Developmental dysplasia of the hip in infants and children
BMJ 2023; 383 doi: https://doi.org/10.1136/bmj-2023-074507 (Published 23 November 2023) Cite this as: BMJ 2023;383:e074507
- Alf Nicholson, head of school1,
- Kevin Dunne, professor of paediatrics1,
- Sarah Taaffe, general practitioner2,
- Yusra Sheikh, consultant paediatric radiologist3,
- John Murphy, consultant neonatologist4
- 1RCSI Bahrain, Kingdom of Bahrain
- 2Irish College of General Practitioners, Dublin, Ireland
- 3Department of Paediatric Radiology, Children’s Health Ireland at Temple Street, Dublin, Ireland
- 4Department of Neonatology, National Maternity Hospital, Dublin, Ireland
- Correspondence to anicholson{at}rcsi-mub.com
What you need to know
Developmental dysplasia of the hip (DDH) is a spectrum of conditions, ranging from a shallow acetabulum with or without instability to a completely dysplastic, unstable, or dislocated hip
Diagnostic accuracy of clinical examination in the newborn period and at the 6-8 week check is low
Signs suggestive of DDH vary according to age, and use of ultrasound increases detection
Late diagnoses increase the need for operative intervention and have long term implications for patients and their families
Whether to screen infants selectively or universally with ultrasound remains controversial, and the body of evidence to support universal ultrasound screening is growing
A 14 month old boy has started to walk over the previous six weeks. His parents are concerned that he is in discomfort and thus tends to walk with a limp. He was born by spontaneous vertex delivery and routine clinical reviews by a midwife on day two of life and his general practitioner at six weeks were normal. He has no family history of developmental dysplasia of the hip (DDH). Observation of his gait shows a left sided limp with apparent shortening of the left leg. An urgent x ray shows a left sided DDH. He is referred to orthopaedics urgently and placed in a hip spica. His parents are perplexed about the late diagnosis and ask about his prognosis.
What is developmental dysplasia of the hip?
DDH is a spectrum of conditions, ranging from a shallow acetabulum (acetabular dysplasia) with or without instability to a completely dysplastic, unstable, or dislocated hip. In most high income countries, DDH is diagnosed by physical examination, supplemented using static or dynamic ultrasound assessment, which can detect DDH across different stages.12 Clinical screening alone is associated with late diagnoses, which can lead to unnecessary surgical intervention, lifelong disability, and litigation.
How common is it?
Mild forms of DDH overlap with physiological immaturity, …
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