The American Academy of Orthopaedic Surgeons Evidence-Based Guideline on Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age

Mulpuri, Kishore MBBS, MS (Orth), MHSc (Epi)—Chair; Song, Kit M. MD, MHA—Vice Chair; Gross, Richard Henry MD; Tebor, Gary B. MD; Otsuka, Norman Yoshinobu MD; Lubicky, John P. MD, FAAOS, FAAP; Szalay, Elizabeth Ann MD; Harcke, H. Theodore MD; Zehr, Bonnie MD, FAAP; Spooner, Andrew MD; Campos-Outcalt, Doug MD, MPA; Henningsen, Charlotte MS; Jevsevar, David S. MD, MBA; Goldberg, Michael MD; Brox, W. Timothy MD; Shea, Kevin MD; Bozic, Kevin J. MD, MBA; Shaffer, William MD; Cummins, Deborah PhD; Murray, Jayson N. MA; Mohiuddin, Mukarram MPH; Shores, Peter MPH; Woznica, Anne MLS; Martinez, Yasseline; Sevarino, Kaitlyn MBA

Journal of Bone & Joint Surgery - American Volume: 21 October 2015 - Volume 97 - Issue 20 - p 1717–1718
doi: 10.2106/JBJS.O.00500
Evidence-Based Orthopaedics
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Introduction

The AAOS Evidence-Based Guideline on Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age includes both diagnosis and nonoperative management. This clinical practice guideline has been endorsed by the American Academy of Pediatrics (AAP), the Pediatric Orthopaedic Society of North America (POSNA), the Society for Pediatric Radiology (SPR), and the Society of Diagnostic Medical Sonography (SDMS). This brief summary of the AAOS Clinical Practice Guideline contains a list of the recommendations and the rating of strength based on the quality of the supporting evidence. Discussion of how each recommendation was developed and the complete evidence report are contained in the full guideline at www.aaos.org/guidelines.

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Summary of Recommendations

UNIVERSAL ULTRASOUND SCREENING

Moderate evidence supports not performing universal ultrasound screening of newborn infants.

Strength of Recommendation: Moderate ★★★☆

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EVALUATION OF INFANTS WITH RISK FACTORS FOR DDH

Moderate evidence supports performing an imaging study before 6 months of age in infants with one or more of the following risk factors: breech presentation, family history, or history of clinical instability.

Strength of Recommendation: Moderate ★★★☆

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IMAGING OF THE UNSTABLE HIP

Limited evidence supports that the practitioner might obtain an ultrasound in infants less than 6 weeks of age with a positive instability examination to guide the decision to initiate brace treatment.

Strength of Recommendation: Limited ★★☆☆

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IMAGING OF THE INFANT HIP

Limited evidence supports the use of an AP pelvis radiograph instead of an ultrasound to assess DDH in infants beginning at 4 months of age.

Strength of Recommendation: Limited ★★☆☆

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SURVEILLANCE AFTER NORMAL INFANT HIP EXAM

Limited evidence supports that a practitioner re-examine infants previously screened as having a normal hip examination on subsequent visits prior to 6 months of age.

Strength of Recommendation: Limited ★★☆☆

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STABLE HIP WITH ULTRASOUND IMAGING ABNORMALITIES

Limited evidence supports observation without a brace for infants with a clinically stable hip with morphologic ultrasound imaging abnormalities.

Strength of Recommendation: Limited ★★☆☆

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TREATMENT OF CLINICAL INSTABILITY

Limited evidence supports either immediate or delayed (2-9 weeks) brace treatment for hips with a positive instability exam.

Strength of Recommendation: Limited ★★☆☆

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TYPE OF BRACE FOR THE UNSTABLE HIP

Limited evidence supports use of the von Rosen splint over Pavlik, Craig, or Frejka splints for initial treatment of an unstable hip.

Strength of Recommendation: Limited ★★☆☆

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MONITORING OF PATIENTS DURING BRACE TREATMENT

Limited evidence supports that the practitioner perform serial physical examinations and periodic imaging assessments (ultrasound or radiograph based on age) during management for unstable infant hips.

Strength of Recommendation: Limited ★★☆☆

Disclosure: The disclosure information for the Work Group members and the AAOS staff on this guideline are found in Appendix IX (page 129) of the guideline document at http://www.aaos.org/research/guidelines/DDHGuidelineFINAL.pdf.

Disclaimer: This Clinical Practice Guideline was developed by an AAOS multidisciplinary volunteer Work Group based on a systematic review of the current scientific and clinical information and accepted approaches to treatment and/or diagnosis. This Clinical Practice Guideline is not intended to be a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. Clinical patients may not necessarily be the same as those found in a clinical trial. Patient care and treatment should always be based on a clinician’s independent medical judgment, given the individual patient’s clinical circumstances.

The complete AAOS guideline is available at http://www.aaos.org/research/guidelines/DDHGuidelineFINAL.pdf.

Copyright 2015 by The Journal of Bone and Joint Surgery, Incorporated