The management of developmental dysplasia of the hip in children aged under three months

Abstract

Aims A national screening programme has existed in the UK for the diagnosis of developmental dysplasia of the hip (DDH) since 1969. However, every aspect of screening and treatment remains controversial. Screening programmes throughout the world vary enormously, and in the UK there is significant variation in screening practice and treatment pathways. We report the results of an attempt by the British Society for Children’s Orthopaedic Surgery (BSCOS) to identify a nationwide consensus for the management of DDH in order to unify treatment and suggest an approach for screening. Methods A Delphi consensus study was performed among the membership of BSCOS. Statements were generated by a steering group regarding aspects of the management of DDH in children aged under three months, namely screening and surveillance (15 questions), the technique of ultrasound scanning (eight questions), the initiation of treatment (19 questions), care during treatment with a splint (ten questions), and on quality, governance, and research (eight questions). A two-round Delphi process was used and a consensus document was produced at the final meeting of the steering group. Results A total of 60 statements were graded by 128 clinicians in the first round and 132 in the second round. Consensus was reached on 30 out of 60 statements in the first round and an additional 12 in the seond. This was summarized in a consensus statement and distilled into a flowchart to guide clinical practice. Conclusion We identified agreement in an area of medicine that has a long history of controversy and varied practice. None of the areas of consensus are based on high-quality evidence. This document is thus a framework to guide clinical practice and on which high-quality clinical trials can be developed. Cite this article: Bone Joint J 2023;105-B(2):209–214.

An Explorative Study into the Aetiology of Developmental Dysplasia of the Hip Using Targeted Urine Metabolomics

“…The potential implications of this new information are considerable, for both screening and treatment strategies. In the UK, 1 in 200 babies are diagnosed with DDH [ 1 ], yet the screening programme is far from optimal [ 33 ]. If DDH could be linked to specific metabolic markers, efficiencies would be instantaneous for the national screening programme.…”

75 years young

“…We feel that this is critical as consensus as a publishing concept has become increasingly popular. [2][3][4][5][6] The choice of this modality must be made carefully; however, it does not replace original research that must continue in these areas. We have nevertheless seen some good consensus work where conclusions are difficult to reach from the current literature, and a concise summary of when and how to undertake this type of work will be important to future researchers and to our readers.…”

Children’s orthopaedics

“…The British Society for Children's Orthopaedic Surgery (BSCOS) has been focusing on providing 'best practice' guidance on common paediatric orthopaedic conditions, with this paper from various institutions in the UK focused on the treatment of DDH after early diagnosis. 6 The management of hip dysplasia varies hugely across the world, however the majority of surgeons would advocate abduction bracing for early displaced hips. In order to generate a consensus approach, the researchers performed a Delphi consensus study amongst the high-quality evidence, the authors (and we here at BJ360) hope that this will form the basis for further high-quality research.…”