6 responses to “Screening for developmental dysplasia of the hip: an evidence-based approach to practice”

  1. useful review

  2. How sensitive is selective ultrasound as compared with radiographs?

  3. I’d be interested in knowing how many “late diagnosed” DDH hips there are. Additionally, what is the NNT for U/S screening of (clinically normal) breech babies or those with a (+) FHx in order to prevent one early-life hip replacement (or substantial disability due to early onset OA)

  4. If a newborn passes the initial clinical screen, is there a need to repeat the exam periodically, and if so , how often and to what age ?

  5. From a Physio perspective, what is the impact, if any, of late bracing on reaching developmental milestones??
    My son was in the Pavlic harness from day 2 of life and was out by 9 weeks old with the final two weeks only wearing at night.

  6. Here are some answers to the comments:

    2. Ultrasounds are ideally used in patients <4 months, while radiographs become useful after the age of 4 months. They are more complementary diagnostic methods rather than comparative ones, and different measures/outcomes are collected from each.

    3. The International Hip Dysplasia Institute (IHDI) has a current prospective study collecting outcomes in DDH. This study has found 34% of patients to be “late-presenting” (defined as diagnosed after 3 months of age) [Mulpuri et al. “What risk factors and characteristics are associated with late-presenting dislocations of the hip in infants?” Clin Orthop Rel Res. 2016 epub]. However, this is likely an overestimate of late-presenting cases as the centres in the study are tertiary referral centres. A lower incidence of late-presenting cases has been seen in other studies [Azzopardi et al J Pediatr Orthop B 2011;20:1-7; Laborie et al Pediatr Radiol 2014;44:410-424; Sharpe et al Arch Dis Child Fetal Neonatal Ed 2006;91:F158-162]. We do not currently know the NNT for screening breech or family history babies.

    4. Every baby should have a clinical hip exam performed at birth. Should that initial clinical screen be normal, hip checks should still be routinely be performed as a part of regular well-baby exams.

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