Although most physicians recommend the first imaging screening for nondislocated hips to be performed at 4 to 6 weeks of age, thus allowing time for normalization of neonatal physiologic immaturity and laxity, this remains an arbitrary time-point, balancing the risk of increased false-positive studies in early age with the potential benefits of early treatment. In a study of 5,170 infants screened at 1 month of age, 99.6% remained normal and 84% to 95% of Graf type II hips normalized at 3 months, indicating that the vast majority continue to normalize after the first month of life [60]. Because of the high false-positive rate of diagnosis with US, the AAP recommends selective US only in the highest risk group, girls with breech presentation at birth [1]. AAP also suggests US as an option in girls with a positive family history, boys with breech presentation, and when the physical examination is inconclusive [1]. US Hips A prospective study using US screening was performed on 2,578 children with an unstable hip on physical examination or risk factors for developmental dysplasia. Screening US was shown to reduce the number of delayed diagnoses and decrease the rate of surgical intervention when compared to clinical screening alone [61]. Other studies have shown that US can help confirm the diagnosis of DDH, leading to a change in the clinical management [62,63]. Variant 3: Child, younger than 4 months of age. Physical findings of DDH. Initial imaging. For the purpose of this variant, positive physical examination is defined as a positive Barlow or Ortolani test, which implies an unstable femoral head that can be dislocated or relocated, respectively [66]. US Hips The AAP guideline published in 2000 [1] did not recommend US screening after a positive physical examination. However, recent studies have shown that 41% to 58% of abnormal findings from a physical examination were Variant 4: Child, between 4 to 6 months of age. Concern for DDH. Initial imaging.
Developmental Dysplasia of the Hip Child. Although most physicians recommend the first imaging screening for nondislocated hips to be performed at 4 to 6 weeks of age, thus allowing time for normalization of neonatal physiologic immaturity and laxity, this remains an arbitrary time-point, balancing the risk of increased false-positive studies in early age with the potential benefits of early treatment. In a study of 5,170 infants screened at 1 month of age, 99.6% remained normal and 84% to 95% of Graf type II hips normalized at 3 months, indicating that the vast majority continue to normalize after the first month of life [60]. Because of the high false-positive rate of diagnosis with US, the AAP recommends selective US only in the highest risk group, girls with breech presentation at birth [1]. AAP also suggests US as an option in girls with a positive family history, boys with breech presentation, and when the physical examination is inconclusive [1]. US Hips A prospective study using US screening was performed on 2,578 children with an unstable hip on physical examination or risk factors for developmental dysplasia. Screening US was shown to reduce the number of delayed diagnoses and decrease the rate of surgical intervention when compared to clinical screening alone [61]. Other studies have shown that US can help confirm the diagnosis of DDH, leading to a change in the clinical management [62,63]. Variant 3: Child, younger than 4 months of age. Physical findings of DDH. Initial imaging. For the purpose of this variant, positive physical examination is defined as a positive Barlow or Ortolani test, which implies an unstable femoral head that can be dislocated or relocated, respectively [66]. US Hips The AAP guideline published in 2000 [1] did not recommend US screening after a positive physical examination. However, recent studies have shown that 41% to 58% of abnormal findings from a physical examination were Variant 4: Child, between 4 to 6 months of age. Concern for DDH. Initial imaging.