Developmental dysplasia of the hip: addressing evidence gaps with a multicentre prospective international study

Schaeffer, Emily K; IHDI Study Group; Mulpuri, Kishore

doi:10.5694/mja18.00154

ARTICLE
AUTHORS
REFERENCES

Topics

Diagnostic techniques and procedures

Musculoskeletal diseases

Pediatric medicine

Summary

There is a lack of high quality evidence available to guide clinical practice in the treatment and management of developmental dysplasia of the hip (DDH).
Evidence has been limited by persistent confusion on diagnostic and classification terminology, variability in surgeon decision making and a reliance on single centre, retrospective studies with small patient numbers.
To address gaps in knowledge regarding screening, diagnosis and management of DDH, the International Hip Dysplasia Institute began a multicentre, international prospective study on infants with hips dislocated at rest.
This review discusses the current state of screening, diagnostic and management practices in DDH and addresses important unanswered questions that will be critical in identifying best practices and optimising patient outcomes.
There is insufficient evidence to support universal ultrasound screening; instead, selective screening should be performed by 6–8 weeks of age on infants with risk factors of breech presentation, family history, or history of clinical hip instability. Follow-up of infants with risk factors and normal initial screening should be considered to at least 6 months of age.
Brace treatment is a sensible first-line treatment for management of dislocated hips at rest in infants < 6 months of age.
Early operative reduction may be considered as there is insufficient evidence to support a protective role for the ossific nucleus in the development of avascular necrosis.

1 BC Children's Hospital, Vancouver, Canada
2 University of British Columbia, Vancouver, Canada
3 Orlando Health Center, Orlando, FL, USA

Correspondence: kmulpuri@cw.bc.ca

Acknowledgements:

We thank members of the IHDI Study Group for their intellectual and data contributions to the IHDI and IHDR studies; and Niamul Quader for supplying the image and data for Box 3.

Competing interests:

We have received funding for research support from the registry seed grant, the IHDI, the Children’s Hospital Research Institute and the I'm a HIPpy Foundation.

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Developmental dysplasia of the hip: addressing evidence gaps with a multicentre prospective international study

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