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

Abstract

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.

International Interdisciplinary Consensus Meeting on the Evaluation of Developmental Dysplasia of the Hip

“…Bacche et al [67], Imrie et al [68] and Clarke et al [27], all described scanning at 6 weeks. Kolb et al [69] and Schaeffer et al [70], both recommended scanning at 6 to 8 weeks. Choudry et al [71] recommended scanning babies with unilateral limitation of abduction at 8 weeks.…”

Dysplasia, malformation, or deformity? - explanation of the basis of hip development disorders and suggestions for future diagnostics and treatment

“…In the diagnosis and treatment of developmental hip joint disorders, there is a notable lack of uniform diagnostic and therapeutic standards in various countries around the world. This applies to the frequency of examinations and their complementarity 15,[31][32][33][34] . There is also the danger of not detecting so-called clinically mute developmental disorders 6,35 .…”

“…Detection of differences at the level of genomic DNA, characteristic of the group of patients with dysplasia, would allow classification of this disorder with varying degrees of aggressiveness based on the obtained genetic profiles. In the future, this could serve as a tool for planning personalized therapy and become part of international standards 15,[31][32][33][34] . Incorrect diagnosis resulting from incomplete patient data is the main cause of disability in childhood and adulthood, and treating such disability imposes a serious burden on state budgets 40 .…”

Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis

“…Closed reduction (CR) followed by 3-4 months immobilization in spica casting is considered the standard method for children presenting at 6-18 months of age, whereas the success rates varied in the literature. In order to improve the success of CR for the treatment of DDH, it is necessary to identify true predictors of failure [7] . In addition, the avascular necrosis (AVN) of the femoral head is the most feared and frequent complication after CR procedure.…”