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Evaluation and Referral for Developmental Dysplasia of the Hip in Infants
Insights
Developmental dysplasia of the hip (DDH) screening aims to detect dislocations early. Current guidelines offer updated direction for clinicians, acknowledging controversies in diagnosing and treating milder hip dysplasia cases.
Area of Science:
- Orthopedics
- Pediatrics
- Radiology
Background:
- Developmental dysplasia of the hip (DDH) presents a spectrum of severity, impacting 1-2% of infants and causing significant arthritis and hip replacements in adults.
- Early detection of DDH is crucial for effective treatment, yet screening practices lack uniformity and robust evidence, leading to ongoing debate.
- Recent studies suggest observation for mild hip variations, contrasting with historical screening approaches.
Purpose of the Study:
- To provide updated, literature-based guidance for clinicians on screening and referral for developmental dysplasia of the hip (DDH).
- To emphasize the primary goal of preventing or detecting hip dislocation by 6-12 months in healthy children.
- To acknowledge limitations in screening programs and the persistent controversy surrounding milder forms of hip dysplasia.
Main Methods:
- Literature review and synthesis of recent evidence-based guidelines and studies.
- Analysis of developments in DDH screening and diagnostic criteria since 2000.
- Consideration of recommendations from major pediatric and orthopedic organizations.
Main Results:
- Significant advancements in understanding DDH, including evidence supporting observation for minor ultrasonographic variations.
- Lack of consensus on ultrasonographic diagnostic criteria for DDH versus developmental variations.
- Emergence of new evidence-based guidelines, such as from the American Academy of Orthopaedic Surgeons.
Conclusions:
- Clinicians require updated direction for DDH screening and referral, balancing early detection with evidence on managing milder forms.
- The diagnosis and treatment of mild hip dysplasia remain areas of controversy and require careful clinical judgment.
- No screening program has completely eliminated late-presenting hip dislocations, highlighting the need for ongoing vigilance.
Abstract:
Developmental dysplasia of the hip (DDH) encompasses a wide spectrum of clinical severity, from mild developmental abnormalities to frank dislocation. Clinical hip instability occurs in 1% to 2% of full-term infants, and up to 15% have hip instability or hip immaturity detectable by imaging studies. Hip dysplasia is the most common cause of hip arthritis in women younger than 40 years and accounts for 5% to 10% of all total hip replacements in the United States. Newborn and periodic screening have been practiced for decades, because DDH is clinically silent during the first year of life, can be treated more effectively if detected early, and can have severe consequences if left untreated. However, screening programs and techniques are not uniform, and there is little evidence-based literature to support current practice, leading to controversy. Recent literature shows that many mild forms of DDH resolve without treatment, and there is a lack of agreement on ultrasonographic diagnostic criteria for DDH as a disease versus developmental variations. The American Academy of Pediatrics has not published any policy statements on DDH since its 2000 clinical practice guideline and accompanying technical report. Developments since then include a controversial US Preventive Services Task Force "inconclusive" determination regarding usefulness of DDH screening, several prospective studies supporting observation over treatment of minor ultrasonographic hip variations, and a recent evidence-based clinical practice guideline from the American Academy of Orthopaedic Surgeons on the detection and management of DDH in infants 0 to 6 months of age. The purpose of this clinical report was to provide literature-based updated direction for the clinician in screening and referral for DDH, with the primary goal of preventing and/or detecting a dislocated hip by 6 to 12 months of age in an otherwise healthy child, understanding that no screening program has eliminated late development or presentation of a dislocated hip and that the diagnosis and treatment of milder forms of hip dysplasia remain controversial.
