Detection and treatment of developmental dysplasia of the hip in infants: updates and recommendations.

Abstract

Purpose of review: Developmental dysplasia of the hip (DDH) is common and is a source of potentially avoidable morbidity through childhood and adult life. Despite progress over the past century, there is a wide variation in policy, practice and outcomes between countries. This review considers information from a geographically wide range of locations to evaluate the impact of these variations and understand how these variations arise. The aim is to help clinicians and policymakers adopt the best practices for their population.

Recent findings: There is a lack of randomized controlled trials to guide decisions on screening. Given the large numbers to treat and preexisting practices, it is unlikely that such trials of sufficient statistical power will be performed. However, many whole population studies are becoming available from different countries that allow an assessment and comparison of the impact of their strategies.

Summary: Standardizing metrics in studies and defining late diagnosis would improve comparisons across studies. The general trend appears to favour universal screening to reduce the risk of late diagnosis, the need for surgery and the subsequent poorer outcomes. Notably, resource-constrained countries like Mongolia have successfully implemented universal screening, showing that effective strategies can be adopted regardless of resources.