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Screening and Treatment of Developmental Dysplasia of the Hip in Children

Posted on: 11/30/1999
There has been some mixed opinion about the routine screening of all infants for a condition called developmental dysplasia of the hip (DDH). In this report, orthopedic surgeons from the Texas Scottish Rite Hospital for Children in Dallas, Texas offer an update on screening and treatment for DDH.

DDH actually refers to several similar conditions affecting the hip. A flattening of the acetabulum (hip socket) is the main problem. this is called dysplasia. Subluxation (partial dislocation) or complete dislocation occurs when the socket is so shallow that the head of the femur (thigh bone) slips out of the socket.

Finding this problem early can help prevent more serious problems later. Taking a history and conducting an exam by the doctor are the first screening steps. If there are concerns, further testing with X-rays or ultrasound can be done.

The American Academy of Pediatrics put out guidelines in the year 2000 for routine DDH screening. But the U.S. Preventive Services Task Force concluded there wasn't enough proof that routine screening for DDH makes a difference.

Other experts from the Pediatric Orthopaedic Society of North America (POSNA) disagreed with the task force. They believe that without screening many more children will suffer hip dislocations that could be prevented with screening. The authors of this article agree with POSNA.

After reviewing all available studies, it appears there is enough evidence to support routine screening. If there are any signs of hip instability at birth, an ultrasound should be done six to eight weeks later.

Precautions can be taken to prevent hip dislocation in the meantime. With intervention, waiting to confirm the diagnosis won't cause further problems. Delaying the ultrasound by a few months reduces the chances of a false positive report.

A false positive test means there are abnormal findings that show up on the imaging but are not really present. In some cases, the abnormalities are present but go away with time and do not require further treatment or evaluation.

The authors note that some studies show the link between DDH and hip osteoarthritis. And it's not clear yet how long surgical treatment can be delayed. The timing and upper age limit for reduction of a dislocated hip remains a hotly debated topic.

Finally, a brief summary of the results of important studies is also presented by age (birth to six months, six months to two years, older than two years) and diagnosis (dysplasia, subluxation, dislocation).

References:
Jeffrey E. Martus, and Daniel J. Sucato, MD. Developmental Disorders of the Hip Age 0-8 Years. In Current Opinion in Orthopaedics. November 2007. Vol. 18. No. 6. Pp. 529-535.

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