Standardized Diagnostic Criteria for Developmental Dysplasia of the Hip in Early Infancy

Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.
Clinical Orthopaedics and Related Research (Impact Factor: 2.88). 09/2011; 469(12):3451-61. DOI: 10.1007/s11999-011-2066-9
Source: PubMed

ABSTRACT Clinicians use various criteria to diagnose developmental dysplasia of the hip (DDH) in early infancy, but the importance of these various criteria for a definite diagnosis is controversial. The lack of uniform, widely agreed-on diagnostic criteria for DDH in patients in this age group may result in a delay in diagnosis of some patients.
Our purpose was to establish a consensus among pediatric orthopaedic surgeons worldwide regarding the most relevant criteria for diagnosis of DDH in infants younger than 9 weeks.
We identified 212 potential criteria relevant for diagnosing DDH in infants by surveying 467 professionals. We used the Delphi technique to reach a consensus regarding the most important criteria. We then sent the survey to 261 orthopaedic surgeons from 34 countries.
The response rate was 75%. Thirty-seven items were identified by surgeons as most relevant to diagnose DDH in patients in this age group. Of these, 10 of 37 (27%) related to patient characteristics and history, 13 of 37 (35%) to clinical examination, 11 of 37 (30%) to ultrasound, and three of 37 (8%) to radiography. A Cronbach alpha of 0.9 for both iterations suggested consensus among the panelists.
We established a consensus regarding the most relevant criteria for the diagnosis of DDH in early infancy and established their relative importance on an international basis. The highest ranked clinical criteria included the Ortolani/Barlow test, asymmetry in abduction of 20° or greater, breech presentation, leg-length discrepancy, and first-degree relative treated for DDH.
Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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    ABSTRACT: BACKGROUND: Wide variation exists in reported prevalence estimates and management standards of developmental dysplasia of the hip (DDH). Discrepancies in diagnosticians' opinions may explain some of this variation. QUESTIONS/PURPOSES: We sought to determine (1) the consistency with which pediatric orthopaedic surgeons rate the importance of diagnostic criteria for DDH, and (2) whether there were geographic differences in how the diagnostic criteria were rated by surgeons. METHODS: One hundred ninety-seven of 220 members of the European Paediatric Orthopaedic Society and 100 of 148 members of the British Society of Children's Orthopaedic Surgery treating children with DDH participated in this cross-sectional study across 35 countries (15 regions). Each rated 37 items in four domains that specialists previously had identified as the most important features associated with DDH in early infancy. We determined consistency using the intraclass correlation coefficient (ICC; two-way random-effects model) interpreted as poor (0-0.40), acceptable (0.41-0.74), or good (≥ 0.75). RESULTS: Poor consistency among surgeons was found in rating the 37 diagnostic criteria (ICC, 0.33; 95% CI, 0.24-0.45). Consistency was poor for three domains (patient characteristics/history: ICC, 0.29; 95% CI, 0.16-0.58; ultrasound: ICC, 0.26; 95% CI, 0.14-0.52; radiography: ICC, 0.34; 95% CI, 0.12-0.95) and acceptable for one (clinical examination: ICC, 0.50; 95% CI, 0.33-0.73). Surgeons in particular regions appeared to have a concept of DDH diagnosis that distinguished them from specialists of other regions; consistency in eight regions was greater (ICC ≥ 0.40) than consistency among all 15 regions. CONCLUSIONS: The consistency of specialists in rating diagnostic criteria for DDH was lower than expected, and there was considerable geographic variation in terms of how specialists assigned importance ratings of the diagnostic criteria; these findings are somewhat counterintuitive, given the frequency with which this condition is diagnosed. These inconsistencies could explain, partly, the widely differing prevalence estimates and management standards of DDH.
    Clinical Orthopaedics and Related Research 03/2013; 471(6). DOI:10.1007/s11999-013-2846-5 · 2.88 Impact Factor
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    ABSTRACT: The diagnosis and treatment of developmental dysplasia of the hip in the infant are uniform, with consensus that diagnostic ultrasound and Pavlik harness management are standard procedures. Sequential procedures for failed early treatment, residual dysplasia and late diagnosis are dependent on the age and the severity of the dysplasia. This paper reviews the treatment of developmental dysplasia of the hip from birth to subsequent follow-up procedures, with particular reference to some of the senior authors' research and the Southampton approach to the management of hip dysplasia.
    Early Human Development 09/2014; 90(11). DOI:10.1016/j.earlhumdev.2014.08.011 · 1.93 Impact Factor
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    ABSTRACT: Background: Since 1985 the hips of the newborns have been sonographically screened at the University Hospital Marburg by staff of the Orthopaedic Department. This study was conducted to collect data on the local incidence of DDH (developmental dysplasia of the hip). Moreover, the diagnostic findings were checked critically to detect weak points. Another aim was to analyse the influence of investigators' experience on the treatment recommendation. Material and Methods: In a retrospective study, 18 247 hip sonograms in a treatment period from 1985 to 2009 were analysed. The following parameters were evaluated: perinatal incidents (e.g., breech presentation, Caesarean section, premature delivery), orthopaedic findings (e.g., club foot, limitation of hip abduction). Bony roof, superior bony rim and cartilaginous roof were analysed; α- and β-angles and hip type according to Graf were documented. Comparisons between variables were calculated by means of adequate statistic tests. χ(2)-values and coefficients of correlation were used to detect significance. Results: All in all 55 physicians of our Orthopaedic Department conducted 350 measurements on average (min. 1; max. 1993). Accuracy of documentation improved over time. In particular in the beginning of the screening, the hip angles according to Graf were not completely determined and sonograms were classified by "visual diagnosis". The β-angle was not measured at the outset. In the course of time we measured a decrease of the diagnosis hip type II a according to Graf. In the years 1985-1989 more than 40 % of the hips were described as physiologically immature. We evaluated a numerical regression of hip type II a to 16 % in time period 1990-1994 and 9 % in time period 2005-2009. There was a significant correlation between breech presentation and decentering and eccentric hips. Inexperienced physicians recommend more often therapeutic interventions (p ≤ 0.01). Treatment of hip type II a according to Graf was inconsistent over time. Conclusion: This study demonstrates the necessity of standardised hip sonography. Treatment according to measured hip type should be concise. Training programmes both for instructors and medical assistant staff is mandatory. "Bedside teaching" is not constructive.
    Zeitschrift fur Orthopadie und Unfallchirurgie 06/2014; 152(3):234-40. DOI:10.1055/s-0034-1368446 · 0.62 Impact Factor

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