New Guidelines for Treatment and Management of Developmental Dysplasia of the Hip in Pediatrics

The American Academy of Orthopaedic Surgeons (AAOS) recently published its clinical practice guideline for detection and nonoperative treatment of developmental dysplasia of the hip (DDH) in pediatric patients. It has been officially endorsed by the American Academy of Pediatrics (AAP), Pediatric Orthopaedic Society of North America, Society of Diagnostic Medical Sonography and the Society for Pediatric Radiology. The intent of the guidelines was to improve treatment and management based on current evidence. The current guidelines used an intense standardized methodology that led to nine recommendations. These recommendations were based on the quality of the evidence. This guideline as well as the AAP Technical Report guideline developed in 2000 continue to support clinical screening of children for DDH. There are some differences between guidelines, though, specifically the age shift in targeted population in the new guideline to include infants only up until six months versus walking age. The nine recommendations include: Universal ultrasound screening, evaluations of infants with risk factors for DDH, imaging of the unstable hip, imaging of the infant hip, surveillance after normal infant hip exam, stable hip with ultrasound imaging abnormalities, treatment of clinical instability, type of brace for the unstable hip, and monitoring of patients during brace treatment. The first two recommendations are the most significant as they are of moderate strength meaning that the benefits exceed the potential harm. Universal ultrasonography screening of newborn infants is not recommended but performing imaging studies before six months of age in infants with significant risk factors is recommended. Risk factors that were determined significant include; breech presentation, family history, and a history of clinical instability. The remaining seven recommendations are of limited strength. These focus on early intervention and management. Only forty-two articles of the 3,990 citations found in peer-reviewed literature fit the rigorous inclusion criteria. It is the authors recommendations that a “concerted and collaborative research effort” is required from the orthopaedic surgeon community to improve the evidence and strengthen the recommendations for future updates of the new guidelines. Readers are encouraged to consult the full guidelines at as discussion of how each recommendation was made as well as the complete evidence report.