Early detection of developmental hip dysplasia: synopsis of the AAP Clinical Practice Guideline.

Abstract

1. Michael J. Goldberg, MD* 1. 2. *Tufts University School of Medicine, New England Medical Center, Boston, MA. This article provides a summary of the practice parameter of early detection of developmental dysplasia of the hip. The reader is urged to refer to the original document for a more thorough presentation.(1) Developmental dysplasia of the hip (DDH) is the preferred term to describe the condition in which the femoral head has an abnormal relationship to the acetabulum. DDH encompasses frank dislocation (luxation), partial dislocation (subluxation), instability wherein the femoral head moves in and out of the socket, and an array of radiographic abnormalities that reflect inadequate formation of the acetabulum. Because many of these findings may not be present at birth, the term “developmental” more accurately reflects the biologic features than does the term “congenital.” DDH may occur in utero, perinatally, or during infancy and childhood. The disorder is uncommon. Treatment is simpler and more effective when the dislocation is detected early. Despite newborn screening programs, dislocated hips continue to be diagnosed later in infancy and childhood. Late detection often delays appropriate therapy and frequently leads to a malpractice claim. The true incidence of DDH can only be presumed. There is no gold standard for diagnosis among newborns. Physical examination, plane radiography, and ultrasonography all are fraught with false-positive and false-negative results. The reported incidence of DDH is influenced by genetic and racial factors, diagnostic criteria, the experience and training of the examiner, and the age of the child at the time of examination. Some newborn screening surveys suggest evidence of instability in as many as 1 in 100 newborns and 1 to 1.5 cases of dislocation per 1,000 newborns. Regardless of the screening method used for the newborn, DDH is detected in 1 of 5,000 infants at 18 months of age. The object of this guideline is to reduce the number of dislocated hips detected …