[Table, Developmental Dysplasia of the Hip]. - The Guide to Clinical Preventive Services 2014

Title	Screening for Developmental Dysplasia of the Hip
Population	Infants who do not have obvious hip dislocations or other abnormalities evident without screening
Recommendation	No recommendation. Grade: I (Insufficient Evidence)

Title

Screening for Developmental Dysplasia of the Hip

Population

Infants who do not have obvious hip dislocations or other abnormalities evident without screening

Recommendation

No recommendation.
Grade: I (Insufficient Evidence)

Risk Assessment	Risk factors for developmental dysplasia of the hip include female sex, family history, breech positioning, and in utero postural deformities. However, the majority of cases of developmental dysplasia of the hip have no identifiable risk factors.
Screening Tests	Screening tests for developmental dysplasia of the hip have limited accuracy. The most common methods of screening are serial physical examinations of the hip and lower extremities, using the Barlow and Ortolani procedures, and ultrasonography.
Interventions	Treatments for developmental dysplasia of the hip include both nonsurgical and surgical options. Nonsurgical treatment with abduction devices is used as early treatment and includes the commonly prescribed Pavlik method. Surgical intervention is used when the dysplasia is severe or diagnosed late, or after an unsuccessful trial of nonsurgical treatment. Avascular necrosis of the hip is the most common and most severe potential harm of both surgical and nonsurgical interventions, and can result in growth arrest of the hip and eventual joint destruction, with significant disability.
Balance of Benefits and Harms	The USPSTF was unable to assess the balance of benefits and harms of screening for developmental dysplasia of the hip due to insufficient evidence. There are concerns about the potential harms associated with treatment of infants identified by routine screening.
Other Relevant USPSTF Recommendations	The USPSTF has made recommendations on screening for hyperbilirubinemia, phenylketonuria, sickle cell disease, congenital hypothyroidism, and hearing loss in newborns. These recommendations are available at http://www.uspreventiveservicestaskforce.org/.

Risk Assessment

Risk factors for developmental dysplasia of the hip include female sex, family history, breech positioning, and in utero postural deformities. However, the majority of cases of developmental dysplasia of the hip have no identifiable risk factors.

Screening Tests

Screening tests for developmental dysplasia of the hip have limited accuracy. The most common methods of screening are serial physical examinations of the hip and lower extremities, using the Barlow and Ortolani procedures, and ultrasonography.

Interventions

Treatments for developmental dysplasia of the hip include both nonsurgical and surgical options. Nonsurgical treatment with abduction devices is used as early treatment and includes the commonly prescribed Pavlik method.
Surgical intervention is used when the dysplasia is severe or diagnosed late, or after an unsuccessful trial of nonsurgical treatment. Avascular necrosis of the hip is the most common and most severe potential harm of both surgical and nonsurgical interventions, and can result in growth arrest of the hip and eventual joint destruction, with significant disability.

Balance of Benefits and Harms

The USPSTF was unable to assess the balance of benefits and harms of screening for developmental dysplasia of the hip due to insufficient evidence. There are concerns about the potential harms associated with treatment of infants identified by routine screening.

Other Relevant USPSTF Recommendations

The USPSTF has made recommendations on screening for hyperbilirubinemia, phenylketonuria, sickle cell disease, congenital hypothyroidism, and hearing loss in newborns. These recommendations are available at http://www.uspreventiveservicestaskforce.org/.

From: Clinical Summaries of Recommendations for Children and Adolescents

Cover of The Guide to Clinical Preventive Services 2014

The Guide to Clinical Preventive Services 2014: Recommendations of the U.S. Preventive Services Task Force.

Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 May.

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