Screening
Because of the "silent" nature of developmental dysplasia of the hip (DDH) in infants before the age at which they can crawl or walk, universal screening using physical exam is standard practice.
Physical exam
The Barlow and Ortolani tests are used to identify hip instability in infants until increased musculature limits their usefulness and sensitivity (around 3-6 months of age). Thereafter, an assessment of hip abduction should be performed. DDH can be bilateral, so symmetric abduction may be present although hip abduction will be limited.
Ultrasound scanning
Although some countries use ultrasound as a universal screening tool, the role of ultrasound as a screening test is controversial.[22][23] Canadian and US guidelines do not recommend universal ultrasound screening of newborn infants. In the US, guidelines suggest that ultrasound is a useful screening test in those infants with a much higher than average risk of DDH (selective screening).[10]
Previous guidelines have recommended ultrasound in all term, breech females. However, in a well-controlled prospective study, 90% of hips initially identified as abnormal spontaneously normalized by 2 to 6 weeks.[4] Therefore, to minimize the chance of false positives, ultrasound screening should be delayed until about 6 weeks of age.[5]
A further evidence-based clinical practice guideline supports performing an imaging study before 6 months of age in infants with one or more of the following risk factors: breech presentation, positive family history, or history of clinical instability.[10]
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