Developmental dysplasia of the hip

Abstract

Key Points: □ Skilled clinical examiners are capable of detecting the vast majority of developmental dysplasia of the hip (DDH) in neonates, and this remains the primary screening method in the United States. Ultrasound (US) is no better than these examiners but may improve DDH diagnosis or exclusion for less-experienced clinical examiners (strong evidence). □ The great majority of hips with neonatal laxity will spontaneously become normal (strong evidence). Of the newborns labeled as DDH by either clinical or US screening, about 90% will spontaneously become normal without treatment (strong evidence). When there is a displaced femoral head and acetabular dysplasia found from late-appearing DDH in a toddler or a preschooler, this usually will lead to an unfavorable long-term result and the need for corrective orthopedic procedures (strong evidence). □ The main aim of health care in DDH is to detect and treat DDH early and in doing so avoid multiple corrective procedures and prevent lifelong hip disease with significant costs (strong evidence). □ US hip imaging in neonates and infants, whether the static or the dynamic method, is highly sensitive to DDH when done by experienced operators but is not specific (false positives). The low specificity leads to overtreatment, excessive imaging, and higher costs. Like the clinical exam, the use of hip US may not prevent late DDH (moderate evidence). □ Hip US for DDH evaluation should not be performed prior to age 3 weeks due to normal neonatal hip laxity that produces high false-positive rates (moderate evidence). □ Conflicting data remain concerning the role of general neonatal or infant population US hip screening with regard to late emergence of DDH and its cost-effectiveness (moderate evidence). © 2010 Springer-Verlag New York.