In using imaging for assessment of babies with one or more risk factors but negative physical exam, there is no proven benefit to ultrasound at 6 weeks vs. Initial diagnostic ultrasound usually is deferred until after age 6 weeks because of the high rate of false positives or immature hips, which spontaneously resolve most often by age 6 weeks. Ultrasonography may be done earlier in guiding treatment of an Ortolani-positive hip. When an imaging study is indicated, whether by risk factors or by suspicious physical examination, it is best to defer diagnostic hip ultrasound until age 6 weeks (adjust for prematurity) or plain anteroposterior pelvis radiograph at ages 4-6 months. The report confirmed that no screening method completely eliminates the risk of late presentation of DDH. In other words, risk factors are poor indicators of DDH, and all children need to undergo periodic hip examination until they begin walking. The importance of the periodic exam cannot be overemphasized because other than female gender, most children with DDH do not have risk factors.
This exam should include the Ortolani test (see resources), hip abduction, gluteal or major thigh crease asymmetry (low specificity) and leg length inequality (Galeazzi sign). The report reinforces the earlier advice to carefully perform and document the periodic hip examination until the child is walking. history of abnormal hip physical examination in the neonatal period, which subsequently normalizes.breech position in the third trimester - both males and females.
Risk factors for which the pediatrician may wish to consider an imaging study in the child with a normal screening physical examination are:.If parents choose to swaddle their infants, encourage hip-healthy swaddling that allows freedom of hip motion and avoids forced position of hip extension and adduction (see ).While the report recognizes many controversies regarding diagnosis and treatment of DDH, it incorporates the latest clinical research and guidance from the American Academy of Orthopaedic Surgeons, and makes the following new recommendations: The purpose of surveillance is to allow early detection of significant hip dysplasia, which in turn permits early intervention and possible avoidance of surgery or future disability. and Canadian pediatric and orthopedic physician organizations, despite an “inconclusive” rating by the U.S.
Latest guidance New guidance on developmental dysplasia of the hip covers changes in risk factors that might prompt an imaging study.ĭDH screening, better termed surveillance, is recommended by all leading U.S. However, most of the guidance remains unchanged from a 2000 clinical practice guideline.Įvaluation and Referral for Developmental Dysplasia of the Hip in Infants, from the AAP Section on Orthopaedics, is available at and will be published in the December issue of Pediatrics. It also encourages hip-healthy methods of swaddling. A new AAP clinical report on the evaluation and referral for developmental dysplasia of the hip (DDH) in infants includes important recommended changes in DDH surveillance for the pediatrician related to risk factors that may prompt an imaging study.