan="1">4.94</td></tr><tr><td align="left" rowspan="1" colspan="1">Palmén [<xref rid="B129" ref-type="bibr">178</xref>]</td><td align="center" rowspan="1" colspan="1">1961</td><td align="left" rowspan="1" colspan="1">Falköping, Sweden</td><td align="center" rowspan="1" colspan="1">12394</td><td align="center" rowspan="1" colspan="1">70</td><td align="center" rowspan="1" colspan="1">5.65</td></tr><tr><td align="left" rowspan="1" colspan="1">Hinderaker et al. [<xref rid="B169" ref-type="bibr">179</xref>]</td><td align="center" rowspan="1" colspan="1">1994</td><td align="left" rowspan="1" colspan="1">All Norway</td><td align="center" rowspan="1" colspan="1">959412</td><td align="center" rowspan="1" colspan="1">9483</td><td align="center" rowspan="1" colspan="1">9.88</td></tr><tr><td align="left" rowspan="1" colspan="1">Beckman et al. [<xref rid="B85" ref-type="bibr">96</xref>]</td><td align="center" rowspan="1" colspan="1">1970–73</td><td align="left" rowspan="1" colspan="1">Västerbotten County, Sweden</td><td align="center" rowspan="1" colspan="1">11613</td><td align="center" rowspan="1" colspan="1">119</td><td align="center" rowspan="1" colspan="1">10.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Almby and Rehnberg [<xref rid="B131" ref-type="bibr">180</xref>]</td><td align="center" rowspan="1" colspan="1">1977</td><td align="left" rowspan="1" colspan="1">Uppsala, Sweden</td><td align="center" rowspan="1" colspan="1">29339</td><td align="center" rowspan="1" colspan="1">298</td><td align="center" rowspan="1" colspan="1">10.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Hiertonn and James [<xref rid="B134" ref-type="bibr">181</xref>]</td><td align="center" rowspan="1" colspan="1">1968</td><td align="left" rowspan="1" colspan="1">Uppsala, Sweden</td><td align="center" rowspan="1" colspan="1">11868</td><td align="center" rowspan="1" colspan="1">242</td><td align="center" rowspan="1" colspan="1">20.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Medbö [<xref rid="B450" ref-type="bibr">182</xref>]</td><td align="center" rowspan="1" colspan="1">1961</td><td align="left" rowspan="1" colspan="1">Ålesund, Norway</td><td align="center" rowspan="1" colspan="1">3242</td><td align="center" rowspan="1" colspan="1">50</td><td align="center" rowspan="1" colspan="1">15.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Cyvín [<xref rid="B451" ref-type="bibr">183</xref>]</td><td align="center" rowspan="1" colspan="1">1977</td><td align="left" rowspan="1" colspan="1">Trondheim, Norway</td><td align="center" rowspan="1" colspan="1">6509</td><td align="center" rowspan="1" colspan="1">146</td><td align="center" rowspan="1" colspan="1">22.4</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Caucasians—Western Europe</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="2" colspan="1">Dickson [<xref rid="B193" ref-type="bibr">184</xref>] </td><td align="center" rowspan="2" colspan="1">1912</td><td align="left" rowspan="1" colspan="1">Paris, France</td><td align="center" rowspan="1" colspan="1">1502</td><td align="center" rowspan="1" colspan="1">12</td><td align="center" rowspan="1" colspan="1">8.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Rennes, France</td><td align="center" rowspan="1" colspan="1">220</td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">41.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Jones [<xref rid="B93" ref-type="bibr">113</xref>]</td><td align="center" rowspan="1" colspan="1">1977</td><td align="left" rowspan="1" colspan="1">Norwich, England</td><td align="center" rowspan="1" colspan="1">29366</td><td align="center" rowspan="1" colspan="1">76</td><td align="center" rowspan="1" colspan="1">2.58</td></tr><tr><td align="left" rowspan="1" colspan="1">Finlay et al. [<xref rid="B95" ref-type="bibr">161</xref>]</td><td align="center" rowspan="1" colspan="1">1967</td><td align="left" rowspan="1" colspan="1">Uxbridge, England</td><td align="center" rowspan="1" colspan="1">14594</td><td align="center" rowspan="1" colspan="1">60</td><td align="center" rowspan="1" colspan="1">4.1</td></tr><tr><td align="left" rowspan="1" colspan="1">O'Brien and McGill [<xref rid="B130" ref-type="bibr">185</xref>]</td><td align="center" rowspan="1" colspan="1">1970</td><td align="left" rowspan="1" colspan="1">Dublin, Ireland</td><td align="center" rowspan="1" colspan="1">10081</td><td align="center" rowspan="1" colspan="1">77</td><td align="center" rowspan="1" colspan="1">7.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Barlow [<xref rid="B30" ref-type="bibr">33</xref>]</td><td align="center" rowspan="1" colspan="1">1962</td><td align="left" rowspan="1" colspan="1">Salford, England</td><td align="center" rowspan="1" colspan="1">9289</td><td align="center" rowspan="1" colspan="1">139</td><td align="center" rowspan="1" colspan="1">14.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Wilkinson [<xref rid="B91" ref-type="bibr">112</xref>]</td><td align="center" rowspan="1" colspan="1">1972</td><td align="left" rowspan="1" colspan="1">Southampton, England</td><td align="center" rowspan="1" colspan="1">6272</td><td align="center" rowspan="1" colspan="1">37</td><td align="center" rowspan="1" colspan="1">5.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Galasko et al. [<xref rid="B452" ref-type="bibr">186</xref>]</td><td align="center" rowspan="1" colspan="1">1980</td><td align="left" rowspan="1" colspan="1">Salford, England</td><td align="center" rowspan="1" colspan="1">11980</td><td align="center" rowspan="1" colspan="1">179</td><td align="center" rowspan="1" colspan="1">14.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Dunn et al. [<xref rid="B133" ref-type="bibr">187</xref>]</td><td align="center" rowspan="1" colspan="1">1985</td><td align="left" rowspan="1" colspan="1">Bristol, England</td><td align="center" rowspan="1" colspan="1">23002</td><td align="center" rowspan="1" colspan="1">445</td><td align="center" rowspan="1" colspan="1">19.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Lennox et al. [<xref rid="B136" ref-type="bibr">188</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="left" rowspan="1" colspan="1">Aberdeen, Scotland</td><td align="center" rowspan="1" colspan="1">67093</td><td align="center" rowspan="1" colspan="1">3354</td><td align="center" rowspan="1" colspan="1">50.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Mitchell [<xref rid="B94" ref-type="bibr">107</xref>]</td><td align="center" rowspan="1" colspan="1">1972</td><td align="left" rowspan="1" colspan="1">Edinburgh, Scotland</td><td align="center" rowspan="1" colspan="1">31961</td><td align="center" rowspan="1" colspan="1">226</td><td align="center" rowspan="1" colspan="1">7.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Drescher [<xref rid="B135" ref-type="bibr">189</xref>]</td><td align="center" rowspan="1" colspan="1">1957</td><td align="left" rowspan="1" colspan="1">Leipzig, Germany</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">All</td><td align="center" rowspan="1" colspan="1">5098</td><td align="center" rowspan="1" colspan="1">164</td><td align="center" rowspan="1" colspan="1">32.2</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Vertex</td><td align="center" rowspan="1" colspan="1">4953</td><td align="center" rowspan="1" colspan="1">104</td><td align="center" rowspan="1" colspan="1">30.0</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Breech</td><td align="center" rowspan="1" colspan="1">145</td><td align="center" rowspan="1" colspan="1">19</td><td align="center" rowspan="1" colspan="1">131</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Caucasians—Eastern Europe</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Szulc [<xref rid="B137" ref-type="bibr">190</xref>]</td><td align="center" rowspan="1" colspan="1">1961–66</td><td align="left" rowspan="1" colspan="1">Poland</td><td align="center" rowspan="1" colspan="1">2608</td><td align="center" rowspan="1" colspan="1">161</td><td align="center" rowspan="1" colspan="1">61.7</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Caucasians—Australia and New Zealand</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Phillips [<xref rid="B116" ref-type="bibr">191</xref>]</td><td align="center" rowspan="1" colspan="1">1968</td><td align="left" rowspan="1" colspan="1">Auckland, New Zealand</td><td align="center" rowspan="1" colspan="1">43025</td><td align="center" rowspan="1" colspan="1">148</td><td align="center" rowspan="1" colspan="1">3.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Bower et al. [<xref rid="B138" ref-type="bibr">192</xref>]</td><td align="center" rowspan="1" colspan="1">1989</td><td align="left" rowspan="1" colspan="1">Western Australia</td><td align="center" rowspan="1" colspan="1">67757</td><td align="center" rowspan="1" colspan="1">450</td><td align="center" rowspan="1" colspan="1">6.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Chaitow and Lillystone [<xref rid="B139" ref-type="bibr">193</xref>]</td><td align="center" rowspan="1" colspan="1">1984</td><td align="left" rowspan="1" colspan="1">Sydney, Australia</td><td align="center" rowspan="1" colspan="1">450</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">6.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Goss [<xref rid="B140" ref-type="bibr">194</xref>]</td><td align="center" rowspan="1" colspan="1">2002</td><td align="left" rowspan="1" colspan="1">Victoria, Australia</td><td align="center" rowspan="1" colspan="1">5166</td><td align="center" rowspan="1" colspan="1">100</td><td align="center" rowspan="1" colspan="1">19.4</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Caucasians—North America</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Coleman [<xref rid="B142" ref-type="bibr">195</xref>]</td><td align="center" rowspan="1" colspan="1">1956</td><td align="left" rowspan="1" colspan="1">Salt Lake City, Utah</td><td align="center" rowspan="1" colspan="1">3500</td><td align="center" rowspan="1" colspan="1">30</td><td align="center" rowspan="1" colspan="1">8.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Ponseti [<xref rid="B141" ref-type="bibr">196</xref>]</td><td align="center" rowspan="1" colspan="1">1978</td><td align="left" rowspan="1" colspan="1">Iowa City, Iowa</td><td align="center" rowspan="1" colspan="1">51359</td><td align="center" rowspan="1" colspan="1">72</td><td align="center" rowspan="1" colspan="1">1.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Gross et al. [<xref rid="B120" ref-type="bibr">167</xref>]</td><td align="center" rowspan="1" colspan="1">1982</td><td align="left" rowspan="1" colspan="1">Oklahoma City, Oklahoma</td><td align="center" rowspan="1" colspan="1">7490</td><td align="center" rowspan="1" colspan="1">39</td><td align="center" rowspan="1" colspan="1">5.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Lehmann and Street [<xref rid="B448" ref-type="bibr">148</xref>]</td><td align="center" rowspan="1" colspan="1">1981</td><td align="left" rowspan="1" colspan="1">Vancouver, British Columbia, Canada</td><td align="center" rowspan="1" colspan="1">23234</td><td align="center" rowspan="1" colspan="1">132</td><td align="center" rowspan="1" colspan="1">5.7*</td></tr><tr><td align="left" rowspan="1" colspan="1">Tredwell and Bell [<xref rid="B145" ref-type="bibr">197</xref>]</td><td align="center" rowspan="1" colspan="1">1981</td><td align="left" rowspan="1" colspan="1">Vancouver, British Columbia, Canada</td><td align="center" rowspan="1" colspan="1">32480</td><td align="center" rowspan="1" colspan="1">321</td><td align="center" rowspan="1" colspan="1">9.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Ritter [<xref rid="B143" ref-type="bibr">198</xref>]</td><td align="center" rowspan="1" colspan="1">1973</td><td align="left" rowspan="1" colspan="1">Indianapolis, Indiana</td><td align="center" rowspan="1" colspan="1">3278</td><td align="center" rowspan="1" colspan="1">30</td><td align="center" rowspan="1" colspan="1">9.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Artz et al. [<xref rid="B121" ref-type="bibr">168</xref>]</td><td align="center" rowspan="1" colspan="1">1975</td><td align="left" rowspan="1" colspan="1">New York, New York</td><td align="center" rowspan="1" colspan="1">19020</td><td align="center" rowspan="1" colspan="1">291</td><td align="center" rowspan="1" colspan="1">15.3</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>All</italic></td><td align="center" rowspan="1" colspan="1">1528069</td><td align="center" rowspan="1" colspan="1">16452</td><td align="center" rowspan="1" colspan="1">10.8</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>Scandinavia</italic></td><td align="center" rowspan="1" colspan="1">1085576</td><td align="center" rowspan="1" colspan="1">10524</td><td align="center" rowspan="1" colspan="1">9.7</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Caucasian's weighted avg.</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>Australia/New Zealand</italic></td><td align="center" rowspan="1" colspan="1">116398</td><td align="center" rowspan="1" colspan="1">701</td><td align="center" rowspan="1" colspan="1">6.0</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>Western Europe</italic></td><td align="center" rowspan="1" colspan="1">185734</td><td align="center" rowspan="1" colspan="1">4312</td><td align="center" rowspan="1" colspan="1">23.2</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><italic>North America</italic></td><td align="center" rowspan="1" colspan="1">140361</td><td align="center" rowspan="1" colspan="1">915</td><td align="center" rowspan="1" colspan="1">6.5</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Mixed/Unknown—All Geographic Locations</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Ein [<xref rid="B453" ref-type="bibr">199</xref>]</td><td align="center" rowspan="1" colspan="1">1957</td><td align="left" rowspan="1" colspan="1">Newark, New Jersey</td><td align="center" rowspan="1" colspan="1">4597</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">1.5</td></tr><tr><td align="left" rowspan="1" colspan="1">Stanisavljevic [<xref rid="B454" ref-type="bibr">200</xref>]</td><td align="center" rowspan="1" colspan="1">1962</td><td align="left" rowspan="1" colspan="1">Detroit, Michigan</td><td align="center" rowspan="1" colspan="1">5125</td><td align="center" rowspan="1" colspan="1">35</td><td align="center" rowspan="1" colspan="1">6.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Weissman and Salama [<xref rid="B254" ref-type="bibr">201</xref>]</td><td align="center" rowspan="1" colspan="1">1969</td><td align="left" rowspan="1" colspan="1">Tel Aviv, Israel</td><td align="center" rowspan="1" colspan="1">6841</td><td align="center" rowspan="1" colspan="1">45</td><td align="center" rowspan="1" colspan="1">2.7</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Klingberg et al. [<xref rid="B261" ref-type="bibr">202</xref>]</td><td align="center" rowspan="1" colspan="1">1976</td><td align="left" rowspan="1" colspan="1">Rehovot, Israel</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">12150</td><td align="center" rowspan="1" colspan="1">172</td><td align="center" rowspan="1" colspan="1">14.2</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">6204</td><td align="center" rowspan="1" colspan="1">49</td><td align="center" rowspan="1" colspan="1">7.9</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">5946</td><td align="center" rowspan="1" colspan="1">123</td><td align="center" rowspan="1" colspan="1">20.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Khrouf et al. [<xref rid="B455" ref-type="bibr">203</xref>]</td><td align="center" rowspan="1" colspan="1">1986</td><td align="left" rowspan="1" colspan="1">Tunis, Tunisia</td><td align="center" rowspan="1" colspan="1">10000</td><td align="center" rowspan="1" colspan="1">41</td><td align="center" rowspan="1" colspan="1">4.1</td></tr></tbody></table><table-wrap-foot><fn><p>*The incidence and either the numerator/denominator were given; appropriate values calculated when possible.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab4" position="float"><label>Table 4</label><caption><p>Incidence of DDH in the ultrasound screening period era (1980s–present)*.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Study</th><th align="center" rowspan="1" colspan="1">Year</th><th align="center" rowspan="1" colspan="1">Location</th><th align="center" rowspan="1" colspan="1">Ethnicity</th><th align="center" rowspan="1" colspan="1">Time</th><th align="center" rowspan="1" colspan="1">No. Pts</th><th align="center" rowspan="1" colspan="1">No. DDH</th><th align="center" rowspan="1" colspan="1">Incid.</th><th align="center" rowspan="1" colspan="1">> Graf IIa</th><th align="center" rowspan="1" colspan="1">Incid. > Graf IIa</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1"><italic>At birth—2 weeks</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Eidelman et al. [<xref rid="B51" ref-type="bibr">157</xref>]</td><td align="center" rowspan="1" colspan="1">2002</td><td align="center" rowspan="1" colspan="1">Ethiopia</td><td align="center" rowspan="1" colspan="1">Black Jews</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">768</td><td align="center" rowspan="1" colspan="1">19</td><td align="center" rowspan="1" colspan="1">24.7</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">13.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Poul et al. [<xref rid="B146" ref-type="bibr">208</xref>]</td><td align="center" rowspan="1" colspan="1">1998</td><td align="center" rowspan="1" colspan="1">London, England</td><td align="center" rowspan="1" colspan="1">Black</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">185</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">0.0</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">0.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Chang et al. [<xref rid="B427" ref-type="bibr">73</xref>]</td><td align="center" rowspan="1" colspan="1">2007</td><td align="center" rowspan="1" colspan="1">Taiwan</td><td align="center" rowspan="1" colspan="1">Indo-Malay (Chinese)</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Danielsson [<xref rid="B75" ref-type="bibr">64</xref>]</td><td align="center" rowspan="1" colspan="1">2000</td><td align="center" rowspan="1" colspan="1">Malmö, Sweden</td><td align="center" rowspan="1" colspan="1">Indo-Med. (Iraqi/Iranian)</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1604</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">4.4</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Danielsson [<xref rid="B75" ref-type="bibr">64</xref>]</td><td align="center" rowspan="1" colspan="1">2000</td><td align="center" rowspan="1" colspan="1">Malmö, Sweden</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">15189</td><td align="center" rowspan="1" colspan="1">115</td><td align="center" rowspan="1" colspan="1">7.6</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Treiber et al. [<xref rid="B456" ref-type="bibr">209</xref>]</td><td align="center" rowspan="1" colspan="1">2008</td><td align="center" rowspan="1" colspan="1">Maribor, Slovenia</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">17393</td><td align="center" rowspan="1" colspan="1">324</td><td align="center" rowspan="1" colspan="1">18.6</td><td align="center" rowspan="1" colspan="1">369</td><td align="center" rowspan="1" colspan="1">21.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Vencálková and Janata [<xref rid="B263" ref-type="bibr">136</xref>]</td><td align="center" rowspan="1" colspan="1">2009</td><td align="center" rowspan="1" colspan="1">Liberec, Czech Republic</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">16678</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">212</td><td align="center" rowspan="1" colspan="1">12.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Rosendahl et al. [<xref rid="B457" ref-type="bibr">210</xref>]</td><td align="center" rowspan="1" colspan="1">1996</td><td align="center" rowspan="1" colspan="1">Bergen, Norway</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">3613</td><td align="center" rowspan="1" colspan="1">1613</td><td align="center" rowspan="1" colspan="1">446.4</td><td align="center" rowspan="1" colspan="1">123</td><td align="center" rowspan="1" colspan="1">34.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Bache et al. [<xref rid="B458" ref-type="bibr">211</xref>]</td><td align="center" rowspan="1" colspan="1">2002</td><td align="center" rowspan="1" colspan="1">Coventry, England</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">29323</td><td align="center" rowspan="1" colspan="1">3866</td><td align="center" rowspan="1" colspan="1">131.8</td><td align="center" rowspan="1" colspan="1">2340</td><td align="center" rowspan="1" colspan="1">79.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Szöke et al. [<xref rid="B459" ref-type="bibr">212</xref>]</td><td align="center" rowspan="1" colspan="1">1988</td><td align="center" rowspan="1" colspan="1">Cologne, Germany</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">1000</td><td align="center" rowspan="1" colspan="1">524</td><td align="center" rowspan="1" colspan="1">524.0</td><td align="center" rowspan="1" colspan="1">40</td><td align="center" rowspan="1" colspan="1">40.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Tönnis et al. [<xref rid="B460" ref-type="bibr">213</xref>]</td><td align="center" rowspan="1" colspan="1">1990</td><td align="center" rowspan="1" colspan="1">Dortmund, Germany</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">2587</td><td align="center" rowspan="1" colspan="1">1877</td><td align="center" rowspan="1" colspan="1">725.6</td><td align="center" rowspan="1" colspan="1">137</td><td align="center" rowspan="1" colspan="1">53.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Rühmann et al. [<xref rid="B461" ref-type="bibr">214</xref>]</td><td align="center" rowspan="1" colspan="1">1998</td><td align="center" rowspan="1" colspan="1">Hanover, Germany</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">6617</td><td align="center" rowspan="1" colspan="1">436</td><td align="center" rowspan="1" colspan="1">65.9</td><td align="center" rowspan="1" colspan="1">217</td><td align="center" rowspan="1" colspan="1">32.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Parten- heimer et al. [<xref rid="B172" ref-type="bibr">215</xref>]</td><td align="center" rowspan="1" colspan="1">2006</td><td align="center" rowspan="1" colspan="1">Greifswald, Germany</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">4–10 days</td><td align="center" rowspan="1" colspan="1">2256</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">110</td><td align="center" rowspan="1" colspan="1">48.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Exner [<xref rid="B147" ref-type="bibr">216</xref>]</td><td align="center" rowspan="1" colspan="1">1988</td><td align="center" rowspan="1" colspan="1">Zurich, Switzerland</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">615</td><td align="center" rowspan="1" colspan="1">521</td><td align="center" rowspan="1" colspan="1">847.2</td><td align="center" rowspan="1" colspan="1">28</td><td align="center" rowspan="1" colspan="1">45.5</td></tr><tr><td align="left" rowspan="1" colspan="1">Peled et al. [<xref rid="B462" ref-type="bibr">217</xref>]</td><td align="center" rowspan="1" colspan="1">2008</td><td align="center" rowspan="1" colspan="1">Haifa, Israel</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">45497</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">2137</td><td align="center" rowspan="1" colspan="1">47.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Giannako- poulou et al. [<xref rid="B101" ref-type="bibr">124</xref>]</td><td align="center" rowspan="1" colspan="1">2002</td><td align="center" rowspan="1" colspan="1">Crete</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">2 wks</td><td align="center" rowspan="1" colspan="1">6140</td><td align="center" rowspan="1" colspan="1">65</td><td align="center" rowspan="1" colspan="1">10.6</td><td align="center" rowspan="1" colspan="1">50</td><td align="center" rowspan="1" colspan="1">8.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Ballerini et al. [<xref rid="B463" ref-type="bibr">218</xref>]</td><td align="center" rowspan="1" colspan="1">1990</td><td align="center" rowspan="1" colspan="1">Milan, Italy</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">2842</td><td align="center" rowspan="1" colspan="1">778</td><td align="center" rowspan="1" colspan="1">273.8</td><td align="center" rowspan="1" colspan="1">57</td><td align="center" rowspan="1" colspan="1">20.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Riboni et al. [<xref rid="B464" ref-type="bibr">219</xref>]</td><td align="center" rowspan="1" colspan="1">1991</td><td align="center" rowspan="1" colspan="1">Milan, Italy</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">1507</td><td align="center" rowspan="1" colspan="1">508</td><td align="center" rowspan="1" colspan="1">337.1</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">10.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Franchin et al. [<xref rid="B465" ref-type="bibr">220</xref>]</td><td align="center" rowspan="1" colspan="1">1992</td><td align="center" rowspan="1" colspan="1">Bari, Italy</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">3000</td><td align="center" rowspan="1" colspan="1">959</td><td align="center" rowspan="1" colspan="1">319.7</td><td align="center" rowspan="1" colspan="1">309</td><td align="center" rowspan="1" colspan="1">103.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Baronciani et al. [<xref rid="B20" ref-type="bibr">20</xref>]</td><td align="center" rowspan="1" colspan="1">1997</td><td align="center" rowspan="1" colspan="1">Lecco, Italy</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">4648</td><td align="center" rowspan="1" colspan="1">1186</td><td align="center" rowspan="1" colspan="1">255.2</td><td align="center" rowspan="1" colspan="1">267</td><td align="center" rowspan="1" colspan="1">57.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Riboni et al. [<xref rid="B466" ref-type="bibr">221</xref>]</td><td align="center" rowspan="1" colspan="1">2003</td><td align="center" rowspan="1" colspan="1">Milan, Italy</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Birth</td><td align="center" rowspan="1" colspan="1">8896</td><td align="center" rowspan="1" colspan="1">2008</td><td align="center" rowspan="1" colspan="1">225.7</td><td align="center" rowspan="1" colspan="1">34</td><td align="center" rowspan="1" colspan="1">3.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Yiv et al. [<xref rid="B107" ref-type="bibr">143</xref>]</td><td align="center" rowspan="1" colspan="1">1997</td><td align="center" rowspan="1" colspan="1">South Australia</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">19622</td><td align="center" rowspan="1" colspan="1">206</td><td align="center" rowspan="1" colspan="1">10.5</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Weighted average (Caucasians)</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">187423</td><td align="center" rowspan="1" colspan="1">14986</td><td align="center" rowspan="1" colspan="1">80.0</td><td align="center" rowspan="1" colspan="1">6445</td><td align="center" rowspan="1" colspan="1">42.2</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>At 4 to 6 weeks</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Eidelman et al. [<xref rid="B51" ref-type="bibr">157</xref>]</td><td align="center" rowspan="1" colspan="1">2002</td><td align="center" rowspan="1" colspan="1">Ethiopia</td><td align="center" rowspan="1" colspan="1">Black Jews</td><td align="center" rowspan="1" colspan="1">6 wks</td><td align="center" rowspan="1" colspan="1">768</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">3.9</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">3.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Doğruel et al. [<xref rid="B68" ref-type="bibr">60</xref>]</td><td align="center" rowspan="1" colspan="1">2008</td><td align="center" rowspan="1" colspan="1">Ankara, Turkey</td><td align="center" rowspan="1" colspan="1">Indo-Med (Turkish)</td><td align="center" rowspan="1" colspan="1">6 wks</td><td align="center" rowspan="1" colspan="1">3541</td><td align="center" rowspan="1" colspan="1">167</td><td align="center" rowspan="1" colspan="1">47.2</td><td align="center" rowspan="1" colspan="1">208</td><td align="center" rowspan="1" colspan="1">58.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Bache et al. [<xref rid="B458" ref-type="bibr">211</xref>]</td><td align="center" rowspan="1" colspan="1">2002</td><td align="center" rowspan="1" colspan="1">Coventry, England</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">6 wks</td><td align="center" rowspan="1" colspan="1">29323</td><td align="center" rowspan="1" colspan="1">92</td><td align="center" rowspan="1" colspan="1">3.1</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Roovers et al. [<xref rid="B467" ref-type="bibr">222</xref>]</td><td align="center" rowspan="1" colspan="1">2005</td><td align="center" rowspan="1" colspan="1">Enschede, Netherlands</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">4 wks</td><td align="center" rowspan="1" colspan="1">4473</td><td align="center" rowspan="1" colspan="1">1697</td><td align="center" rowspan="1" colspan="1">379.4</td><td align="center" rowspan="1" colspan="1">132</td><td align="center" rowspan="1" colspan="1">29.5</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Weighted average (Caucasians)</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">33796</td><td align="center" rowspan="1" colspan="1">1789</td><td align="center" rowspan="1" colspan="1">52.9</td><td align="center" rowspan="1" colspan="1">132</td><td align="center" rowspan="1" colspan="1">29.5</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>At 4 to 6 Months</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Krolo et al. [<xref rid="B444" ref-type="bibr">129</xref>]</td><td align="center" rowspan="1" colspan="1">1989–2001</td><td align="center" rowspan="1" colspan="1">Zagreb, Croatia</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">4 months</td><td align="center" rowspan="1" colspan="1">2010</td><td align="center" rowspan="1" colspan="1">120</td><td align="center" rowspan="1" colspan="1">59.7</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">7.5</td></tr><tr><td align="left" rowspan="1" colspan="1">Akman et al. [<xref rid="B268" ref-type="bibr">223</xref>]</td><td align="center" rowspan="1" colspan="1">2007</td><td align="center" rowspan="1" colspan="1">Ankara, Turkey</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">6 months</td><td align="center" rowspan="1" colspan="1">403</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">14</td><td align="center" rowspan="1" colspan="1">34.7</td></tr></tbody></table><table-wrap-foot><fn><p>*The data for the last two columns those having > Graf IIa instability are for all hips, while the previous columns are for children.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab5" position="float"><label>Table 5</label><caption><p>General demographics of childhood hip dysplasia.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Study</th><th align="center" rowspan="1" colspan="1">Year</th><th align="center" rowspan="1" colspan="1">Location</th><th align="center" rowspan="1" colspan="1">Ethnicity</th><th align="center" rowspan="1" colspan="1">No. DDH</th><th align="center" rowspan="1" colspan="1">M</th><th align="center" rowspan="1" colspan="1">%M</th><th align="center" rowspan="1" colspan="1">F</th><th align="center" rowspan="1" colspan="1">%F</th><th align="center" rowspan="1" colspan="1">B</th><th align="center" rowspan="1" colspan="1">%Bil.</th><th align="center" rowspan="1" colspan="1">U</th><th align="center" rowspan="1" colspan="1">%Unil.</th><th align="center" rowspan="1" colspan="1">R</th><th align="center" rowspan="1" colspan="1">%R</th><th align="center" rowspan="1" colspan="1">L</th><th align="center" rowspan="1" colspan="1">%L</th><th align="center" rowspan="1" colspan="1">%RU</th><th align="center" rowspan="1" colspan="1">%LU</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Ang et al. [<xref rid="B61" ref-type="bibr">56</xref>]</td><td align="center" rowspan="1" colspan="1">1997</td><td align="center" rowspan="1" colspan="1">Singapore</td><td align="center" rowspan="1" colspan="1">Indo-Malay (mixed)</td><td align="center" rowspan="1" colspan="1">96</td><td align="center" rowspan="1" colspan="1">35</td><td align="center" rowspan="1" colspan="1">37</td><td align="center" rowspan="1" colspan="1">61</td><td align="center" rowspan="1" colspan="1">63</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Chai and Sivanan- tham [<xref rid="B468" ref-type="bibr">224</xref>]</td><td align="center" rowspan="1" colspan="1">1990</td><td align="center" rowspan="1" colspan="1">Kuala Lumpur, Malaysia</td><td align="center" rowspan="1" colspan="1">Indo-Malay (mixed)</td><td align="center" rowspan="1" colspan="1">22</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">23</td><td align="center" rowspan="1" colspan="1">17</td><td align="center" rowspan="1" colspan="1">77</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">14</td><td align="center" rowspan="1" colspan="1">19</td><td align="center" rowspan="1" colspan="1">86</td><td align="center" rowspan="1" colspan="1">11</td><td align="center" rowspan="1" colspan="1">58</td><td align="center" rowspan="1" colspan="1">8</td><td align="center" rowspan="1" colspan="1">42</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Wada et al. [<xref rid="B240" ref-type="bibr">83</xref>]</td><td align="center" rowspan="1" colspan="1">1993</td><td align="center" rowspan="1" colspan="1">Tokushima, Japan</td><td align="center" rowspan="1" colspan="1">Indo-Malay (Japanese)</td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">18</td><td align="center" rowspan="1" colspan="1">90</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">80</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">29</td><td align="center" rowspan="1" colspan="1">17</td><td align="center" rowspan="1" colspan="1">71</td><td align="center" rowspan="1" colspan="1">19</td><td align="center" rowspan="1" colspan="1">81</td></tr><tr><td align="left" rowspan="1" colspan="1">Kaushal et al. [<xref rid="B59" ref-type="bibr">57</xref>]</td><td align="center" rowspan="1" colspan="1">1976</td><td align="center" rowspan="1" colspan="1">Chandigarh, India</td><td align="center" rowspan="1" colspan="1">Indo-Med (Indian)</td><td align="center" rowspan="1" colspan="1">23</td><td align="center" rowspan="1" colspan="1">19</td><td align="center" rowspan="1" colspan="1">83</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">17</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">39</td><td align="center" rowspan="1" colspan="1">14</td><td align="center" rowspan="1" colspan="1">61</td><td align="center" rowspan="1" colspan="1">39</td><td align="center" rowspan="1" colspan="1">61</td></tr><tr><td align="left" rowspan="1" colspan="1">Mamouri et al. [<xref rid="B62" ref-type="bibr">65</xref>]</td><td align="center" rowspan="1" colspan="1">2004</td><td align="center" rowspan="1" colspan="1">Mashhad, Iran</td><td align="center" rowspan="1" colspan="1">Indo-Med (Iranian)</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">30</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">70</td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">60</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">40</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">30</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">75</td><td align="center" rowspan="1" colspan="1">25</td></tr><tr><td align="left" rowspan="1" colspan="1">Pashapour and Golmaham- madlou [<xref rid="B63" ref-type="bibr">66</xref>]</td><td align="center" rowspan="1" colspan="1">2007</td><td align="center" rowspan="1" colspan="1">Urmia, Iran</td><td align="center" rowspan="1" colspan="1">Indo-Med (Iranian)</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">8</td><td align="center" rowspan="1" colspan="1">80</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Abdinejad et al. [<xref rid="B31" ref-type="bibr">34</xref>]</td><td align="center" rowspan="1" colspan="1">1996</td><td align="center" rowspan="1" colspan="1">Shriz, Iran</td><td align="center" rowspan="1" colspan="1">Indo-Med (Iranian)</td><td align="center" rowspan="1" colspan="1">30</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">50</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">50</td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">13</td><td align="center" rowspan="1" colspan="1">43</td><td align="center" rowspan="1" colspan="1">13</td><td align="center" rowspan="1" colspan="1">87</td></tr><tr><td align="left" rowspan="1" colspan="1">Mirdad [<xref rid="B65" ref-type="bibr">63</xref>]</td><td align="center" rowspan="1" colspan="1">2002</td><td align="center" rowspan="1" colspan="1">Aseer, Saudi Arabia</td><td align="center" rowspan="1" colspan="1">Indo-Med (Saudi)</td><td align="center" rowspan="1" colspan="1">300</td><td align="center" rowspan="1" colspan="1">64</td><td align="center" rowspan="1" colspan="1">21.3</td><td align="center" rowspan="1" colspan="1">236</td><td align="center" rowspan="1" colspan="1">78.7</td><td align="center" rowspan="1" colspan="1">149</td><td align="center" rowspan="1" colspan="1">49.7</td><td align="center" rowspan="1" colspan="1">150</td><td align="center" rowspan="1" colspan="1">50.0</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">5.3</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">5.3</td><td align="center" rowspan="1" colspan="1">50</td><td align="center" rowspan="1" colspan="1">50</td></tr><tr><td align="left" rowspan="1" colspan="1">Kremli et al. [<xref rid="B150" ref-type="bibr">225</xref>]</td><td align="center" rowspan="1" colspan="1">2003</td><td align="center" rowspan="1" colspan="1">Riyadh, Saudi Arabia</td><td align="center" rowspan="1" colspan="1">Indo-Med (Saudi)</td><td align="center" rowspan="1" colspan="1">600</td><td align="center" rowspan="1" colspan="1">87</td><td align="center" rowspan="1" colspan="1">14.5</td><td align="center" rowspan="1" colspan="1">513</td><td align="center" rowspan="1" colspan="1">85.5</td><td align="center" rowspan="1" colspan="1">218</td><td align="center" rowspan="1" colspan="1">36.3</td><td align="center" rowspan="1" colspan="1">382</td><td align="center" rowspan="1" colspan="1">73.7</td><td align="center" rowspan="1" colspan="1">223</td><td align="center" rowspan="1" colspan="1">37.2</td><td align="center" rowspan="1" colspan="1">159</td><td align="center" rowspan="1" colspan="1">26.5</td><td align="center" rowspan="1" colspan="1">58.4</td><td align="center" rowspan="1" colspan="1">41.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Mufti [<xref rid="B166" ref-type="bibr">226</xref>]</td><td align="center" rowspan="1" colspan="1">1988</td><td align="center" rowspan="1" colspan="1">Riyadh, Saudi Arabia</td><td align="center" rowspan="1" colspan="1">Indo-Med (Saudi) and others</td><td align="center" rowspan="1" colspan="1">79</td><td align="center" rowspan="1" colspan="1">34</td><td align="center" rowspan="1" colspan="1">44</td><td align="center" rowspan="1" colspan="1">44</td><td align="center" rowspan="1" colspan="1">56</td><td align="center" rowspan="1" colspan="1">36</td><td align="center" rowspan="1" colspan="1">46</td><td align="center" rowspan="1" colspan="1">41</td><td align="center" rowspan="1" colspan="1">54</td><td align="center" rowspan="1" colspan="1">29</td><td align="center" rowspan="1" colspan="1">37</td><td align="center" rowspan="1" colspan="1">12</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">53</td><td align="center" rowspan="1" colspan="1">37</td></tr><tr><td align="left" rowspan="1" colspan="1">Dğruel [<xref rid="B68" ref-type="bibr">60</xref>]</td><td align="center" rowspan="1" colspan="1">2008</td><td align="center" rowspan="1" colspan="1">Ankara, Turkey</td><td align="center" rowspan="1" colspan="1">Indo-Med (Turkish)</td><td align="center" rowspan="1" colspan="1">167</td><td align="center" rowspan="1" colspan="1">83</td><td align="center" rowspan="1" colspan="1">49.7</td><td align="center" rowspan="1" colspan="1">84</td><td align="center" rowspan="1" colspan="1">50.3</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Kutlu et al. [<xref rid="B267" ref-type="bibr">59</xref>]</td><td align="center" rowspan="1" colspan="1">1992</td><td align="center" rowspan="1" colspan="1">Konya, Turkey</td><td align="center" rowspan="1" colspan="1">Indo-Med (Turkish)</td><td align="center" rowspan="1" colspan="1">56</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">29</td><td align="center" rowspan="1" colspan="1">40</td><td align="center" rowspan="1" colspan="1">71</td><td align="center" rowspan="1" colspan="1">28</td><td align="center" rowspan="1" colspan="1">50</td><td align="center" rowspan="1" colspan="1">28</td><td align="center" rowspan="1" colspan="1">50</td><td align="center" rowspan="1" colspan="1">13</td><td align="center" rowspan="1" colspan="1">23</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">27</td><td align="center" rowspan="1" colspan="1">46</td><td align="center" rowspan="1" colspan="1">54</td></tr><tr><td align="left" rowspan="1" colspan="1">Kraus and Schwartzman [<xref rid="B33" ref-type="bibr">43</xref>]</td><td align="center" rowspan="1" colspan="1">1957</td><td align="center" rowspan="1" colspan="1">Fort Apache, Arizona</td><td align="center" rowspan="1" colspan="1">Nat. Am.</td><td align="center" rowspan="1" colspan="1">107</td><td align="center" rowspan="1" colspan="1">21</td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">86</td><td align="center" rowspan="1" colspan="1">80</td><td align="center" rowspan="1" colspan="1">51</td><td align="center" rowspan="1" colspan="1">48</td><td align="center" rowspan="1" colspan="1">56</td><td align="center" rowspan="1" colspan="1">52</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Coleman [<xref rid="B34" ref-type="bibr">42</xref>]</td><td align="center" rowspan="1" colspan="1">1968</td><td align="center" rowspan="1" colspan="1">Fort Defiance AZ, Shiprock NM, Gallup NM</td><td align="center" rowspan="1" colspan="1">Nat. Am.</td><td align="center" rowspan="1" colspan="1">77</td><td align="center" rowspan="1" colspan="1">14</td><td align="center" rowspan="1" colspan="1">18</td><td align="center" rowspan="1" colspan="1">63</td><td align="center" rowspan="1" colspan="1">82</td><td align="center" rowspan="1" colspan="1">29</td><td align="center" rowspan="1" colspan="1">38</td><td align="center" rowspan="1" colspan="1">48</td><td align="center" rowspan="1" colspan="1">62</td><td align="center" rowspan="1" colspan="1">81</td><td align="center" rowspan="1" colspan="1">23</td><td align="center" rowspan="1" colspan="1">30</td><td align="center" rowspan="1" colspan="1">49</td><td align="center" rowspan="1" colspan="1">38</td><td align="center" rowspan="1" colspan="1">62</td></tr><tr><td align="left" rowspan="1" colspan="1">Walker [<xref rid="B37" ref-type="bibr">37</xref>]</td><td align="center" rowspan="1" colspan="1">1977</td><td align="center" rowspan="1" colspan="1">Island Lake, Manitoba</td><td align="center" rowspan="1" colspan="1">Nat. Am.</td><td align="center" rowspan="1" colspan="1">420</td><td align="center" rowspan="1" colspan="1">145</td><td align="center" rowspan="1" colspan="1">34.5</td><td align="center" rowspan="1" colspan="1">275</td><td align="center" rowspan="1" colspan="1">65.5</td><td align="center" rowspan="1" colspan="1">231</td><td align="center" rowspan="1" colspan="1">55.0</td><td align="center" rowspan="1" colspan="1">189</td><td align="center" rowspan="1" colspan="1">45.0</td><td align="center" rowspan="1" colspan="1">77</td><td align="center" rowspan="1" colspan="1">18.3</td><td align="center" rowspan="1" colspan="1">112</td><td align="center" rowspan="1" colspan="1">26.7</td><td align="center" rowspan="1" colspan="1">40.7</td><td align="center" rowspan="1" colspan="1">53.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Rabin et al. [<xref rid="B242" ref-type="bibr">40</xref>]</td><td align="center" rowspan="1" colspan="1">1965</td><td align="center" rowspan="1" colspan="1">Many Farms District, Navajo Indian Reservation</td><td align="center" rowspan="1" colspan="1">Nat. Am.</td><td align="center" rowspan="1" colspan="1">31</td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">19</td><td align="center" rowspan="1" colspan="1">25</td><td align="center" rowspan="1" colspan="1">81</td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">19</td><td align="center" rowspan="1" colspan="1">25</td><td align="center" rowspan="1" colspan="1">81</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">48</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">32</td><td align="center" rowspan="1" colspan="1">60</td><td align="center" rowspan="1" colspan="1">40</td></tr><tr><td align="left" rowspan="1" colspan="1">MacKenzie et al. [<xref rid="B469" ref-type="bibr">227</xref>]</td><td align="center" rowspan="1" colspan="1">1960</td><td align="center" rowspan="1" colspan="1">Aberdeen and London, UK</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">134</td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">114</td><td align="center" rowspan="1" colspan="1">85</td><td align="center" rowspan="1" colspan="1">31</td><td align="center" rowspan="1" colspan="1">23</td><td align="center" rowspan="1" colspan="1">103</td><td align="center" rowspan="1" colspan="1">77</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Wilkinson and Carter [<xref rid="B470" ref-type="bibr">228</xref>]</td><td align="center" rowspan="1" colspan="1">1960</td><td align="center" rowspan="1" colspan="1">London, England</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">149</td><td align="center" rowspan="1" colspan="1">17</td><td align="center" rowspan="1" colspan="1">11.4</td><td align="center" rowspan="1" colspan="1">132</td><td align="center" rowspan="1" colspan="1">88.6</td><td align="center" rowspan="1" colspan="1">42</td><td align="center" rowspan="1" colspan="1">28</td><td align="center" rowspan="1" colspan="1">107</td><td align="center" rowspan="1" colspan="1">28</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Noble et al. [<xref rid="B92" ref-type="bibr">114</xref>]</td><td align="center" rowspan="1" colspan="1">1978</td><td align="center" rowspan="1" colspan="1">Newcastle upon Tyne, England</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">271</td><td align="center" rowspan="1" colspan="1">60</td><td align="center" rowspan="1" colspan="1">22.1</td><td align="center" rowspan="1" colspan="1">211</td><td align="center" rowspan="1" colspan="1">77.9</td><td align="center" rowspan="1" colspan="1">103</td><td align="center" rowspan="1" colspan="1">38.0</td><td align="center" rowspan="1" colspan="1">168</td><td align="center" rowspan="1" colspan="1">62.0</td><td align="center" rowspan="1" colspan="1">39</td><td align="center" rowspan="1" colspan="1">14.4</td><td align="center" rowspan="1" colspan="1">129</td><td align="center" rowspan="1" colspan="1">47.6</td><td align="center" rowspan="1" colspan="1">23.2</td><td align="center" rowspan="1" colspan="1">76.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Wray and Muddu [<xref rid="B162" ref-type="bibr">229</xref>]</td><td align="center" rowspan="1" colspan="1">1978</td><td align="center" rowspan="1" colspan="1">Stockport, England</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">130</td><td align="center" rowspan="1" colspan="1">48</td><td align="center" rowspan="1" colspan="1">37</td><td align="center" rowspan="1" colspan="1">82</td><td align="center" rowspan="1" colspan="1">63</td><td align="center" rowspan="1" colspan="1">39</td><td align="center" rowspan="1" colspan="1">30</td><td align="center" rowspan="1" colspan="1">91</td><td align="center" rowspan="1" colspan="1">70</td><td align="center" rowspan="1" colspan="1">56</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">113</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Heikkilä [<xref rid="B74" ref-type="bibr">105</xref>]</td><td align="center" rowspan="1" colspan="1">1984</td><td align="center" rowspan="1" colspan="1">Southern Finland</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">1035</td><td align="center" rowspan="1" colspan="1">208</td><td align="center" rowspan="1" colspan="1">20.1</td><td align="center" rowspan="1" colspan="1">827</td><td align="center" rowspan="1" colspan="1">79.9</td><td align="center" rowspan="1" colspan="1">342</td><td align="center" rowspan="1" colspan="1">33.0</td><td align="center" rowspan="1" colspan="1">693</td><td align="center" rowspan="1" colspan="1">67.0</td><td align="center" rowspan="1" colspan="1">225</td><td align="center" rowspan="1" colspan="1">21.7</td><td align="center" rowspan="1" colspan="1">559</td><td align="center" rowspan="1" colspan="1">54.0</td><td align="center" rowspan="1" colspan="1">28.7</td><td align="center" rowspan="1" colspan="1">71.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Fredens- borg [<xref rid="B77" ref-type="bibr">95</xref>]</td><td align="center" rowspan="1" colspan="1">1976</td><td align="center" rowspan="1" colspan="1">Malmö, Sweden</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">548</td><td align="center" rowspan="1" colspan="1">118</td><td align="center" rowspan="1" colspan="1">21.5</td><td align="center" rowspan="1" colspan="1">430</td><td align="center" rowspan="1" colspan="1">78.5</td><td align="center" rowspan="1" colspan="1">314</td><td align="center" rowspan="1" colspan="1">57.3</td><td align="center" rowspan="1" colspan="1">234</td><td align="center" rowspan="1" colspan="1">42.7</td><td align="center" rowspan="1" colspan="1">143</td><td align="center" rowspan="1" colspan="1">21.6</td><td align="center" rowspan="1" colspan="1">91</td><td align="center" rowspan="1" colspan="1">16.6</td><td align="center" rowspan="1" colspan="1">61.1</td><td align="center" rowspan="1" colspan="1">38.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Darmonov [<xref rid="B446" ref-type="bibr">131</xref>]</td><td align="center" rowspan="1" colspan="1">1996</td><td align="center" rowspan="1" colspan="1">Stara Zagora, Bulgaria</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">124</td><td align="center" rowspan="1" colspan="1">24</td><td align="center" rowspan="1" colspan="1">19.4</td><td align="center" rowspan="1" colspan="1">100</td><td align="center" rowspan="1" colspan="1">80.6</td><td align="center" rowspan="1" colspan="1">31</td><td align="center" rowspan="1" colspan="1">25.0</td><td align="center" rowspan="1" colspan="1">93</td><td align="center" rowspan="1" colspan="1">75.0</td><td align="center" rowspan="1" colspan="1">27</td><td align="center" rowspan="1" colspan="1">21.8</td><td align="center" rowspan="1" colspan="1">61</td><td align="center" rowspan="1" colspan="1">49.2</td><td align="center" rowspan="1" colspan="1">30.7</td><td align="center" rowspan="1" colspan="1">69.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Tomáš [<xref rid="B260" ref-type="bibr">138</xref>]</td><td align="center" rowspan="1" colspan="1">1989</td><td align="center" rowspan="1" colspan="1">Bardejov, Slovakia</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">323</td><td align="center" rowspan="1" colspan="1">81</td><td align="center" rowspan="1" colspan="1">25.1</td><td align="center" rowspan="1" colspan="1">242</td><td align="center" rowspan="1" colspan="1">74.9</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Czéizel et al. [<xref rid="B157" ref-type="bibr">139</xref>]</td><td align="center" rowspan="1" colspan="1">1974</td><td align="center" rowspan="1" colspan="1">Békéscsaba, Hungary</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">523</td><td align="center" rowspan="1" colspan="1">77</td><td align="center" rowspan="1" colspan="1">14.7</td><td align="center" rowspan="1" colspan="1">446</td><td align="center" rowspan="1" colspan="1">85.3</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Poul et al. [<xref rid="B151" ref-type="bibr">135</xref>]</td><td align="center" rowspan="1" colspan="1">1992</td><td align="center" rowspan="1" colspan="1">Brno, Czechoslo- vakia</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">656</td><td align="center" rowspan="1" colspan="1">197</td><td align="center" rowspan="1" colspan="1">30.0</td><td align="center" rowspan="1" colspan="1">459</td><td align="center" rowspan="1" colspan="1">70.0</td><td align="center" rowspan="1" colspan="1">119</td><td align="center" rowspan="1" colspan="1">18.1</td><td align="center" rowspan="1" colspan="1">537</td><td align="center" rowspan="1" colspan="1">81.9</td><td align="center" rowspan="1" colspan="1">88</td><td align="center" rowspan="1" colspan="1">13.4</td><td align="center" rowspan="1" colspan="1">449</td><td align="center" rowspan="1" colspan="1">68.4</td><td align="center" rowspan="1" colspan="1">16.4</td><td align="center" rowspan="1" colspan="1">83.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Vencálková and Janata [<xref rid="B263" ref-type="bibr">136</xref>]</td><td align="center" rowspan="1" colspan="1">2009</td><td align="center" rowspan="1" colspan="1">Liberec, Czech</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">452</td><td align="center" rowspan="1" colspan="1">63</td><td align="center" rowspan="1" colspan="1">14.3</td><td align="center" rowspan="1" colspan="1">390</td><td align="center" rowspan="1" colspan="1">45.7</td><td align="center" rowspan="1" colspan="1">113</td><td align="center" rowspan="1" colspan="1">25.0</td><td align="center" rowspan="1" colspan="1">339</td><td align="center" rowspan="1" colspan="1">75.0</td><td align="center" rowspan="1" colspan="1">131</td><td align="center" rowspan="1" colspan="1">29.0</td><td align="center" rowspan="1" colspan="1">208</td><td align="center" rowspan="1" colspan="1">46.0</td><td align="center" rowspan="1" colspan="1">38.6</td><td align="center" rowspan="1" colspan="1">61.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Di Bella et al. [<xref rid="B102" ref-type="bibr">125</xref>]</td><td align="center" rowspan="1" colspan="1">1997</td><td align="center" rowspan="1" colspan="1">Sicily, Italy</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">51</td><td align="center" rowspan="1" colspan="1">8</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">43</td><td align="center" rowspan="1" colspan="1">84</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">48</td><td align="center" rowspan="1" colspan="1">94</td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">18</td><td align="center" rowspan="1" colspan="1">39</td><td align="center" rowspan="1" colspan="1">76</td><td align="center" rowspan="1" colspan="1">19</td><td align="center" rowspan="1" colspan="1">81</td></tr><tr><td align="left" rowspan="1" colspan="1">Padilla-Esteban et al. [<xref rid="B100" ref-type="bibr">122</xref>]</td><td align="center" rowspan="1" colspan="1">1990</td><td align="center" rowspan="1" colspan="1">Madrid, Spain</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">1747</td><td align="center" rowspan="1" colspan="1">607</td><td align="center" rowspan="1" colspan="1">34.5</td><td align="center" rowspan="1" colspan="1">1140</td><td align="center" rowspan="1" colspan="1">65.3</td><td align="center" rowspan="1" colspan="1">648</td><td align="center" rowspan="1" colspan="1">37.1</td><td align="center" rowspan="1" colspan="1">1099</td><td align="center" rowspan="1" colspan="1">62.9</td><td align="center" rowspan="1" colspan="1">413</td><td align="center" rowspan="1" colspan="1">23.6</td><td align="center" rowspan="1" colspan="1">686</td><td align="center" rowspan="1" colspan="1">39.3</td><td align="center" rowspan="1" colspan="1">37.6</td><td align="center" rowspan="1" colspan="1">62.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Romero et al. [<xref rid="B158" ref-type="bibr">230</xref>]</td><td align="center" rowspan="1" colspan="1">1989</td><td align="center" rowspan="1" colspan="1">Chile</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">97</td><td align="center" rowspan="1" colspan="1">13</td><td align="center" rowspan="1" colspan="1">13</td><td align="center" rowspan="1" colspan="1">84</td><td align="center" rowspan="1" colspan="1">86</td><td align="center" rowspan="1" colspan="1">66</td><td align="center" rowspan="1" colspan="1">68</td><td align="center" rowspan="1" colspan="1">30</td><td align="center" rowspan="1" colspan="1">31</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">50</td><td align="center" rowspan="1" colspan="1">50</td></tr><tr><td align="left" rowspan="1" colspan="1">Tijmes et al. [<xref rid="B114" ref-type="bibr">149</xref>]</td><td align="center" rowspan="1" colspan="1">1971</td><td align="center" rowspan="1" colspan="1">Llanquihue, Chile</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">137</td><td align="center" rowspan="1" colspan="1">33</td><td align="center" rowspan="1" colspan="1">24.1</td><td align="center" rowspan="1" colspan="1">104</td><td align="center" rowspan="1" colspan="1">75.9</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Robinson [<xref rid="B152" ref-type="bibr">231</xref>]</td><td align="center" rowspan="1" colspan="1">1968</td><td align="center" rowspan="1" colspan="1">New York State</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">339</td><td align="center" rowspan="1" colspan="1">68</td><td align="center" rowspan="1" colspan="1">20.1</td><td align="center" rowspan="1" colspan="1">271</td><td align="center" rowspan="1" colspan="1">79.9</td><td align="center" rowspan="1" colspan="1">70</td><td align="center" rowspan="1" colspan="1">21.9</td><td align="center" rowspan="1" colspan="1">249</td><td align="center" rowspan="1" colspan="1">78.1</td><td align="center" rowspan="1" colspan="1">81</td><td align="center" rowspan="1" colspan="1">25.4</td><td align="center" rowspan="1" colspan="1">168</td><td align="center" rowspan="1" colspan="1">52.7</td><td align="center" rowspan="1" colspan="1">32.5</td><td align="center" rowspan="1" colspan="1">67.5</td></tr><tr><td align="left" rowspan="1" colspan="1">Hazel and Beals [<xref rid="B111" ref-type="bibr">150</xref>]</td><td align="center" rowspan="1" colspan="1">1989</td><td align="center" rowspan="1" colspan="1">Portland, Oregon, USA</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">32</td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">19</td><td align="center" rowspan="1" colspan="1">26</td><td align="center" rowspan="1" colspan="1">81</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">13</td><td align="center" rowspan="1" colspan="1">28</td><td align="center" rowspan="1" colspan="1">87</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">23</td><td align="center" rowspan="1" colspan="1">72</td><td align="center" rowspan="1" colspan="1">18</td><td align="center" rowspan="1" colspan="1">82</td></tr><tr><td align="left" rowspan="1" colspan="1">Hadlow [<xref rid="B29" ref-type="bibr">32</xref>]</td><td align="center" rowspan="1" colspan="1">1988</td><td align="center" rowspan="1" colspan="1">New Plymouth, New Zealand</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">172</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">9.3</td><td align="center" rowspan="1" colspan="1">162</td><td align="center" rowspan="1" colspan="1">94.2</td><td align="center" rowspan="1" colspan="1">87</td><td align="center" rowspan="1" colspan="1">50.6</td><td align="center" rowspan="1" colspan="1">85</td><td align="center" rowspan="1" colspan="1">49.4</td><td align="center" rowspan="1" colspan="1">11</td><td align="center" rowspan="1" colspan="1">6.4</td><td align="center" rowspan="1" colspan="1">74</td><td align="center" rowspan="1" colspan="1">43.0</td><td align="center" rowspan="1" colspan="1">12.9</td><td align="center" rowspan="1" colspan="1">87.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Doig and Shannon [<xref rid="B109" ref-type="bibr">146</xref>]</td><td align="center" rowspan="1" colspan="1">1975</td><td align="center" rowspan="1" colspan="1">Christchurch, New Zealand</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">62</td><td align="center" rowspan="1" colspan="1">14</td><td align="center" rowspan="1" colspan="1">23</td><td align="center" rowspan="1" colspan="1">48</td><td align="center" rowspan="1" colspan="1">77</td><td align="center" rowspan="1" colspan="1">29</td><td align="center" rowspan="1" colspan="1">47</td><td align="center" rowspan="1" colspan="1">33</td><td align="center" rowspan="1" colspan="1">53</td><td align="center" rowspan="1" colspan="1">11</td><td align="center" rowspan="1" colspan="1">18</td><td align="center" rowspan="1" colspan="1">22</td><td align="center" rowspan="1" colspan="1">35</td><td align="center" rowspan="1" colspan="1">33</td><td align="center" rowspan="1" colspan="1">67</td></tr><tr><td align="left" rowspan="1" colspan="1">Paterson [<xref rid="B106" ref-type="bibr">67</xref>]</td><td align="center" rowspan="1" colspan="1">1976</td><td align="center" rowspan="1" colspan="1">South Australia</td><td align="center" rowspan="1" colspan="1">Caucasian and others</td><td align="center" rowspan="1" colspan="1">43</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">24</td><td align="center" rowspan="1" colspan="1">31</td><td align="center" rowspan="1" colspan="1">76</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">36</td><td align="center" rowspan="1" colspan="1">84</td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">21</td><td align="center" rowspan="1" colspan="1">27</td><td align="center" rowspan="1" colspan="1">63</td><td align="center" rowspan="1" colspan="1">25</td><td align="center" rowspan="1" colspan="1">75</td></tr><tr><td align="left" rowspan="1" colspan="1">Yiv et al. [<xref rid="B107" ref-type="bibr">143</xref>]</td><td align="center" rowspan="1" colspan="1">1997</td><td align="center" rowspan="1" colspan="1">South Australia</td><td align="center" rowspan="1" colspan="1">Caucasian and others</td><td align="center" rowspan="1" colspan="1">206</td><td align="center" rowspan="1" colspan="1">48</td><td align="center" rowspan="1" colspan="1">23.3</td><td align="center" rowspan="1" colspan="1">158</td><td align="center" rowspan="1" colspan="1">76.7</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Bower et al. [<xref rid="B45" ref-type="bibr">44</xref>]</td><td align="center" rowspan="1" colspan="1">1987</td><td align="center" rowspan="1" colspan="1">Western Australia</td><td align="center" rowspan="1" colspan="1">Caucasian and others</td><td align="center" rowspan="1" colspan="1">437</td><td align="center" rowspan="1" colspan="1">101</td><td align="center" rowspan="1" colspan="1">23.1</td><td align="center" rowspan="1" colspan="1">336</td><td align="center" rowspan="1" colspan="1">76.9</td><td align="center" rowspan="1" colspan="1">165</td><td align="center" rowspan="1" colspan="1">37.8</td><td align="center" rowspan="1" colspan="1">223</td><td align="center" rowspan="1" colspan="1">51.0</td><td align="center" rowspan="1" colspan="1">65</td><td align="center" rowspan="1" colspan="1">14.9</td><td align="center" rowspan="1" colspan="1">158</td><td align="center" rowspan="1" colspan="1">36.2</td><td align="center" rowspan="1" colspan="1">29.1</td><td align="center" rowspan="1" colspan="1">70.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Weighted Averages</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"><bold>9717</bold></td><td align="center" rowspan="1" colspan="1"><bold>2373</bold></td><td align="center" rowspan="1" colspan="1"><bold>24.5</bold></td><td align="center" rowspan="1" colspan="1"><bold>7317</bold></td><td align="center" rowspan="1" colspan="1"><bold>75.5</bold></td><td align="center" rowspan="1" colspan="1"><bold>2989</bold></td><td align="center" rowspan="1" colspan="1"><bold>36.6</bold></td><td align="center" rowspan="1" colspan="1"><bold>5169</bold></td><td align="center" rowspan="1" colspan="1"><bold>63.4</bold></td><td align="center" rowspan="1" colspan="1"><bold>1814</bold></td><td align="center" rowspan="1" colspan="1"><bold>22.2</bold></td><td align="center" rowspan="1" colspan="1"><bold>3229</bold></td><td align="center" rowspan="1" colspan="1"><bold>39.6</bold></td><td align="center" rowspan="1" colspan="1"><bold>36.0</bold></td><td align="center" rowspan="1" colspan="1"><bold>64.0</bold></td></tr></tbody></table></table-wrap><table-wrap id="tab6" position="float"><label>Table 6</label><caption><p>Prevalence of adult acetabular dysplasia amongst different racial groups.</p></caption><table frame="hsides" rules="groups"><tbody><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" colspan="3" rowspan="1">Male</td><td align="center" colspan="3" rowspan="1">Female</td><td align="center" colspan="3" rowspan="1">Male and female</td><td align="center" rowspan="2" colspan="1">CEA*</td></tr><tr><td align="left" rowspan="1" colspan="1">Study</td><td align="center" rowspan="1" colspan="1">Year</td><td align="center" rowspan="1" colspan="1">Ethnicity</td><td align="center" rowspan="1" colspan="1">Location</td><td align="center" rowspan="1" colspan="1">No. Dysp.</td><td align="center" rowspan="1" colspan="1">No. Hips</td><td align="center" rowspan="1" colspan="1">%</td><td align="center" rowspan="1" colspan="1">No. Dysp.</td><td align="center" rowspan="1" colspan="1">No. Hips</td><td align="center" rowspan="1" colspan="1">%</td><td align="center" rowspan="1" colspan="1">No. Dysp.</td><td align="center" rowspan="1" colspan="1">No. Hips.</td><td align="center" rowspan="1" colspan="1">%</td></tr><tr><td align="left" colspan="14" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Ali-Gombe et al. [<xref rid="B386" ref-type="bibr">382</xref>]</td><td align="center" rowspan="1" colspan="1">1996</td><td align="center" rowspan="1" colspan="1">African</td><td align="center" rowspan="1" colspan="1">Nigeria</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">126</td><td align="center" rowspan="1" colspan="1">2.4</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="left" rowspan="1" colspan="1">Msamati et al. [<xref rid="B471" ref-type="bibr">383</xref>]</td><td align="center" rowspan="1" colspan="1">2003</td><td align="center" rowspan="1" colspan="1">African</td><td align="center" rowspan="1" colspan="1">Malawi</td><td align="center" rowspan="1" colspan="1">12</td><td align="center" rowspan="1" colspan="1">104</td><td align="center" rowspan="1" colspan="1">11.5</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">76</td><td align="center" rowspan="1" colspan="1">13.2</td><td align="center" rowspan="1" colspan="1">22</td><td align="center" rowspan="1" colspan="1">180</td><td align="center" rowspan="1" colspan="1">12.2</td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="left" rowspan="1" colspan="1">Skirving [<xref rid="B472" ref-type="bibr">384</xref>]</td><td align="center" rowspan="1" colspan="1">1981</td><td align="center" rowspan="1" colspan="1">African</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">162</td><td align="center" rowspan="1" colspan="1">2.5</td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Average—Black</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"><bold>26</bold></td><td align="center" rowspan="1" colspan="1"><bold>342</bold></td><td align="center" rowspan="1" colspan="1"><bold>7.6</bold></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Yoshimura et al. [<xref rid="B379" ref-type="bibr">385</xref>]</td><td align="center" rowspan="1" colspan="1">1998</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Britain</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">1303</td><td align="center" rowspan="1" colspan="1">0.3</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">195</td><td align="center" rowspan="1" colspan="1">2.1</td><td align="center" rowspan="1" colspan="1">8</td><td align="center" rowspan="1" colspan="1">1498</td><td align="center" rowspan="1" colspan="1">0.5</td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="left" rowspan="2" colspan="1">Croft et al. [<xref rid="B377" ref-type="bibr">386</xref>] </td><td align="center" rowspan="1" colspan="1">1991</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Britain</td><td align="center" rowspan="1" colspan="1">26</td><td align="center" rowspan="1" colspan="1">2604</td><td align="center" rowspan="1" colspan="1">1.0</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"><20°</td></tr><tr><td align="center" rowspan="1" colspan="1">1991</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Britain</td><td align="center" rowspan="1" colspan="1">94</td><td align="center" rowspan="1" colspan="1">2604</td><td align="center" rowspan="1" colspan="1">3.6</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"><25°</td></tr><tr><td align="left" rowspan="1" colspan="1">Smith et al. [<xref rid="B378" ref-type="bibr">387</xref>]</td><td align="center" rowspan="1" colspan="1">1995</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Britain</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">393</td><td align="center" rowspan="1" colspan="1">3.8</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">393</td><td align="center" rowspan="1" colspan="1">3.8</td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="left" rowspan="1" colspan="1">Lane et al. [<xref rid="B391" ref-type="bibr">388</xref>]</td><td align="center" rowspan="1" colspan="1">2000</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">USA</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">118</td><td align="center" rowspan="1" colspan="1">5.9</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">118</td><td align="center" rowspan="1" colspan="1">5.9</td><td align="center" rowspan="1" colspan="1"><30°</td></tr><tr><td align="left" rowspan="1" colspan="1">Jacobsen [<xref rid="B473" ref-type="bibr">389</xref>]</td><td align="center" rowspan="1" colspan="1">2007</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">Denmark</td><td align="center" rowspan="1" colspan="1">90</td><td align="center" rowspan="1" colspan="1">1352</td><td align="center" rowspan="1" colspan="1">6.7</td><td align="center" rowspan="1" colspan="1">152</td><td align="center" rowspan="1" colspan="1">2215</td><td align="center" rowspan="1" colspan="1">6.9</td><td align="center" rowspan="1" colspan="1">242</td><td align="center" rowspan="1" colspan="1">3567</td><td align="center" rowspan="1" colspan="1">6.8</td><td align="center" rowspan="1" colspan="1"><20°</td></tr><tr><td align="left" rowspan="1" colspan="1">Inoue et al. [<xref rid="B384" ref-type="bibr">390</xref>]</td><td align="center" rowspan="1" colspan="1">2000</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">France</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">549</td><td align="center" rowspan="1" colspan="1">1.8</td><td align="center" rowspan="1" colspan="1">13</td><td align="center" rowspan="1" colspan="1">234</td><td align="center" rowspan="1" colspan="1">5.6</td><td align="center" rowspan="1" colspan="1">23</td><td align="center" rowspan="1" colspan="1">783</td><td align="center" rowspan="1" colspan="1">2.9</td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="left" rowspan="1" colspan="1">Skirving [<xref rid="B472" ref-type="bibr">384</xref>]</td><td align="center" rowspan="1" colspan="1">1981</td><td align="center" rowspan="1" colspan="1">Caucasian</td><td align="center" rowspan="1" colspan="1">England</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">300</td><td align="center" rowspan="1" colspan="1">5.0</td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Average—Caucasian</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"><bold>302</bold></td><td align="center" rowspan="1" colspan="1"><bold>5161</bold></td><td align="center" rowspan="1" colspan="1"><bold>5.9</bold></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="2" colspan="1">Lau et al. [<xref rid="B383" ref-type="bibr">391</xref>] </td><td align="center" rowspan="1" colspan="1">1995</td><td align="center" rowspan="1" colspan="1">Indo-Malay (Chinese)</td><td align="center" rowspan="1" colspan="1">Hong Kong</td><td align="center" rowspan="1" colspan="1">89</td><td align="center" rowspan="1" colspan="1">999</td><td align="center" rowspan="1" colspan="1">8.9</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">89</td><td align="center" rowspan="1" colspan="1">999</td><td align="center" rowspan="1" colspan="1">8.9</td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="center" rowspan="1" colspan="1">1995</td><td align="center" rowspan="1" colspan="1">Indo-Malay (Chinese)</td><td align="center" rowspan="1" colspan="1">Hong Kong</td><td align="center" rowspan="1" colspan="1">21</td><td align="center" rowspan="1" colspan="1">999</td><td align="center" rowspan="1" colspan="1">2.1</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">21</td><td align="center" rowspan="1" colspan="1">999</td><td align="center" rowspan="1" colspan="1">2.1</td><td align="center" rowspan="1" colspan="1"><20°</td></tr><tr><td align="left" rowspan="2" colspan="1">Hoaglund et al. [<xref rid="B474" ref-type="bibr">392</xref>] </td><td align="center" rowspan="1" colspan="1">1973</td><td align="center" rowspan="1" colspan="1">Indo-Malay (Chinese)</td><td align="center" rowspan="1" colspan="1">Hong Kong</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">248</td><td align="center" rowspan="1" colspan="1">0.4</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">252</td><td align="center" rowspan="1" colspan="1">1.2</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">500</td><td align="center" rowspan="1" colspan="1">0.8</td><td align="center" rowspan="1" colspan="1"><20°</td></tr><tr><td align="center" rowspan="1" colspan="1">1973</td><td align="center" rowspan="1" colspan="1">Indo-Malay (Chinese)</td><td align="center" rowspan="1" colspan="1">Hong Kong</td><td align="center" rowspan="1" colspan="1">25</td><td align="center" rowspan="1" colspan="1">248</td><td align="center" rowspan="1" colspan="1">10.1</td><td align="center" rowspan="1" colspan="1">25</td><td align="center" rowspan="1" colspan="1">252</td><td align="center" rowspan="1" colspan="1">9.9</td><td align="center" rowspan="1" colspan="1">50</td><td align="center" rowspan="1" colspan="1">500</td><td align="center" rowspan="1" colspan="1">10.0</td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="left" rowspan="1" colspan="1">Yoshimura et al. [<xref rid="B379" ref-type="bibr">385</xref>]</td><td align="center" rowspan="1" colspan="1">1998</td><td align="center" rowspan="1" colspan="1">Indo-Malay (Japanese)</td><td align="center" rowspan="1" colspan="1">Japan</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">99</td><td align="center" rowspan="1" colspan="1">16.2</td><td align="center" rowspan="1" colspan="1">19</td><td align="center" rowspan="1" colspan="1">99</td><td align="center" rowspan="1" colspan="1">19.2</td><td align="center" rowspan="1" colspan="1">35</td><td align="center" rowspan="1" colspan="1">198</td><td align="center" rowspan="1" colspan="1">17.7</td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="left" rowspan="1" colspan="1">Inoue et al. [<xref rid="B384" ref-type="bibr">390</xref>]</td><td align="center" rowspan="1" colspan="1">2000</td><td align="center" rowspan="1" colspan="1">Indo-Malay (Japanese)</td><td align="center" rowspan="1" colspan="1">Japan</td><td align="center" rowspan="1" colspan="1">42</td><td align="center" rowspan="1" colspan="1">820</td><td align="center" rowspan="1" colspan="1">5.1</td><td align="center" rowspan="1" colspan="1">83</td><td align="center" rowspan="1" colspan="1">718</td><td align="center" rowspan="1" colspan="1">11.6</td><td align="center" rowspan="1" colspan="1">125</td><td align="center" rowspan="1" colspan="1">1538</td><td align="center" rowspan="1" colspan="1">8.1</td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="left" rowspan="1" colspan="1">Han et al. [<xref rid="B475" ref-type="bibr">393</xref>]</td><td align="center" rowspan="1" colspan="1">1998</td><td align="center" rowspan="1" colspan="1">Indo-Malay (Korean)</td><td align="center" rowspan="1" colspan="1">Korea</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">319</td><td align="center" rowspan="1" colspan="1">1.3</td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">272</td><td align="center" rowspan="1" colspan="1">2.2</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">591</td><td align="center" rowspan="1" colspan="1">1.7</td><td align="center" rowspan="1" colspan="1"><20°</td></tr><tr><td align="left" rowspan="2" colspan="1">Moussa and Alomran [<xref rid="B392" ref-type="bibr">394</xref>]</td><td align="center" rowspan="1" colspan="1">2007</td><td align="center" rowspan="1" colspan="1">Indo-Med (Saudi)</td><td align="center" rowspan="1" colspan="1">Saudi Arabia</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">208</td><td align="center" rowspan="1" colspan="1">1.4</td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="center" rowspan="1" colspan="1">2007</td><td align="center" rowspan="1" colspan="1">Indo-Med (Saudi)</td><td align="center" rowspan="1" colspan="1">Saudi Arabia</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">208</td><td align="center" rowspan="1" colspan="1">0.0</td><td align="center" rowspan="1" colspan="1"><20°</td></tr><tr><td align="left" rowspan="2" colspan="1">Goker et al. [<xref rid="B385" ref-type="bibr">395</xref>]</td><td align="center" rowspan="1" colspan="1">2004</td><td align="center" rowspan="1" colspan="1">Indo-Med (Turkish)</td><td align="center" rowspan="1" colspan="1">Turkey</td><td align="center" rowspan="1" colspan="1">13</td><td align="center" rowspan="1" colspan="1">130</td><td align="center" rowspan="1" colspan="1">10.0</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">54</td><td align="center" rowspan="1" colspan="1">7.4</td><td align="center" rowspan="1" colspan="1">17</td><td align="center" rowspan="1" colspan="1">184</td><td align="center" rowspan="1" colspan="1">9.2</td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="center" rowspan="1" colspan="1">2004</td><td align="center" rowspan="1" colspan="1">Indo-Med (Turkish)</td><td align="center" rowspan="1" colspan="1">Turkey</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">130</td><td align="center" rowspan="1" colspan="1">2.3</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">54</td><td align="center" rowspan="1" colspan="1">0.0</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">184</td><td align="center" rowspan="1" colspan="1">1.6</td><td align="center" rowspan="1" colspan="1"><20°</td></tr><tr><td align="left" rowspan="1" colspan="1">Aktas et al. [<xref rid="B476" ref-type="bibr">396</xref>]</td><td align="center" rowspan="1" colspan="1">2000</td><td align="center" rowspan="1" colspan="1">Indo-Med (Turkish)</td><td align="center" rowspan="1" colspan="1">Turkey</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">202</td><td align="center" rowspan="1" colspan="1">2.5</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">293</td><td align="center" rowspan="1" colspan="1">1.0</td><td align="center" rowspan="1" colspan="1">8</td><td align="center" rowspan="1" colspan="1">495</td><td align="center" rowspan="1" colspan="1">1.6</td><td align="center" rowspan="1" colspan="1">≤22.5°</td></tr><tr><td align="left" rowspan="1" colspan="1">Umer et al. [<xref rid="B477" ref-type="bibr">397</xref>]</td><td align="center" rowspan="1" colspan="1">2006</td><td align="center" rowspan="1" colspan="1">Mixed—not stated</td><td align="center" rowspan="1" colspan="1">Singapore</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">19</td><td align="center" rowspan="1" colspan="1">522</td><td align="center" rowspan="1" colspan="1">3.6</td><td align="center" rowspan="1" colspan="1"><20°</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Average—Indo-Malay</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"><bold>327</bold></td><td align="center" rowspan="1" colspan="1"><bold>4122</bold></td><td align="center" rowspan="1" colspan="1"><bold>7.9</bold></td><td align="center" rowspan="1" colspan="1"><25°</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">°</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"><bold>57</bold></td><td align="center" rowspan="1" colspan="1"><bold>3004</bold></td><td align="center" rowspan="1" colspan="1"><bold>1.9</bold></td><td align="center" rowspan="1" colspan="1"><20°</td></tr><tr><td align="left" rowspan="2" colspan="1">Johnsen et al. [<xref rid="B41" ref-type="bibr">152</xref>]</td><td align="center" rowspan="1" colspan="1">2008</td><td align="center" rowspan="1" colspan="1">Sámi</td><td align="center" rowspan="1" colspan="1">Norway</td><td align="center" rowspan="1" colspan="1">21</td><td align="center" rowspan="1" colspan="1">150</td><td align="center" rowspan="1" colspan="1">14.0</td><td align="center" rowspan="1" colspan="1">35</td><td align="center" rowspan="1" colspan="1">165</td><td align="center" rowspan="1" colspan="1">21.2</td><td align="center" rowspan="1" colspan="1">56</td><td align="center" rowspan="1" colspan="1">315</td><td align="center" rowspan="1" colspan="1"><bold>17.8</bold></td><td align="center" rowspan="1" colspan="1"><20°</td></tr><tr><td align="center" rowspan="1" colspan="1">2008</td><td align="center" rowspan="1" colspan="1">Sámi</td><td align="center" rowspan="1" colspan="1">Norway</td><td align="center" rowspan="1" colspan="1">26</td><td align="center" rowspan="1" colspan="1">150</td><td align="center" rowspan="1" colspan="1">17.3</td><td align="center" rowspan="1" colspan="1">40</td><td align="center" rowspan="1" colspan="1">165</td><td align="center" rowspan="1" colspan="1">24.2</td><td align="center" rowspan="1" colspan="1">66</td><td align="center" rowspan="1" colspan="1">315</td><td align="center" rowspan="1" colspan="1"><bold>21.0</bold></td><td align="center" rowspan="1" colspan="1"><25°</td></tr></tbody></table><table-wrap-foot><fn><p>*CEA = center-edge angle of Wiberg [<xref rid="B374" ref-type="bibr">398</xref>].</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab7" position="float"><label>Table 7</label><caption><p>Archeological studies of hip dysplasia.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Study</th><th align="center" rowspan="1" colspan="1">Year</th><th align="left" rowspan="1" colspan="1">Archeological location</th><th align="left" rowspan="1" colspan="1">Era</th><th align="center" rowspan="1" colspan="1">M</th><th align="center" rowspan="1" colspan="1">F</th><th align="center" rowspan="1" colspan="1">U</th><th align="center" rowspan="1" colspan="1">B</th><th align="center" rowspan="1" colspan="1">No. DDH</th><th align="center" rowspan="1" colspan="1">No. Skeletons</th><th align="center" rowspan="1" colspan="1">Prevalence</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1"><italic>European peoples</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Blondiaux and Millot [<xref rid="B393" ref-type="bibr">408</xref>]</td><td align="center" rowspan="1" colspan="1">1991</td><td align="left" rowspan="1" colspan="1">North and Eastern France</td><td align="left" rowspan="1" colspan="1">4th–13th century</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">700</td><td align="center" rowspan="1" colspan="1">8.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Mafart et al. [<xref rid="B394" ref-type="bibr">409</xref>]</td><td align="center" rowspan="1" colspan="1">2007</td><td align="left" rowspan="1" colspan="1">Southern France</td><td align="left" rowspan="1" colspan="1">8th–17th century</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">900</td><td align="center" rowspan="1" colspan="1">10.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Mitchell and Redfern [<xref rid="B395" ref-type="bibr">410</xref>]</td><td align="center" rowspan="1" colspan="1">2007</td><td align="left" rowspan="1" colspan="1">Spitalfields, London, UK</td><td align="left" rowspan="1" colspan="1">1100–1530</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">3290</td><td align="center" rowspan="1" colspan="1">2.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Hawkes and Wells [<xref rid="B478" ref-type="bibr">411</xref>]</td><td align="center" rowspan="1" colspan="1">1983</td><td align="left" rowspan="1" colspan="1">Worthy Park, Hampshire, South England</td><td align="left" rowspan="1" colspan="1">5th–7th century</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">99</td><td align="center" rowspan="1" colspan="1">0</td></tr><tr><td align="left" rowspan="1" colspan="1">Eng et al. [<xref rid="B397" ref-type="bibr">412</xref>]</td><td align="center" rowspan="1" colspan="1">2009</td><td align="left" rowspan="1" colspan="1">Transylvania, Romania</td><td align="left" rowspan="1" colspan="1">1550–1700</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">70</td><td align="center" rowspan="1" colspan="1">28.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Masnicová and Beňuš [<xref rid="B398" ref-type="bibr">413</xref>]</td><td align="center" rowspan="1" colspan="1">2003</td><td align="left" rowspan="1" colspan="1">Devín, Slovakia</td><td align="left" rowspan="1" colspan="1">9th–12th century</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">327</td><td align="center" rowspan="1" colspan="1">3.1</td></tr><tr><td align="left" rowspan="1" colspan="1">Maat et al. [<xref rid="B396" ref-type="bibr">414</xref>]</td><td align="center" rowspan="1" colspan="1">1995</td><td align="left" rowspan="1" colspan="1">Dordrecht, Netherlands</td><td align="left" rowspan="1" colspan="1">1375–1572</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">100</td><td align="center" rowspan="1" colspan="1">10.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Lieverse [<xref rid="B399" ref-type="bibr">415</xref>]</td><td align="center" rowspan="1" colspan="1">2005</td><td align="left" rowspan="1" colspan="1">Cis-Baikal, Siberia</td><td align="left" rowspan="1" colspan="1">6800–1000 BC</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">271</td><td align="center" rowspan="1" colspan="1">3.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Bourbou [<xref rid="B402" ref-type="bibr">416</xref>]</td><td align="center" rowspan="1" colspan="1">2003</td><td align="left" rowspan="1" colspan="1">Southern Greece</td><td align="left" rowspan="1" colspan="1">6th–7th century</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">225</td><td align="center" rowspan="1" colspan="1">0.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Lieverse [<xref rid="B401" ref-type="bibr">417</xref>]</td><td align="center" rowspan="1" colspan="1">2008</td><td align="left" rowspan="1" colspan="1">Padova, Italy</td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">213</td><td align="center" rowspan="1" colspan="1">4.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Bisel [<xref rid="B400" ref-type="bibr">418</xref>]</td><td align="center" rowspan="1" colspan="1">1991</td><td align="left" rowspan="1" colspan="1">Herculaneum, Italy</td><td align="left" rowspan="1" colspan="1">79 AD</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">139</td><td align="center" rowspan="1" colspan="1">7.2</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Mid-Eastern/ Egyptian peoples</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Goldstein et al. [<xref rid="B404" ref-type="bibr">419</xref>]</td><td align="center" rowspan="1" colspan="1">1976</td><td align="left" rowspan="1" colspan="1">Tel Sheva, Negev</td><td align="left" rowspan="1" colspan="1">200 BC</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">73</td><td align="center" rowspan="1" colspan="1">0.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Ortner [<xref rid="B403" ref-type="bibr">420</xref>]</td><td align="center" rowspan="1" colspan="1">1979</td><td align="left" rowspan="1" colspan="1">Bâb edh-Dhrâ, Jordan</td><td align="left" rowspan="1" colspan="1">Early Bronze Age (3150–2200 BC)</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">92</td><td align="center" rowspan="1" colspan="1">10.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Mathieson et al. [<xref rid="B405" ref-type="bibr">421</xref>]</td><td align="center" rowspan="1" colspan="1">1997</td><td align="left" rowspan="1" colspan="1">Gisr el-Mudir, Saqqara, Egypt</td><td align="left" rowspan="1" colspan="1">2890–2650 BC</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">24</td><td align="center" rowspan="1" colspan="1">41.7</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Indigenous peoples</italic></td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Lahr and Bowan [<xref rid="B413" ref-type="bibr">422</xref>]</td><td align="center" rowspan="1" colspan="1">1992</td><td align="left" rowspan="1" colspan="1">Kechipawan, New Mexico</td><td align="left" rowspan="1" colspan="1">1300–1600</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">54</td><td align="center" rowspan="1" colspan="1">0.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Pfeiffer [<xref rid="B410" ref-type="bibr">423</xref>]</td><td align="center" rowspan="1" colspan="1">1984</td><td align="left" rowspan="1" colspan="1">Uxbridge, Ontario</td><td align="left" rowspan="1" colspan="1">1490</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">312<sup>∧</sup></td><td align="center" rowspan="1" colspan="1">3.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Clabeaux [<xref rid="B411" ref-type="bibr">424</xref>]</td><td align="center" rowspan="1" colspan="1">1977</td><td align="left" rowspan="1" colspan="1">Fort Erie, Niagara River, Ontario</td><td align="left" rowspan="1" colspan="1">Pre- colonization</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">286</td><td align="center" rowspan="1" colspan="1">7.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Wakefield et al. [<xref rid="B408" ref-type="bibr">425</xref>]</td><td align="center" rowspan="1" colspan="1">1937</td><td align="left" rowspan="1" colspan="1">Eastern Arkansas</td><td align="left" rowspan="1" colspan="1">Pre- colonization</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">100</td><td align="center" rowspan="1" colspan="1">10.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Gregg et al. [<xref rid="B412" ref-type="bibr">426</xref>]</td><td align="center" rowspan="1" colspan="1">1981</td><td align="left" rowspan="1" colspan="1">Crow Creek, South Dakota</td><td align="left" rowspan="1" colspan="1">14th century</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">486</td><td align="center" rowspan="1" colspan="1">2.1</td><td align="center" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1">Miles [<xref rid="B479" ref-type="bibr">427</xref>]</td><td align="center" rowspan="1" colspan="1">1975</td><td align="left" rowspan="1" colspan="1">Mesa Verde, Colorado</td><td align="left" rowspan="1" colspan="1">750–1300 AD</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">179</td><td align="center" rowspan="1" colspan="1">0.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Goldstein [<xref rid="B480" ref-type="bibr">428</xref>]</td><td align="center" rowspan="1" colspan="1">1957</td><td align="left" rowspan="1" colspan="1">Texas</td><td align="left" rowspan="1" colspan="1">800–1700 AD</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">146</td><td align="center" rowspan="1" colspan="1">0.0</td></tr><tr><td align="left" rowspan="1" colspan="1"> Loveland et al. [<xref rid="B409" ref-type="bibr">429</xref>]</td><td align="center" rowspan="1" colspan="1">1985</td><td align="left" rowspan="1" colspan="1">Red River County, Texas</td><td align="left" rowspan="1" colspan="1">1100–1800 AD</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">75</td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Wheeler [<xref rid="B414" ref-type="bibr">430</xref>]</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">El Morro Valley, New Mexico</td><td align="left" rowspan="1" colspan="1">13th Century</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">26</td><td align="center" rowspan="1" colspan="1">0.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Merbs and Vestergaard [<xref rid="B415" ref-type="bibr">431</xref>]</td><td align="center" rowspan="1" colspan="1">1985</td><td align="left" rowspan="1" colspan="1">Sundown, Prescott, Arizona</td><td align="left" rowspan="1" colspan="1">1100–1200 AD</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">26</td><td align="center" rowspan="1" colspan="1">0.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Drusini et al. [<xref rid="B407" ref-type="bibr">432</xref>]</td><td align="center" rowspan="1" colspan="1">1987</td><td align="left" rowspan="1" colspan="1">Maguana, Santo Domingo</td><td align="left" rowspan="1" colspan="1">late 15th century</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">108</td><td align="center" rowspan="1" colspan="1">46.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Western Europe</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">8</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">12</td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">25</td><td align="center" rowspan="1" colspan="1">5089</td><td align="center" rowspan="1" colspan="1">4.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Eastern Europe</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">668</td><td align="center" rowspan="1" colspan="1">6.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Mediterra- nean</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">577</td><td align="center" rowspan="1" colspan="1">3.5</td></tr><tr><td align="left" rowspan="1" colspan="1">Middle East</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">189</td><td align="center" rowspan="1" colspan="1">10.6</td></tr><tr><td align="left" rowspan="1" colspan="1">Indigenous</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">11</td><td align="center" rowspan="1" colspan="1">1798</td><td align="center" rowspan="1" colspan="1">6.1</td></tr><tr><td align="left" rowspan="1" colspan="1">All</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">26</td><td align="center" rowspan="1" colspan="1">17</td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">44</td><td align="center" rowspan="1" colspan="1">8321</td><td align="center" rowspan="1" colspan="1">5.3</td></tr></tbody></table><table-wrap-foot><fn><p><sup>∧</sup>The skeletal remains derived from an ossuary make it impossible to reconstruct each individual from the commingled bones; the minimal number of individual skeletons is given. This results in a prevalence that cannot exceed the number calculated but may be less if there were more individuals represented in the ossuary.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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