Normal pelvic radiograph at 4 months can reliably exclude DDH in children with risk factors [56] and decrease the need for treatment in infants who are 4 to 6 months of age with positive US by 40% [58]. This eliminates unnecessary serial follow-ups and potential for iatrogenic treatment-related complications. Thus, for infants with suspected hip dysplasia, a radiograph is often obtained between 4 to 6 months of age [21,56-58]. However, there are a few limitations to pelvic radiograph. The timing for the appearance of the ossific nucleus varies widely, from 1.5 to 8 months of age [65], and in dysplastic hips, its appearance is often delayed and, when it does appear, is often eccentric [54,70]. US Hips There is insufficient evidence to recommend the use of US as the evaluation may be inadequate because of the suboptimal visualization of the anatomy of the hip joint from decreased acoustic penetration. Radiography Pelvis Shortly after the appearance of the ossific nucleus, pelvic radiography becomes the preferred imaging modality as it facilitates the assessment of the femoral head ossific nucleus and the development of the proximal femur and bony acetabular morphology [1]. There is ongoing debate regarding the necessity of serial radiographic studies for Variant 6: Child, younger than 6 months of age. Known diagnosis of DDH, nonoperative surveillance imaging in harness. The treatment algorithm for DDH varies among practices but typically includes a trial of nonoperative management using abduction splinting, often with a Pavlik harness. The efficacy of the Pavlik harness decreases with age. It is most effective if the harness is applied before 6 weeks of age, and the harness can be used up to 6 months of age. The overall success rate of the harness ranges from 67% to 83% [28]. Surgical intervention is typically reserved for children with severe dysplasia or dislocation, late presentation or diagnosis, or failed nonoperative management [73].
Developmental Dysplasia of the Hip Child. Normal pelvic radiograph at 4 months can reliably exclude DDH in children with risk factors [56] and decrease the need for treatment in infants who are 4 to 6 months of age with positive US by 40% [58]. This eliminates unnecessary serial follow-ups and potential for iatrogenic treatment-related complications. Thus, for infants with suspected hip dysplasia, a radiograph is often obtained between 4 to 6 months of age [21,56-58]. However, there are a few limitations to pelvic radiograph. The timing for the appearance of the ossific nucleus varies widely, from 1.5 to 8 months of age [65], and in dysplastic hips, its appearance is often delayed and, when it does appear, is often eccentric [54,70]. US Hips There is insufficient evidence to recommend the use of US as the evaluation may be inadequate because of the suboptimal visualization of the anatomy of the hip joint from decreased acoustic penetration. Radiography Pelvis Shortly after the appearance of the ossific nucleus, pelvic radiography becomes the preferred imaging modality as it facilitates the assessment of the femoral head ossific nucleus and the development of the proximal femur and bony acetabular morphology [1]. There is ongoing debate regarding the necessity of serial radiographic studies for Variant 6: Child, younger than 6 months of age. Known diagnosis of DDH, nonoperative surveillance imaging in harness. The treatment algorithm for DDH varies among practices but typically includes a trial of nonoperative management using abduction splinting, often with a Pavlik harness. The efficacy of the Pavlik harness decreases with age. It is most effective if the harness is applied before 6 weeks of age, and the harness can be used up to 6 months of age. The overall success rate of the harness ranges from 67% to 83% [28]. Surgical intervention is typically reserved for children with severe dysplasia or dislocation, late presentation or diagnosis, or failed nonoperative management [73].