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Screening for Developmental Dysplasia of the Hip: Recommendation Statement

Abbreviations: USPSTF—US Preventive Services Task Force • DDH—developmental dysplasia of the hip • AVN—avascular necrosis of the hip • AAP—American Academy of Pediatrics

The first 300 words of the full text of this article appear below.

The US Preventive Services Task Force (USPSTF) concludes that evidence is insufficient to recommend routine screening for developmental dysplasia of the hip (DDH) in infants as a means to prevent adverse outcomes (I recommendation).^*

The pathophysiology and natural history of DDH are poorly understood. There is evidence that screening leads to earlier identification; however, 60% to 80% of the hips of newborns identified as abnormal or as suspicious for DDH by physical examination and >90% of those identified by ultrasound in the newborn period resolve spontaneously and require no intervention. There is poor evidence (poor-quality studies) of the effectiveness of both surgical and nonsurgical interventions; avascular necrosis of the hip (AVN) is reported in 0% to 60% of children who are treated for DDH. Thus, the USPSTF was unable to assess the balance of benefits and harms of screening for DDH but was concerned about the potential harms associated with treatment of infants identified by routine screening.

	CLINICAL CONSIDERATIONS

 

• This USPSTF screening recommendation applies only to infants who do not have obvious hip dislocations or other abnormalities evident without screening. DDH represents a spectrum of anatomic abnormalities in which the femoral head and the acetabulum are aligned improperly or grow abnormally. DDH can lead to premature degenerative joint disease, impaired walking, and pain. Risk factors for DDH include female gender, family history of DDH, breech positioning, and in utero postural deformities. However, the majority of cases of DDH have no identifiable risk factors.
  
• Screening tests for DDH have limited accuracy. The most common methods of screening are serial physical examinations of the hip and lower extremities using the Barlow and Ortolani procedures and ultrasonography. The Barlow examination is performed by adducting a flexed hip with gentle posterior force to identify a dislocatable hip. The Ortolani examination is performed by abducting a flexed . . . [Full Text of this Article]

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