Early detection of developmental dysplasia of the hip: An evidence-based review

Abstract

Introduction: The developmental dysplasia of the hip (DDH) is the most frequent pathology in children. An early detection of DDH is very important to prevent invasive interventions. DDH screening strategies are still controversial. Objectives: To perform a review based on the evidence of when, to whom and how to make an early detection of DDH and to define the follow-up based on the results. Methodology: A research was conducted based on the MEDLINE database of: randomized clinical trials (RCT), meta-analysis, and cohort and case-control studies until July of 2005. The remarks of two systematic reviews were also analysed: American Academy of Paediatrics and Canadian Task Force on Preventive Health Care. The articles were evaluated by significance levels based on the Strength of Recommendation Taxonomy. A total of 83 articles were included in the review. Results: Three DDH early detections were benchmarked: clinical exam, selective ultrasonography (US) and universal US. Only two RCT studies were conducted, and no significant statistical differences were detected. Discussion: The DDH detection clinical exam must be carried-out to all newborns and during the infant periodical vigilance (recommendation B). Female gender, positive family history for DDH and birth pelvic presentation are risk factors to be considered in case the physical exam results turn out to be negative or doubtful (recommendation A). Conclusions: An evidence based decision algorithm is hereby proposed. Other studies, namely more RCTs that compare the effectiveness of the three defined strategies should be conducted.