New Criteria Issued for

  Developmental Dysplasia of the Hip
 August 19, 2009 — The American College of Radiology has issued Appropriateness Criteria to guide radiologists in deciding on radiologic imaging and treatment for children with developmental dysplasia of the hip (DDH)
  • Late detection could lead to early degenerative changes in adulthood — possibly resulting in the need for joint replacement. Hopefully, the appropriate use of imaging set forth in these criteria will help decrease the number of late DDH diagnoses
  • Until the age of 12 months, children should be clinically evaluated for DDH at each well-baby visit (typically performed at 1 – 2 weeks and at 2, 4, 6, 9, and 12 months of age
  • examination findings indicating DDH include positive Ortolani or Barlow test results for ligamentous or capsular laxity, asymmetric skin folds, and shortening of the thigh on the dislocated side.
  • At present, there is no consensus opinion regarding optimal imaging screening for DDH
  • Screening with ultrasound offers the benefits of early diagnosis of DDH, but these benefits must be balanced against increased treatment and cost factors
  • randomized trials evaluating the merits of primary screening with ultrasound have not demonstrated a significant reduction in late diagnosis of DDH
  • Typical practice in the United States is to selectively perform hip ultrasound in infants with risk factors such as family history of DDH, breech presentation, and inconclusive findings on physical examination.
  • Ultrasound for DDH should not be done until after 2 weeks of age, because laxity often occurs after birth and may be transient, with spontaneous resolution.
  • There is no established role for the use of radiography for generalized screening for DDH. Pelvic radiography should optimally be delayed until after 4 months of age, when ossification centers of the femoral heads have developed in most infants.
  • Computed tomography in DDH is primarily used for follow-up rather than for initial diagnosis.
  • Magnetic resonance imaging also may be useful to evaluate complex dislocations and suspected avascular necrosis.
  • The main use of arthrography is during surgery
 Files to Download from attachment
1-ACR New Guidelines August 2009.
2-Review about DDH from American Family Physician 2006.
3-AAP Guidelines on Early screening of DDH.







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