Diagnosis and treatment of developmental dysplasia of the hip in the Netherlands: National questionnaire of paediatric orthopaedic surgeons on current practice in children less than 1 year old

Rick H M Heeres,J A Van Der Sluijs,M M E H Witbreuk

doi:10.1007/s11832-011-0355-1

Abstract

PurposeThere is no consensus in the literature regarding the diagnosis and treatment of developmental dysplasia of the hip (DDH). We designed a national questionnaire to assess the various opinions and current practice of paediatric orthopaedic surgeons in the Netherlands regarding the diagnosis and treatment of DDH in children less than 1 year old.MethodsThe questionnaire was sent to all members of the Dutch Paediatric Orthopaedic Society (DPOS). It discusses different methods and criteria used in the diagnosis of DDH, the use of different therapies and the use of different imaging techniques to evaluate the result of treatment.ResultsWith 38 responders, the overall response rate to the survey was 67%. Most surgeons use clinical, radiographic and/or ultrasound examination for the diagnosis. The starting point of treatment is usually on the mild part of the DDH spectrum. The Pavlik harness is most popular in the treatment of dislocated hips, whereas in dysplastic hips, most surgeons use a rigid splint. The duration of treatment has a wide range and evaluation of the effect of treatment is predominantly done by radiography.ConclusionsThe diagnosis and treatment of DDH in the Netherlands has as much diversity as the literature has recommendations about this subject. The lack of consensus on many aspects of DDH diagnosis and treatment should form the basis for a discussion among Dutch paediatric orthopaedic surgeons. Using the available evidence, it should be possible to formulate a more uniform protocol for the diagnosis and treatment of DDH.

Highlights

Purpose There is no consensus in the literature regarding the diagnosis and treatment of developmental dysplasia of the hip (DDH)
The lack of consensus on many aspects of DDH diagnosis and treatment should form the basis for a discussion among Dutch paediatric orthopaedic surgeons
In developmental dysplasia of the hip (DDH), the acetabular dysplasia is characterised by an immature, shallow acetabulum, which can be combined with subluxation or dislocation of the femoral head

Summary

Introduction

In developmental dysplasia of the hip (DDH), the acetabular dysplasia is characterised by an immature, shallow acetabulum, which can be combined with subluxation or dislocation of the femoral head. In the Netherlands, in the current screening protocol, the incidence of DDH in the first months of life is estimated at 3.7% and the incidence of hip dislocation at 0.4% [1]. As part of the programme for child health surveillance, screening for DDH in the Netherlands is selective: a selection of infants are referred for visualisation of the hip joint. This selection is done by the child healthcare centres. During the first year of life, the hips are clinically assessed at 3 months and 6 months. The clinical hip signs sought are leg length differences using the Galeazzi test and limited hip abduction in flexion

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